DESK REVIEWS | How are long-term care budgets allocated and dispersed, across levels of the long- term care system? Do budgets get dispersed through geographical areas?

DESK REVIEW | How are long-term care budgets allocated and dispersed, across levels of the long- term care system? Do budgets get dispersed through geographical areas?

The National Fund for Social Assistance (Fundo Nacional de Assistência Social) transfers budget to states and municipalities according to the Pluriannual Plan, the Law of Budgetary Guidelines, and the Annual Budget Law. It is considered a decentralized system in which each level of government can manage how the money will be spent (Brazilian Ministry of Citizenship, n.d.). The social care budget allocated to assist older people has changed over the years (in R$ millions) within each of the country’s regions. This federal allocation considers the number of older people locally, the increase in the value of minimum salary/basic pension, poverty levels, among other variables (Brasil, 2011).


Brazilian Ministry of Citizenship. (n.d.). Módulo II: o Financiamento do SUAS. Retrieved July 17, 2019, from

Brasil. (2011). Caderno SUAS: Financiamento da Assistência Social no Brasil.


LTC budgets are allocated to the Social Welfare Department and then dispersed across various service providers of subsidised services in different districts which deliver different types of services.

Subsidised community care services are provided predominantly by non-governmental organisations (NGOs) receiving funding mostly from the Government, supplemented by donations and users fees. Residential care services are delivered by a mix of NGOs and private providers. The Government provides financial subsidies to NGOs through subvention with service quality monitored by the Social Welfare Department (Yuen, 2014). Despite the long standing government policy of “ageing in place”, there is a significant imbalance in government expenditures on residential care ($4,793.9 millions) and community care ($2,364.6 millions) according to the report in the 2017-2018 financial year (Legislative Council Secretariat, 2019, December 13).


Legislative Council Secretariat. (2019, December 13). Government expenditure on the elderly. Retrieved from

Yuen, P. P. (2014). Financing Health Care and Long-term Care in a Rapidly Ageing Context: Assessing Hong Kong’s Readiness. Public Policy and Administration, 17(1), 56-64.

At the administrative level, the Ministry of Social Justice and Empowerment works in close collaboration with the state governments. The budgets are generally dispersed to the states through the respective national schemes, which are responsible of providing the health care services to older persons.

The Financial Management Groups (FMG) of the program management support units, working under the National Health Mission, help the state and district levels maintain accounts, release funds, and create expenditure reports along with utilisation certificates and conduct audits (Verma & Khanna, 2013). The funds are allocated to each state/union territory through the State Health Society (SHS), which enables the various activities of the programmes to be carried out (Verma & Khanna, 2013). The SHS further disperses the funds to CHCs, PHCs and Sub-centres via the District Health Society (DHS), covering the state and district levels (Verma & Khanna, 2013).


Verma, R., & Khanna, P. (2013). National program of health-care for the elderly in India: A hope for healthy ageing. International Journal of Preventive Medicine, 4(10), 1103–1107. Available from:

There is no funding specifically for long-term care services. However, the amount allocated within the health sector in counties is distributed within programs in an efficient way while prioritizing cost-effective and efficient programmes (Ministry of Health, 2016b). Programs that are directed towards achieving the “Big Four Plan”  agenda, reflect on the actual financial requirement and are in full compliance with government priorities are given priority in terms of funding (Republic of Kenya, 2018a).


Ministry of Health. (2016b). National and county health budget analysis FY 2016/17. Nairobi, Kenya.

Republic of Kenya. (2018a). Guidelines for the preparation of the medium-term budget for the period 2019/20 -2021/22. Nairobi, Kenya.

No. The central/federal offices of these institutions decide how budgets are allocated and dispersed, given that the exact budget they requested, is granted by the Ministry of Finance.

LTC budgets are allocated to each of the 20 District Health Boards (DHBs) who then allocate funding to the different services (Ministry of Health, 2016). DHB funding in turn is calculated on a population-based funding formula (PBFF) which assigns a higher weighting to people with higher health needs, Māori and Pacific people, and people who are financially less well off (The Treasury, 2017).


Ministry of Health. (2016). DHB spending on services for older people. Ministry of Health website. Available from:

Social Workers Registration Board website. Available from:

The Treasury. (2017). District Health Board Financial Performance to 2016 and 2017 Plans. Available from:

See above. When Departments reprioritise budgets to allocate to the establishment of a new service, need or requirement, the allocation process often requires that the funds are taken away from somewhere else (instead of additional funding becoming available) (EMERALD, 2017). Where major programme changes are required, Departments will engage Treasury, Cabinet and then Parliament (according to set budget cycle deadlines) for the reprioritisation of funds, plans, and allocations (see section on budget process, as well as (EMERALD, 2017) p.36).


EMERALD. (2017). Moving towards Universal Health Coverage for Mental Disorders in South Africa.