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Findings from National Health Accounts: Investing in Reproductive Health

Findings from National Health Accounts: Investing in Reproductive Health. Tania Dmytraczenko Senior Health Economist, PHR plus Global Health Council Conference 1 June 2005. Acknowledgements. Egypt Driss Zine Eddine El Idrissi Samir Fouad Manjiri Bhawalker Osmat Azzam Jordan

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Findings from National Health Accounts: Investing in Reproductive Health

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  1. Findings from National Health Accounts: Investing in Reproductive Health Tania Dmytraczenko Senior Health Economist, PHRplus Global Health Council Conference 1 June 2005

  2. Acknowledgements • Egypt • Driss Zine Eddine El Idrissi • Samir Fouad • Manjiri Bhawalker • Osmat Azzam • Jordan • Fatina Halawani • Patricia Hernandez • Rwanda • Susna De • Emmanuel Kabanda • Vianney Nizeyimana

  3. Outline • Background • Method • Results • Next steps

  4. Background

  5. Background Achieving the Millennium Development Goals • Addressing the principles causes of the burden of disease • Maternal health indicators • Reproductive health (RH) more broadly • Managing for results

  6. Background “We manage what we measure” • Support sound policy decisions by tracking: • Who finances RH services and programs? • How much do they spend? • Where do RH funds go, i.e., what is the distribution among providers and ultimately among services provided? • Hospitals vs. ambulatory care facilities • Curative care vs. prevention programs • Who benefits from spending for RH? • Socio-economic groups • Gender • Geographic distribution

  7. Method

  8. Definition of reproductive health expenditures • Family planning services • Outpatient counseling and issuance of contraceptive commodities • Female and male surgical sterilization • Retail sale of family planning commodities • Maternal health services • Antenatal care • Deliveries • Emergency obstetric care • Postnatal care

  9. Definition of reproductive health expenditures (continued) • Other reproductive health services • STI • RTI • Gynecological services • Oncology • Infertility • IEC, public awareness, health education campaigns • Training • Research

  10. Method Reproductive Health Accounts: Countries covered • Ongoing in Mexico, Karnataka (India) • Bangladesh, Nepal, Sri Lanka, India (2 states)

  11. Results

  12. Reproductive health results Reproductive health indicators *subsequent to discharge Source: DHS 2000, 2002

  13. = USD $10.9M = USD $127.6M or $5.31 / WRA or $98.14 / WRA Reproductive health results Reproductive health within context of general health care RH spending as a percentage of total health expenditures Rwanda Jordan Total Health Expenditures Total Health Expenditures

  14. Reproductive health results Where do reproductive health dollarscome from? Rwanda Egypt Jordan RH is being financed mostly by either: donors (Rwanda) or government and households (Egypt, Jordan)

  15. Jordan Egypt 16% 6% 17% 12% Reproductive health results Public versus donor priorities in resource allocation Rwanda 4% 37% Donor funding is concentrated on RH and HIV/AIDS in Rwanda

  16. Reproductive health results Who is managing reproductive health funds? Rwanda Jordan Public entities are the largest payer / purchaser of RH

  17. Reproductive health results Who is financing reproductive health expenditures by public entities? Origin of funds managed by public entities in Rwanda 25% 85% Donors finance a large share of RH expenditures by public entities and 100% of spending by NGOs

  18. Reproductive health results What types of RH services are being funded and by whom in Rwanda? 2002 % of THE for HIV/ADS Households finance half of all curative care while donor funds go principally towards prevention programs

  19. Reproductive health results Breakdown by RH categories in Rwanda 2002

  20. Reproductive health results : maternal health Deliveries If all deliveries were to take place at facilities, current expenditures (60% of which are financed by households) on deliveries would need to increase by 3 fold

  21. Reproductive health results : family planning Breakdown of expenditures by method mix 2002 % of FP commodity expenditure

  22. Reproductive health results : family planning Utilization vs OOP expenditure on commodities % of use/OOP expenditure for each FP commodity Oral Contraceptives Condoms Injectables

  23. Reproductive health results : family planning Utilization of commodities by quintile DHS 2000

  24. Reproductive health results Conclusion of RH subanalysis • Dependence on donors to finance RH • Low government contribution to RH • In fact, households finance more than the government • Households contribute close to half of all curative RH expenditures • Donor expenditures are primarily targeted for prevention and public health programs

  25. Reproductive health results Conclusion (cont’d) • Optimal mix of spending on curative versus prevention? • Curative = 18% of total RH expenditures • Prevention and public health programs = 66% of total RH exp • Little is being spent on maternal health care services • Financial burden on households • Households pay to obtain donated contraceptives given to the government • Consultation fees • Anecdotal evidence that fees may be charged by some facilities for the commodity itself* • In some service delivery points, households payments exceed price of donated commodities • Oral contraceptives (households pay twice as much) • Injections (households pay the same amount)

  26. Thank You Reports related to this presentation are available at www.phrplus.org

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