Presentation Title
Anne JuilletHealth Systems 20/20, Abt Associates
National Health Accounts: What do they reveal in Cte
dIvoire?June 15, 2011Global Health ConferenceWashington, DC
Abt Associates Inc. In collaboration with:I Aga Khan Foundation
I Bitrn y Asociados I BRAC University I Broad Branch Associates I
Deloitte Consulting, LLP I Forum One Communications I RTI
International I Training Resources Group I Tulane Universitys
School of Public Health
IntroductionContextUntil 2009, Cte dIvoire did not have a
comprehensive system to determine funds available for service
provision within the health sectorObjectiveEstimate the
contributions of different public and private stakeholders within
the health sectorImprove financial managementEnsure that funding is
effectively and adequately allocated;Provide data for
decision-makers
Methodology
National Health Accounts (NHA)Internationally recognized tool
which synthesizes and monitors trends in health spendingIntegrates
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)Examine health expenditures in Cte dIvoire in 2007 and
2008
ResultsHealth sectors programmatic priorities in Cte
dIvoire:Responsible, equitable and effective health system in which
all the inhabitants of Cte dIvoire have access to quality care
throughout the entire countrySpecific requirements: 1- Restore the
health system in post-conflict areas 2- Base system on primary
health care at district level 3- Improve availability and
accessibility of essential medicines including ARVs, blood
products, and vaccines 4- Implement new mechanisms of financing
based on national or community solidarity
Total expenditures on health increased by 9.9% between 2007 and
2008:2007: US $1,164,133,665 ( or US $58/person )2008: US
$1,368,600,860 ( or US $66/person )
Total spending on health in Cte dIvoire is much higher than in
other sub-Saharan countries where the average is US $30/person
Results
Contribution by person by funding source (US $)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 spending29.74727.870
Main source of health funding: The Household- Households
contributed to 69% of Total Health Expenditure (THE) in 2008
Main Financing Agent: The Household 96% of household spending
goes directly towards health services (as opposed to insurance
schemes).Out-of-pocket (OOP) spending represents 66% of THE in
2008Risk sharing (insurance) schemes are underdeveloped and not
widely available throughout the countryDue to high OOP, risk of
catastrophic expenses accrued by households is high
Majority of OOP = Drugs76% 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 facilities8% THE is dedicated to public health
servicesExpenditures on contagious diseases represent 5.3% of
THEExpenditures for maternal and child health care represent 2.6%
of THE
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Government health expendituresAs a financing agent for health,
the government spent: US $191.2 million in 2007
US $204.5 million in 2008
Overall, the national budgets contribution remains weak, as
spending for health budget is 5% of the total national budget
Ministry of Health principal expenditures Public administration
+ Specialized facilities (incl. teaching hospitals)The MoH
contributions are to public administration and to specialized
facilities (as opposed to primary health care or public health
programs)
ConclusionsFunding is not aligned with the national strategy of
enhancing access to health services for the most vulnerable
populations Households purchase more expensive medicines from the
private sector rather than the public sector Systems of prepayment
are almost non-existentThe health system is centered around
teaching hospitals and specialized establishments to the detriment
of care provided at the secondary and primary levelsSpending on
public health services represents only 8% of total spending of
health in 2008
To improve the efficiency and effectiveness of health care
delivery, Cte dIvoire should:Develop a national policy for supplies
and distribution of essential medicines to reduce OOP
spendingDevelop a national or community insurance systemGive
priority to delivery of space primary health care services and
public health interventionsRecommendations
ContactsAbt Associates, Health Systems 20/20Abidjan, Cte
dIvoireAnne JUILLET ([email protected]) Dsir BOKO
([email protected])
Ministry of Health, Finance Department Abidjan, Cte
dIvoireMarina YO ([email protected])Mathieu KOUASSI
([email protected])Salif KONE ([email protected])
Thank youwww.HealthSystems2020.org
Abt Associates Inc. In collaboration with:I Aga Khan Foundation
I Bitrn y Asociados I BRAC University I Broad Branch Associates I
Deloitte Consulting, LLP I Forum One Communications I RTI
International I Training Resources Group I Tulane Universitys
School of Public Health
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