ETHIOPIA’S NATIONAL HEALTH ACCOUNTS

1995-2008Abdifatah Ahmed

Haramaya University

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)

• What are health care expenditures?– any type of expenditure for which the primary

objective is to improve or prevent the deterioration of health status.

• The aim of compiling NHA is – to achieve a comprehensive and consistent

synthesis of health related activities.

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.

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?

Methods• Different methods of health

accounting(determining health care expenditure)– NHA – System of national accounts (SNA)

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

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).

• subacconunts

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)

• 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)

• 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%

NHA 3 subaccounts1. 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%

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%

• 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.

National subaccounts findings1.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.

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.

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)

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.

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).

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).

• NHA 2

• NHA 3

• NHA 4