How can countries prioritize health care spending to meet their needs?
Fifteen years ago, many countries did not have complete estimates of their sources of health care funding. Today, thanks to the joint efforts of World Health Organization, the World Bank, and USAID-funded projects implemented by Abt Associates, more than 40 countries have completed at least one round of National Health Accounts, a method of estimating national health care spending.
National Health Accounts (NHA) captures health care spending in a country’s public sector, private sector, and international partners over a defined period—often one year.
“Abt Associates builds local capacity to produce health spending analyses so local leaders understand where their health care funding comes from, how funds are allocated, and the type of health care they are buying,” said Catherine Connor, deputy director of Health Systems 20/20.
Abt Associates innovated the subaccount methodology —an NHA for a single disease or health area— to track spending on HIV/AIDS, reproductive health, child health, and malaria. Today Abt is working closely with the World Health Organization to make NHA data available globally, reduce the time and cost of NHA, and encourage expenditure questions on standard household surveys such as the Demographic and Health Survey to capture out-of-pocket health spending data.
While some countries, such as the Democratic Republic of the Congo, recently finished their first NHA analysis, others, such as Kenya, have carried out a series of NHA estimates and can accurately measure health spending trends.
Democratic Republic of the Congo
The Democratic Republic of the Congo’s first NHA found a per capita national health spending of $13, which is only one-third of the cost of a very basic package of health benefits, according to World Health Organization estimates.
“The data … send a clear message to the government and other stakeholders to substantially increase their contribution to the health sector to improve the health of the population and reduce the financial burden borne by households,” said Mr. Gérard Eloko, Democratic Republic of the Congo NHA director.
Vietnam
Vietnam projected a growing funding gap in their HIV prevention service plans through 2015 through a combined NHA and HIV/AIDS Program Sustainability analysis. Consequently, the Vietnam Ministry of Health and the Vietnam Administration for HIV/AIDS Control developed a new national HIV strategy to address the gap by increasing domestic funding for the HIV program and expanding Vietnam’s national health insurance coverage to HIV/AIDS patients.
Kenya
Former Kenyan Minister of Health, Charity Ngilu, speaks at an National Health Accounts launch event in 2005.
Photo credit: Health Systems 20/20.
Kenya’s four NHAs – the latest of which was released in November 2011 – have found that households and other private sources continue to pay for the majority of health care in the country. Previous NHAs have led to recommendations for improving child and maternal health, eliminating barriers to tuberculosis treatment, and increasing public investment in the health sector.
To maintain momentum for future NHAs, the University of Nairobi worked with Abt Associates to design a course in resource tracking, which has grown into a Master of Health Economics program beginning in May 2012. The university received 30 applications for the program during its first two weeks of registration.
“By institutionalizing NHA, owning the results, and acting on them, governments can make smart decisions to improve the health outcomes in their countries,” Connor said. “Using this methodology, countries are increasing their ability to develop solutions to their health care challenges.”