Population growth, an unfinished agenda of communicable diseases and maternal health and nutrition, and the rapid rise of Non-communicable diseases are putting increasing strain on not just the Ministry of Health budget, but also the broader financial position of the government as a whole. These pressures are ultimately financially unsustainable, given current and projected future economic conditions. But many of the health burdens and costs can be avoided, or at least delayed, with good primary and secondary prevention. There are practical options for making health financing in Vanuatu more effective, efficient, equitable, affordable, and accountable. Improving efficiency of public expenditure is a key to achieving this.