Spotlight
Expansion of and support for health accounting institutionalization, through health accounts (HA), has driven advocacy for increases in domestic funding and country decision-making capacities.
- In India, multiple analyses of population surveys documented the impoverishing effects of out-of-pocket health expenditures among households near the poverty line and were used to influence major reforms such as the National Rural Health Mission in 2005 and RSBY (national health insurance) scheme in 2007 as a result.
- In Kenya, the 2000/01 HA showed that households were financing over half of health expenditures. This provided the evidence to justify and secure a 30% increase in its 2006 budget allocation from the Ministry of Finance, its largest increase since 1963.
- In Ethiopia, out-of-pocket spending data from successive HAs helped revamp the country's health financing policy structure – leading to policies to revise the fee waiver system for the poor and to introduce community-based and social health insurance mechanisms.
- In Liberia, 2007-8 household data showed that blanket "free health care" did not fully remove financial barriers; HA data helped support a new health financing policy based on general taxation, insurance and limited user fees for a subset of services.
Health accounting permits countries to measure and track spending in the health sector over time. With health accounts, policymakers can learn from past expenditures, improve resource allocation, inform health sector planning and improve governance and accountability of the health system. The World Health Organization (WHO) coordinates global efforts to improve country health accounting through the System of Health Accounts (SHA).
Health accounts (HA) estimated using the SHA methodology represent a standardized product of health accounting by which countries and international partners can compare and analyze health financing data over time. HAs provide the data that they use to advocate for investments in health and to support decisions in health programming. With HAs, countries can better plan activities that will achieve health sector goals, such as achieving universal health coverage, increasing financial protection and reducing inequities in health outcomes.
Institutionalization of HAs generates consistent and comprehensive data on health spending in a country. Countries that perform regular, institutionalized HAs have greater country-owned capacity for evidence-based policy-making through
- increased coordination between the national and sub-national levels,
- promotion of institutional capacity building,
- strengthened public sector governance,
- improved transparency and accountability, and
- enhanced opportunity to support national and international health agendas, monitor aid flows and direct resources to areas where they are most needed.
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