Health financing in Syria: from fragmentation and donor dependence to a phased and nationally-led transition
After more than a decade of conflict, Syria’s health financing system faces a double challenge. Humanitarian aid remains essential in many areas, yet this model has left the system fragmented, vulnerable to donor volatility, and poorly equipped for a longer-term transition towards equity and financial protection. Even before the conflict, out-of-pocket spending was high and financial protection incomplete, with public support for national health insurance closely tied to affordability and protection for poorer groups. During the conflict, humanitarian actors became central in some areas, while households continued to bear substantial costs for medicines, diagnostics, transport, and specialist care.
This brief examines the shift from a predominantly state-funded but only partially protective model to a fragmented landscape marked by humanitarian dependence, high out-of-pocket spending, and weak pooling arrangements. The current transition creates an opportunity to rebuild national stewardship, but this is taking place under severe fiscal constraint, weak institutional capacity, and continued donor volatility.
The brief makes recommendations for a transition to a basic public financing function, reduced household financial burden, the creation of financing data systems, and the introduction of a realistic Essential Health Services Package.
Further information
There’s more on this study here – Strengthening health system financing in complex humanitarian contexts: An exploratory analysis from Northwest Syria
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