Updates to National Health Accounts: SHA 2011 April 23, 2014 Abt - - PowerPoint PPT Presentation
Updates to National Health Accounts: SHA 2011 April 23, 2014 Abt Associates Inc. In collaboration with: Broad Branch Associates | Development Alternatives Inc. (DAI) | Futures Institute | Johns Hopkins Bloomberg School of Public Health (JHSPH) |
Abt Associates Inc. In collaboration with:
Broad Branch Associates | Development Alternatives Inc. (DAI) | Futures Institute | Johns Hopkins Bloomberg School of Public Health (JHSPH) | Results for Development Institute (R4D) | RTI International | Training Resources Group, Inc. (TRG)
April 23, 2014
Monitoring execution: Comparison with what was
Informing resource allocation decisions Transparency/accountability Value for money
Globally accepted methodology for tracking amount and
Captures spending from public, private and overseas
stakeholders International standardization for cross-country comparison Answers key policy questions
How much is spent on health care? From where do funds for health come? Who and how are these funds managed? To where do these funds go?
SHA 1.0 (2000) Classification scheme developed by OECD (called ICHA) Covers three health care dimensions: Financing Agents, Providers, Functions NHA (extension of SHA) (2003) “SHA for Developing Countries” Extends SHA classifications to developing country context by adding subcategories Has a fourth health care dimension: Financing Sources, Financing Agents, Providers and Functions Classifications linked to the SHA
1990s: 7 countries
Support to country-led efforts in NHA production Strengthening regional networks to build NHA
awareness and capacity e.g. USAID/LAC Since 2000: 35 countries
Co-development of NHA Producer’s Guide Co-development of sub-accounts methodologies:
HIV/AIDS, Reproductive Health, Malaria, Child Health
Development of NHA Production Tool Establishment of health expenditure module in DHS USAID-UNAIDS collaborate to harmonize NHA and NASA methods Facilitation of developing country input into the System of Health Accounts (SHA
2011) framework
Proactive promotion of use of NHA data
Public (incl parastatals), 30% Households, 51% Other Private sources, 3% Donors, 16% Other, 0%
Kenya Financing Sources in 2002
Kenya Policy Impact: NHA evidence for MoH to justify and secure 30% increase in 2006 budget allocation from MoF, the biggest increase since 1963. Households (over half of whom live in poverty) finance 51% of all health expenditures
Other examples: Niger, Rwanda
Other examples: Liberia, Kenya, Ethiopia, Vietnam
10 20 30 40 50 60 1994/95 2000/01 2003/04 2006/07
Percentage of Population Insured by HIO
20 40 60 80 1994/95 2001/02 2007/08 2008/09
OOP spending as percentage of total health spending
RH spending as percentage of the total (2008-09 NHA) Maternal and child mortality rates, 2000 and 2007
RH spending 10% Other health spending 90%
200 400 600
Maternal Mortality Rate (per 100,000 live births) Infant Mortality Rate (per 1000) Under 5 Mortality Rate (per 1000) Neonatal (per 1000) Post-neonatal (per 1000)
2007 2000
Other examples: Zambia, Vietnam, Kenya, Namibia, Liberia, Malawi
Civil societies in Kenya had difficulties engaging
2002 NHA HIV/AIDS subaccounts showed that
the government did not contribute to ARV treatment Policy Impact Kenya Treatment Access Movement (KETAM) used NHA to lobby for budget line-item for ARV.
Commission on Information and Accountability
total & per capita health expenditure by financing
source
total & per capita reproductive, maternal, new born,
and child health expenditure by financing source Use of NHA to track donors’ and partner
Before (SHA 1/ NHA) After (SHA 2011) SHA 1 for OECD NHA for developing countries SHA 2011 for both WHO finances and manages health spending WHO + HOW is health spending financed and managed Sub-account analysis for selected diseases (HIV, malaria, RH) Full disease breakdown Some unclear classifications Refined provider/ functional classification
NEW: Revenues of financing schemes (FS) NEW: Financing schemes (HF) Financing agents (FA) Health providers (HP) Functions (HC)
Raising revenue for health Managing/ pooling resources Purchasing services
NEW: Beneficiaries NEW: Factors of provision (FP)
Helps countries understand relative burden of diseases on
Of interest to broader group of stakeholders Informs planning and health financing strategies e.g.
Key diseases that were tracked through sub-accounts are still captured Reproductive health services including FP NCDs – an area which countries increasingly want to track
HIV/AIDS 8% TB 1% Malaria 21% Respiratory infections 1% Diarrheal diseases 1% Neglected tropical diseases 1% Other inf. and parasitic diseases 3% Contraceptive management 0% Other reproductive health 12% Nutritional deficiencies 6% NCDs 3% Injuries 0% Other 43% Malaria 21% HIV/AIDS 8%
First round completed First exercise ongoing in 2014 Benin Burundi Burkina Faso Haiti Democratic Republic of Congo India Fiji Kenya Ghana Malawi Liberia Mozambique Sudan Philippines Niger Sierra Leone Tanzania Vietnam …+17 other countries
Are countries spending enough to cover an essential
How are countries raising domestic funding for health? How are resources channeled from sources to providers?
How much are countries allocating to different diseases?
For more information visit:
WHO - http://www.who.int/health-accounts/documentation/en/ OECD - http://www.oecd.org/els/health-systems/health-expenditure.htm HFG - http://www.oecd.org/els/health-systems/health-expenditure.htm / HS2020 - http://www.healthsystems2020.org/section/topics/nha