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) | Results for Development Institute (R4D) | RTI International | Training Resources Group, Inc. (TRG)
Why is it important to track health spending? Monitoring execution: Comparison with what was planned/budgeted Informing resource allocation decisions Transparency/accountability Value for money
Agenda Brief history of resource tracking and USAID’s leadership Using NHA for policy System of Health Accounts (SHA) 2011 framework – what’s new and why is it better? Questions
BRIEF HISTORY OF RESOURCE TRACKING AND USAID’S LEADERSHIP
What is National Health Accounts? Globally accepted methodology for tracking amount and flow of health expenditures 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?
Health Accounts is not new…
1990s – 2011: SHA 1.0 for OECD countries and NHA for developing countries SHA 1.0 (2000) Classification scheme developed by OECD (called ICHA) Covers three health care dimensions: Financing NHA (extension of SHA) (2003) Agents, Providers, “SHA for Developing Countries” Functions 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
USAID’s leadership in resource tracking 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
USING NHA FOR POLICY
Using NHA to mobilize resources for health Kenya Financing Sources in 2002 Other, 0% Other Private Kenya Policy Impact: sources, 3% Donors, 16% Public (incl NHA evidence for MoH to parastatals), 30% justify and secure 30% increase in 2006 budget allocation from MoF, the biggest increase since 1963. Households, 51% Households (over half of whom live in poverty) finance 51% of all health expenditures Other examples: Niger, Rwanda
Using NHA to monitor effectiveness of risk- pooling – key metric of UHC Egypt: Is the expansion of insurance containing OOP? OOP spending as Percentage of Population percentage of total health Insured by HIO 80 spending 60 50 60 40 40 30 20 20 10 0 0 1994/95 2000/01 2003/04 2006/07 1994/95 2001/02 2007/08 2008/09 Other examples: Liberia, Kenya, Ethiopia, Vietnam
Using NHA to improve resource allocation Namibia: Informed Need for Reprioritization of RH RH spending as percentage of Maternal and child mortality the total (2008-09 NHA) rates, 2000 and 2007 Post-neonatal (per 1000) RH spending Other Neonatal (per 1000) 10% health spending Under 5 Mortality Rate (per 1000) 90% Infant Mortality Rate (per 1000) Maternal Mortality Rate (per 100,000 live births) 0 200 400 600 2007 2000 Other examples: Zambia, Vietnam, Kenya, Namibia, Liberia, Malawi
Using NHA to allocate resources – civil society Civil societies in Kenya had difficulties engaging in national debates, due to paucity of data to substantiate their claims/requests 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.
Using NHA for mutual country-donor accountability to global health initiatives Commission on Information and Accountability for Women’s and Children’s Health (COIA) recommended developing countries to report: 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 governments’ commitments to financing reproductive health (2012 London Summit on Family Planning)
SHA 2011 FRAMEWORK WHAT’S NEW? WHY BETTER?
SHA 2011 replaces SHA 1.0 SHA 2011: Updates based on practitioners’ experience and new trends in health systems
What’s new? Before (SHA 1/ NHA) After (SHA 2011) SHA 1 for OECD SHA 2011 for both NHA for developing countries WHO finances and manages health WHO + HOW is health spending spending financed and managed Sub-account analysis for selected Full disease breakdown diseases (HIV, malaria, RH) Some unclear classifications Refined provider/ functional classification
Classifications following the financing flow NEW: Revenues of financing schemes (FS) NEW: Financing schemes (HF) Financing agents (FA) Health providers (HP) NEW: Factors of provision (FP) Raising revenue Functions (HC) for health NEW: Beneficiaries Managing/ pooling resources Purchasing services
From sub-accounts to full disease distribution. Why …? Helps countries understand relative burden of diseases on health system Of interest to broader group of stakeholders Informs planning and health financing strategies e.g. designing benefits package
Full disease distribution based on ICD-10 classifications 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
Full disease distribution: Democratic Republic of Congo TB 1% HIV/AIDS HIV/AIDS 8% 8% Malaria Malaria Other 21% 21% 43% Respiratory infections 1% Diarrheal diseases Other 1% reproductive Neglected health tropical 12% Other inf. diseases Injuries and 1% 0% parasitic Nutritional Contraceptive NCDs diseases deficiencies management 3% 6% 3% 0%
Health Accounts with SHA 2011 – coming to a country near you 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
Recap – questions important to USAID and its partners Are countries spending enough to cover an essential package of health services? How are countries raising domestic funding for health? How are resources channeled from sources to providers? Who are the middle men and how do they manage the funds? How much are countries allocating to different diseases?
QUESTIONS 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
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