National Health Accounts: What do they Reveal in Cote d'Ivoire?
National Health Accounts: What do they reveal in Côte d’Ivoire?<br />Anne Juillet<br />Health Systems 20/20, Abt Associates<br />June 15, 2011<br />Global Health Conference<br />Washington, DC<br />
Introduction<br />Context<br />Until 2009, Côte d’Ivoire did not have a comprehensive system to determine funds available for service provision within the health sector<br />Objective<br />Estimate the contributions of different public and private stakeholders within the health sector<br />Improve financial management<br />Ensure that funding is effectively and adequately allocated;<br />Provide data for decision-makers<br />
Methodology<br />National Health Accounts (NHA)<br />Internationally recognized tool which synthesizes and monitors trends in health spending<br />Integrates the collection, processing, and analysis of both primary (private enterprises, insurance companies, donors, and international NGOs) and secondary data (Ministry of Health, households, and national institutions)<br />Examine health expenditures in Côte d’Ivoire in 2007 and 2008<br />
Results<br />Health sector’s programmatic priorities in Côte d’Ivoire:<br />Responsible, equitable and effective health system in which all the inhabitants of Côte d’Ivoire have access to quality care throughout the entire country<br />Specific requirements: <br />1- Restore the health system in post-conflict areas <br />2- Base system on primary health care at district level <br />3- Improve availability and accessibility of essential medicines including ARVs, blood products, and vaccines <br />4- Implement new mechanisms of financing based on national or community solidarity<br />
Results<br />Total expenditures on health increased by 9.9% between 2007 and 2008:<br />2007: US $1,164,133,665 ( or US $58/person )<br />2008: US $1,368,600,860 ( or US $66/person )<br />Total spending on health in Côte d’Ivoire is much higher than in other sub-Saharan countries where the average is US $30/person<br />
Contribution by person by funding source (US $)<br />27.870<br />29.747<br /><ul><li>In 2008, household expenditures represented US $45.70/person, while the public sector spent US $11/ person and donors contributed US $9/person.
Per person household expenditure on health is 4 times that of national government spending</li></li></ul><li>Main source of health funding: The Household<br />- Households contributed to 69% of Total Health Expenditure (THE) in 2008<br />
Main Financing Agent: The Household <br /><ul><li>96% of household spending goes directly towards health services (as opposed to insurance schemes).
Out-of-pocket (OOP) spending represents 66% of THE in 2008
Risk sharing (insurance) schemes are underdeveloped and not widely available throughout the country
Due to high OOP, risk of catastrophic expenses accrued by households is high</li></li></ul><li>Majority of OOP = Drugs<br /><ul><li>76% of households’ OOP goes directly to medicines bought in private sector (higher prices than in public sector) because public procurement system is unable to meet demand from public sector facilities
Expenditures on contagious diseases represent 5.3% of THE
Expenditures for maternal and child health care represent 2.6% of THE</li></li></ul><li>Government health expenditures<br />As a financing agent for health, the government spent: <br /> US $191.2 million in 2007<br /> US $204.5 million in 2008<br />Overall, the national budget’s contribution remains weak, as spending for health budget is 5% of the total national budget<br />
Ministry of Health principal expenditures Public administration + Specialized facilities (incl. teaching hospitals)<br /><ul><li>The MoH contributions are to public administration and to specialized facilities (as opposed to primary health care or public health programs)</li></li></ul><li>Conclusions<br />Funding is not aligned with the national strategy of enhancing access to health services for the most vulnerable populations <br />Households purchase more expensive medicines from the private sector rather than the public sector <br />Systems of prepayment are almost non-existent<br />The health system is centered around teaching hospitals and specialized establishments to the detriment of care provided at the secondary and primary levels<br />Spending on public health services represents only 8% of total spending of health in 2008 <br />
To improve the efficiency and effectiveness of health care delivery, Côte d’Ivoire should:<br />Develop a national policy for supplies and distribution of essential medicines to reduce OOP spending<br />Develop a national or community insurance system<br />Give priority to delivery of space primary health care services and public health interventions<br />Recommendations<br />