Health Accounting Developments
in WHO
Patricia Hernández
WHO-NHA Unit Geneva
Paris, September 2004
Evidence and Information for Policy
A young project in the institution:
Objectives (1999-)
• Introduction of an agenda centered basic expenditure &
financing concepts
• A framework based on available experience with an
incremental approach to expand and refine the
methodology
• Creation of a database collating all entries published by
each country but converging towards a homogeneous
reporting system
• Activities include capacity building, technical advice,
specialized communication and validation procedures
• Identification of country-specific problems and generation
of country-specific solutions
Evidence and Information for Policy
The core activity: Proto-accounting
Report of Financing Agents
• Designed to promote the measurement of resources
assigned to health in Member States, with emphasis on
quantifying the purchasing transactions
• A Best estimates approach:
– Emphasis placed on official data, on primary records and on a
validation procedure
– NA type adjustments of a statistical, conceptual, exhaustiveness &
balancing nature
– A permanent updating procedure when better sources available
• An active search of validation agents:
– national entities, HA, NA & financing experts, international
organizations (WB, CARICOM, etc.), HA networks (Shared
Alliance, APNHAN, etc.), use of the decentralized WHO
structures (RO, WR), etc.
Evidence and Information for Policy
Indicators in the public domain
• 192 Member States
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of which 105 have validated the level of their estimates
70 countries have at least one NHA estimate
Three quarters have some basic functional government finance indicators
Over a half have a household survey
• Coverage for 1995-2001. Updating 1998-2002 to be released in 2005
• Includes ratios and per capita levels of main aggregates and Financing
Agents
• Main outlets:
– World Health Report, WHO website (www.who.int/nha), Regional Offices
Reports
– WB-WDI, UNDP/HDR, several ECOSOC entities
Evidence and Information for Policy
A Global Public Good
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Easy access
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Wide geopolitical coverage
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Best estimate to date. In terms of conceptual, methodological & information
advances, progressive quality control improvement
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Sources and methods transparent
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Contribution to increase the awareness of the amount of health resources in
Member States
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First release in June 2000, annual updates
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Response to specific requests:
– WHO & Outside (UNAIDS, WB, UNRWA, EIU, BBC, The Economist, ..)
Evidence and Information for Policy
Capacity building
• Guide to Producing NHA (WB-WHO-USAID PG, 2003)
– PG to be published in Russian and in Spanish, programmed in French.
Sumary in Arabic by EMRO. Officious translation in Mongolian, and
several other languages.
– A supplement in preparation to generate distribution of resources among
population groups, by geopolitical entities, by demographic characteristics,
by disease and interventions and by socioeconomic conditions
– Preparation of methodological material on implementation issues focusing
mainly on private spending and on external resource measurement
(currently fairly aggregate estimates)
• The WHO web-site facilitates the discussion of country specific
problems to HA building by way of an Expert Panel
• Technical material made available to consultants and
organizations working on capacity building
Evidence and Information for Policy
Capacity Building within WHO
• Country specific technical visits: China, India, Namibia, Togo
• Technical exchanges with some 50 NHGA developers in
countries: Vietnam, Samoa, Suriname, Chad, Chile, Uruguay, Ecuador,
Iran, Algeria, etc
• Support to networks: Francophone Africa; CIS countries; APNHAN;
Eastern, Central and Southern Africa networks; EMRO; Shared Alliance,
AMR.
• NHA training courses & support of technical events
– Global attendance: NHA sessions in Bali, South Africa, Crete
– Regional Workshops:
• through the regional offices EURO, AFRO, EMRO and PAHO
• HQ staff provided training for CEE/CIS workshops, Francophone
Africa, EMRO, SEARO, AMRO, WPRO
– Country Workshops: India
Evidence and Information for Policy
Harmonization of Expenditure on
Health Reporting
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Expenditure on health in websites of Regional WHO offices
Global Resource Tracking Blueprint initiative by the Gates Foundation/CGD
HIV/AIDS and NAA
Malaria
IVB and GAVI sustainability analysis
Social Security (ILO)
Resources for Research
Pharmaceutical expenditure [first release for 180 Member States: The Drug
Situation in the World, 2004: financing chapter+ annex table]
• OECD Partnerships
• Formal agreement for reporting OECD aggregates in the World Health Report
• External funding data from OECD/DAC
Evidence and Information for Policy
How much is spent on health in Member
States?
How do health systems perform?
Have been the WHO concerns in 1998-2000.
Related measures released in June 2000:
Fairness of contribution: financing sources
Pooling strategies: financing agents
Services purchased: provision and functions
Effectiveness and efficiency: spending vs. health
outcomes
Evidence and Information for Policy
Updating tasks
How much is spent on health in the
whole world?
Who pays for it?
On what is it spent?
On whom is it spent?
Who benefits?
Evidence and Information for Policy
Analytical framework of health accounting resource flows
Existing schemes
SHA
Trade, Employment, Prices
Resource flows potentially to be monitored by
WHO-HQ
LAC & other regional
experiences
Financing
Financing
Sources
Financial Agents
Sources
Financial Agents
ICHA
Financing
Financial Agents (Sources of funding)
Production
Production
Cost of production factors
Providers
Cost of production factors
Providers
Production
Providers
Consumption
Consumption
Health services (Functions)
Beneficiaries
Health services (Functions)
Beneficiaries
Beneficiaries
Consumption
Health services (Functions)
Beneficiaries
Beneficiaries
Demographic characteristics
Apparent health needs and interventions
Changes in level and distribution of health stock
Geopolitical subnational entities,
Demographic & socio-economic characteristics
Apparent health needs and interventions
Beneficiaries
Beneficiaries
Geopolitical subnational
entities (county),
Socio-economic characteristics
Apparent health needs and interventions
Evidence and Information for Policy