ABSTRACT
Urban health related services have typically been characterized by domination of tertiary level hospital services and inequity of provision, both in terms of geographical concentration and socio-economic distribution of users. This chapter provides a framework for analyzing recurrent and capital expenditure in a city on health care, water and sanitation services and municipal environmental provision. The main providers of services and their sources of finance are identified and described, and the major issues arising from financing patterns discussed. Health, water and sanitation, and environmental services are rarely provided by one authority or agency in a city. Instead, the suppliers of services are many and exceptionally heterogeneous and there are multiple sources of funds. Government financing includes expenditure at all levels of government, together with expenditure of public corporations or parastatals. National governments finance part of a city's expenditure usually through a number of hybrid financing arrangements such as grants and revenue sharing.
