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National Health Accounts and its policy use in Ethiopia

National Health Accounts and its policy use in Ethiopia. World Public Health Congress, Addis Ababa , April 24, 2012. Outline. Country profile Health financing in Ethiopia NHA in Ethiopia Major NHA findings (from four NHA rounds) NHA policy use Conclusion. General Country Profile.

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National Health Accounts and its policy use in Ethiopia

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  1. National Health Accounts and its policy use in Ethiopia World Public Health Congress, Addis Ababa, April 24, 2012.

  2. Outline • Country profile • Health financing in Ethiopia • NHA in Ethiopia • Major NHA findings (from four NHA rounds) • NHA policy use • Conclusion

  3. General Country Profile • 9 regional states and two city admins • Over 82 million population • 1.1 million sq. km. Map of Ethiopia

  4. Health financing in Ethiopia • Health was/is generally under financed • Ethiopia recognized the need for clear financing policy and developed/approved the HCF strategy in 1998 • Overall, health financing evidence was lacking • NHA has been critical in generating health financing evidence since 2000.

  5. Health financing in Ethiopia (3): The ‘spider web’ flow of funds…

  6. NHA in Ethiopia • Ethiopia conducted four NHA • First round in 2000 based on 1995/96 spending • General NHA only • Second round in 2003 based on1999/00 spending • General NHA only • Third round in 2007 based on 2004/05 spending • General NHA • Child health and reproductive health subaccounts

  7. NHA in Ethiopia (2) • Fourth round in 2010 based on 2007/08 • General NHA • HIV/AIDS subaccount • Child health subaccount • Reproductive health subaccount • Malaria subaccount • TB subaccount • Health information system (HIS) subaccount All rounds of NHA financed by USAID through the HSFR Bilateral project

  8. NHA in Ethiopia (3): Data Collection Methodology (Fourth NHA) • Primary Sources: • For the first three rounds 1-3 household income, consumption and expenditure /HHICES/ data was used. • General HH survey: A total of over 10,000 households surveyed by a local consultant using a survey tool developed and used in other countries and contextualized to the Ethiopian situation. • Targeted HIV/AIDS survey (sample of PLWHA): About 4,000 PLWHA were interviewed on their health service utilization. • Institutional surveys: Donors, local and international NGOs, private and parastatal employers, and insurance enterprises; • Secondary sources: • All relevant documents (published and unpublished) were collected by the NHA team from all sources; • Audited government account (MOFED).

  9. NHA in Ethiopia (3): INSTITUTIONAL SURVEYS: (Fourth NHA) • Donors (Bilateral and Multilateral): Census of 31 donors. Twenty five partners (81%) filled in and returned the questionnaire. • NGOs (International and Local): Census of 251 NGOs (95 international and 156 local NGOs. 86 (about 90%) and 138 (88%)  of international and local NGOs respectively filled in and returned the questionnaires. • Employers (Parastatals and private employers): • 214 private enterprises (employers) 15% of the total 2,915 private sector employees. • 30 public enterprises/parastatals 30% of 108 public enterprise/employers. • Ethiopian Air Lines, Ethiopian Electric Power Corporation, Ethiopian Telecommunication Corporation & Commercial Bank of Ethiopia were also covered in the study. • A total of 198 (about 80%) of the 248 employers filled-in and returned the questionnaires.  • Insurance: All 10 were surveyed and completed the questionnaire (1 public, 9 private).

  10. NHA findings: Comparison between 3rd and 4th NHA Financing sources (in US$).

  11. NHA Findings • Overall spending in health is increasing overtime • Total health spending: Birr 11, 123, 022,113 Billion (USD1.2 Billion) in 2007/08. • 128% increase from 2004/05. • Per capita health expenditure estimated to be USD 16.1(increased from USD 7.1 in 2004/05)

  12. NHA findings: Source of health financing in 2007/08 (Fourth NHA)

  13. NHA Findings: Trends in Per Capita Health Expenditure in USD

  14. Policy use of NHA The last four NHA round evidences used: • As input for FMOH and partners evaluation of subsequent health sector development programs (HSDP) • Input for designing HSDP including HSDP-IV; • Generate evidence on health sector spending in HSDP priority areas; • NHA evidence is used in policy dialogue and negotiation with health sector development partners

  15. Policy use of NHA (2) • Used in health financing reforms initiation and implementation: • To convince law makers and finance that health is not adequately financed, and government budget allocation for health is increasing overtime • Enabled ratification of HCF reform legal frameworks and guiding implementation of the reforms including revenue retention and use at health facility level • Systematizing fee waiver system • The evidence also revealed the burden on households: • The showed the need for risk pooling and financial protection: • CBHI under piloting and legal framework put in place for SHI, and will start very soon

  16. Conclusion • Ethiopia substantially benefited from conducting subsequent rounds of NHA • NHA evidence was useful for initiation and implementation of the various financing reforms • Recognized the usefulness of the evidence, • Ethiopia needs to speed-up institutionalization of NHA

  17. Thank You

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