2. Introduction
• National Health Accounts
– are a set of accounts that describe all expenditure
flows within the health sector, both governmental
and non-governmental.
– they describe;·
• Where does the money come from? (sources of
funding)·
• Where does the money go? (uses of funds)
3. • What are health care expenditures?
– any type of expenditure for which the primary
objective is to improve or prevent the
deterioration of health status.
4. • The aim of compiling NHA is
– to achieve a comprehensive and consistent
synthesis of health related activities.
5. History
– 1st conducted by Abel-Smith with support of WHO
in 1960 (Chile and Sri Lanka)
– World health report of 2000 states
“health systems: improving performance”. NHA is
one such tool to improve performance.
6. Why create National Health Accounts?
• Reveal
– How much does a country spend on health care?
– Who is paying and for what services?
– How much is allocated to priority health programs
or populations?
– Who are the key providers?
7. Methods
• Different methods of health
accounting(determining health care
expenditure)
– NHA
– System of national accounts (SNA)
8. SNA
• Standardized system of
stastical analysis
• Purpose: international
cross-comparability and
internal consistency
• Responsible body:
– national stastical agencies
and
– UN
• Show link between health
sector and macro-
economy
NHA
• Not standardized
• Developed with in the
health sector of countries
• Purpose: Constructed to
fill their perceived need
of data on HE
• Responsible body:
– Individuals research team
– The health ministry
– In some occasions may not
supported nationally
• Shows flow of resources
with in the heath system
9. NHA Ethiopia
• Ethiopia previously conducted three rounds
of NHA, for 1995/96, 1999/2000, and
2004/05
• This fourth round of NHA estimates overall
health care expenditures in Ethiopian fiscal
years (EFY) 2000 (2007/08).
11. Major findings
General NHA
• NHA 1
– THE during the FY 1995/96 was estimated at Birr
1,454.31 million [US$230.11 million]
– about 3.83% of the GDP during the FY which was
estimated at Birr 37,937.60 million [US$6,002.78
million], at 1995/96 at current market price
– per capita health expenditure amounts to Birr
25.83 (USD 4.09)
12. • NHA 2
– The total health expenditure in EFY 1992 was
estimated to be ETB 2.9 billion (355.5) 2 million
USD).
– The per capital health expenditure has increased
by about one dollar from 4.5 USD to 5.6 USD per
person per year between the two
estimates.(Ethio-Eritrean war)
13. • NHA 3
– National health expenditure ETB
4,507,743,583.53 (US$521,729,581.43)
– Health expenditures per capita ETB 61.71 (USD
7.14)
– Health expenditures as a % of GDP 5%
14. NHA 3 subaccounts
1. Reproductive health expenditure
– Reproductive health expenditure ETB
556,063,682 (US$ 64,359,222)
– RH expenditures per women of reproductive age
ETB 31.87 (US$ 3.69)
– RH expenditures as a % of total of overall health
spending 12%
15. 2. Child health expenditure
– Child health expenditure ETB 873,462,162 (US$
101,095,158)
– CH expenditures per children under 5 ETB 67.92
(US$ 7.86)
– CH expenditures as a % of total of overall health
spending 19%
16. • NHA 4
– The nominal total health sector spending increased
from Birr 4.5 million (US$522 million) in 2004/05 to
more than Birr 11.12 billion (US$1.2 billion) in
2007/08.
– Per capita NHE -more than doubling from US$7.1 per
capita per annum in 2004/05 to US$16.1(150 ETB) in
2007/08.
– Recommended -US$34 per capital spending amount
– Revised HSDP-III per capita spending target-US$12.
– which means that health spending in Ethiopia
comprises 4.5 percent of GDP.
17. National subaccounts findings
1.HIV/AIDS
– Ethiopia’s total national expenditure on HIV/AIDS in
2007/08 was Birr 2,319,594,664 (US$248,000,114), or
20 % of NHE
– largest amount of spending on a single disease
– The per capita HIV/AIDS national health expenditure
• relative to the total population of the country) was US$3.27
while
• The per capita HIV/AIDS health expenditure relative to the
total population of PLWHA 14 was US$180.
18. Reproductive health subaccount findings
– spending on RH was Birr 1,411,728,484
(US$150,935,347), about 13 % of NHE.
– This equates to Birr 74.6 (US$8) per woman of
reproductive age (15-49 years), an increase from
Birr 32 (US$3.60) in 2004/05.
19. child health subaccount findings
– CH care expenditures accounted for about 10
percent of NHE in 2007/08
– the overall spending was Birr 1.1 billion (US$114
million)
– the per capita spending per individual children
under five increased from Birr 67.9 (US7.7) to Birr
82.5 (US$8.8)
20. 4. malaria subaccount findings
– a total of Birr 519,538,250 was spent on
malaria;
– per capita amount of Birr 10.3 (US$1.1) 19 .
– The spending on malaria accounts for 5 percent of
THE.
21. 5.Tuberculosis subaccount findings
– In 2007/8, Birr 447, 461,443 (US$47,840,466)was
spent on TB.
– This amount accounted for 4 percent of NHE.
– Per capita spending was Birr 6.05 (US$0.65).
22. 6.health information system subaccount findings
– Of the total financial resources that flow to the
Ethiopian health system Birr 11,123,022,113
(US$1,189,221,027), spending on HIS was Birr
157,313,538 (US$16,819,221), only 1.4 percent of
NHE in 2007/08.
– The per capita spending on HIS was Birr 2.1
(US$0.23).
