National Health Accounts Key to Tracking Health Expenditures

In Kenya, The Minister of Health hands over the National Health Accounts report to stakeholders

The rapid growth in international health aid for the developing world in the past two decades has been accompanied by improvements in health, but the potential benefits of these resources are far from realized. Just as important as the funding itself is ensuring that the funding is allocated well every step of the way, from budgets and pocketbooks to populations and patients. One key tool for tracking the flow of health funding is National Health Accounts (NHA), an internationally accepted methodology (endorsed by the World Health Organization [WHO]), the World Bank, and the United States Agency for International Development [USAID]) for measuring total — public, private, and donor — health expenditures in a given country. Drawing on its strong history of survey design, data collection, and analysis, Abt Associates is a key partner for many governments and policymakers as they conduct NHA estimations to better understand how health funding is spent in their country. Governments use this information to identify and address issues of affordability and sustainability of health services as well as the alignment of health policy with national needs and priorities.

Developing local capacity to track health expenditures

Nzoya Dhim, from the Kenya NHA team, proudly showing the ‘Guide to Producing National Health Accounts’

A proud partner of USAID’s global health financing projects including Partnerships for Health Reform (PHR), Partnerships for Health Reform plus (PHRplus) and Health Systems 20/20, Abt Associates has over fourteen years of experience working to make NHA useful, relevant, and accessible to policymakers in developing countries, particularly in Africa. Early in the development of NHA, Abt Associates played a lead role in gathering input from developing countries to create a more contextually relevant version of the System of Health Accounts (SHA), the methodology used to map out health financing in developed countries. The result was the Guide to producing national health accounts, jointly published by WHO, USAID, and the World Bank (now available to the public in English, French, Spanish, and Arabic, with Chinese and Russian versions coming soon). Since 1995, Abt Associates has supported over 50 NHA estimations in 28 countries, and in the process, trained over 1,300 people how to conduct NHA estimations and helped spread the NHA methodology across the developing world. Abt Associates hires local consultants and trains country teams on everything from data collection to interpreting and presenting the policy implications of the NHA findings. In 1999, through USAID’s Partnerships for Health Reform (PHR) project, Abt Associates organized the first international NHA Symposium in collaboration with the International Health Economics Association (iHEA). At this biannual international conference, Abt Associates has showcased developing country experiences with NHA. This year, the company will sponsor developing country NHA experts to attend the 2009 NHA Symposium in Beijing, China.

Ethiopia National Health Accounts training workshop

Designing innovative resource tracking tools

In 2002, Abt Associates pioneered the development of “subaccount” estimations — a complementary analysis that breaks down aggregate health expenditure information by specific health issues such as HIV/AIDS, malaria, tuberculosis, reproductive health, and child health. Abt Associates has assisted 13 countries complete 55 subaccount estimations and used the fieldwork to write practical subaccount guidelines in collaboration with WHO and individual and organizational experts in each issue area. To better equip developing countries to address their own health needs, Abt Associates is in the process of developing innovative ways to make health resource tracking a more routine and open process rather than a periodic study. These new techniques include adding health expenditure questions to routine household surveys to eliminate the need for additional NHA surveys, adoption of web-based database tools to track donor and NGO financial data, and publishing NHA data tables on country websites to promote wide access and use of findings.

Informing decisions that matter

Abt Associates is perhaps best known for its commitment to converting information and ideas into positive, measurable impact and this certainly applies to the firm’s NHA work. The recently-launched Policy Impact Database highlights NHA policy results, such as how a reproductive health subaccount in Rwanda helped policymakers align funding for a priority health issue or how an HIV/AIDS subaccount helped bring civil society organizations into health policy discussions in Kenya. By involving a broad array of health stakeholders and identifying critical policy questions from the start, Abt Associates helps ensure that NHA estimations add value to decisions to improve health outcomes.

When Abt Associates started working on NHA in 1995, 12 developing countries had successfully completed an NHA estimation. As of 2009, over 100 countries have completed at least 1 health account estimation, over 40 have completed two or more, and NHA is recognized as the international standard for tracking health expenditures in developing countries.