Health Accounts: A Tool for Resource Mobilization and Pooling

Based on the System of Health Accounts framework (SHA 2011), Health Accounts provide a comprehensive approach to understanding total resource flows to the sector, including public, private, and donor contributions. This framework uses a standard set of tables to organize the flow of resources in an easy-to-understand manner, allowing countries to incorporate their country-specific categories for looking at the spending breakdown. The global application of the SHA 2011 framework is widespread, with 38 African countries, 9 American countries, 11 Middle Eastern countries, 10 European countries, and 16 Asian countries conducting Health Accounts. These accounts provide snapshots of the three health financing functions: resource mobilization, pooling, and purchasing. Resource mobilization refers to how sustainable financing for health is, and it involves understanding how funds are raised, managed, and delivered to the health sector. The resource mobilization function is critical in understanding the sustainability of health financing. It involves examining the share of government spending out of total health spending, which varies across countries. For example, in low-income countries, government spending on health is often low compared to out-of-pocket payments. In contrast, high-income countries tend to have higher government spending on health as a proportion of total health spending. The use of Health Accounts has led to significant policy changes in several countries. In India, the 2004-05 Health Accounts report showed low public spending for health compared to high out-of-pocket payments, leading to the establishment of the National Rural Health Mission to increase public financing for health. The mission invested an additional $3.3 billion in the health sector. Similarly, in Ethiopia, the Health Accounts highlighted low investments in health, leading to a push to increase resources for health. The government increased its spending on health as a proportion of GDP from 5% to 5.6% between 2007/08 and 2010/11. In Ethiopia, the revenue retention policy enabled facilities to keep and reinvest user fees in the facility, increasing the availability of resources for health services. The use of Health Accounts has provided valuable insights into the health financing functions, enabling countries to make informed decisions about resource mobilization, pooling, and purchasing. By understanding the flow of resources in the health sector, countries can improve the sustainability of health financing and increase access to quality health services.