Health Accounting Developments in WHO

1. Health Accounting Developments in WHO Patricia Hernández WHO-NHA Unit Geneva Paris, September 2004 Evidence and Information for Policy

2. 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

3. The core activity: Proto-accountingReport 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

4. Indicators in the public domain • 192 Member States • 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

5. A Global Public Good • Easy access • Wide geopolitical coverage • Best estimate to date. In terms of conceptual, methodological & information advances, progressive quality control improvement • Sources and methods transparent • Contribution to increase the awareness of the amount of health resources in Member States • First release in June 2000, annual updates • Response to specific requests: • WHO & Outside (UNAIDS, WB, UNRWA, EIU, BBC, The Economist, ..) Evidence and Information for Policy

6. 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

7. 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

8. Harmonization of Expenditure on Health Reporting • 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

9. 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

10. 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

11. Analytical framework of health accounting resource flows Existing schemes SHA Resource flows potentially to be monitored by WHO-HQ LAC & other regional experiences Financing Financial Agents (Sources of funding) Production Providers Consumption Health services (Functions) Beneficiaries Financing Sources Financial Agents Production Cost of production factors Providers Consumption Health services (Functions) Beneficiaries Financing Sources Financial Agents Production Cost of production factorsProviders Consumption Health services (Functions) Beneficiaries Beneficiaries Trade, Employment, Prices ICHA Beneficiaries Changes in level and distribution of health stock Geopolitical subnational entities, Demographic & socio-economic characteristics Apparent health needs and interventions Beneficiaries Geopolitical subnational entities (county), Socio-economic characteristics Apparent health needs and interventions Beneficiaries Demographic characteristics Apparent health needs and interventions Evidence and Information for Policy