Government health expenditure on reproductive health
The total per capita annual government expenditure on reproductive health (RH) services and programs.
Areas for RH expenditures include family planning, maternal, newborn and child health care, treatment and prevention of STDs and HIV/AIDS and other RH conditions, infertility, abortion and postabortion care, RH and sexuality counseling, information, and education, and treatment and prevention for sexual abuse, gender-based violence and harmful practices, such as female genital cutting (WHO/UNFPA, 2008).
This indicator is calculated as the sum of annual expenditures by government ministries and agencies for RH services and programs divided by the total population.
This indicator is a subcategory for RH from the core indicator for Total Expenditure on Health in the WHO Health System Strengthening (HSS) Handbook. For more background on the process and criteria used in developing the WHO Handbook of indicators for HSS and for details on this and related indicators, see WHO (2010) and USAID (2009).
Data are collected through reporting by the ministries of finance and health and other relevant ministries and agencies. If public expenditure reviews that track whether government expenditures correspond with budget plans are available, these can be a helpful source of information. The best source of health expenditure data is from national health accounts (NHA), which combine expenditure data from all sources and through all types of financial agents. NHA data include all health service expenditures and can be disaggregated by government versus other sources and by the target areas of the expenditures. WHO, World Bank and USAID have jointly developed a guide to undertake NHA that has been adapted to meet the needs of low-income countries. Ideally, health expenditures should be calculated on an annual basis. Government RH expenditure data can be further disaggregated by type of RH service or program. For more information on NHA, see WHO (2010) and WHO/World Bank/USAID (2003).
Reports from government ministries (i.e., finance, health, etc.) and agencies; NHA data; public expenditure reviews
This indicator provides information on the overall availability of funds for and level of government commitment to RH services and programs. Whether expenditures are considered sufficient requires estimates of the amounts needed to ensure access to the desired level of RH services. The indicator will also allow per capita comparisons with other countries with similar and/or higher levels of gross domestic product (GDP). Health financing is fundamental to the ability of health systems to maintain and improve human welfare and is basic to achieving Millennium Development Goals for health: #4. reduce child mortality; #5. improve maternal health; and #6. combat HIV/AIDs . In 2005, WHO Member States endorsed a resolution urging governments to develop health financing systems aimed at universal coverage, which is described as raising sufficient health funds to allow access to needed services without the risk of a financial catastrophe for households. Despite substantial increases in external assistance for health since 2000, the available resources are still insufficient in most low-income settings to assure universal coverage with even a very basic set of interventions (WHO, 2010).
Informed health financing policy decision-making requires reliable information on the quantity of financial resources used for health, their sources and the way they are used. The use of complied data on expenditures, such as the NHA, provides for monitoring progress in HSS, specifically health spending for all public and private sectors, different healthcare activities, providers, diseases, population groups and regions in a country. It helps in developing national strategies and in raising funds for effective health financing. Moreover, the information can be used to make financial projections of a country’s health system requirements and compare its experiences with those in the past or with those of other countries.
In most countries, information on government health expenditures directed through the ministry of health is typically available through the ministry of finance or regional authorities in decentralized systems. However, information on government health expenditures that are directed through non-health ministries, such as military or police health services, are sometimes more difficult to obtain. While budget information is available in ‘real time’, there is often a delay of about one year in the production of consolidated expenditure accounts. Breaking down expenditures for RH services and programs may be complicated when these services overlap with health services that are not specifically defined as RH (e.g., nutrition care and adolescent health). Data on total expenditures for RH services cannot show how efficiently or effectively resources are being utilized.
policy, health system strengthening (HSS)
The Global Fund, 2009, Monitoring and Evaluation Toolkit: HIV, Tuberculosis and Malaria and Health Systems Strengthening. http://www.hivpolicy.org/Library/HPP000485.pdf
USAID, 2009, Measuring the Impact of Health Systems Strengthening, A Review of the Literature, Washington, DC: USAID. https://www.researchgate.net/publication/274064201_Measuring_the_Impact_of_Health_Systems_Strengthening_A_Review_of_the_Literature
WHO/World Bank/USAID, 2003, Guide to producing national health accounts with special applications for low-income and middle-income countries. Geneva: WHO. http://www.who.int/health-accounts/documentation/publication_nha_guide/en/
WHO, 2010, Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies, Geneva: WHO. http://www.who.int/healthinfo/systems/WHO_MBHSS_2010_full_web.pdf
WHO/UNFPA, 2008, National-level monitoring of the achievement of universal access to reproductive health: conceptual and practical considerations and related indicators, Geneva: WHO. http://whqlibdoc.who.int/publications/2008/9789241596831_eng.pdf
WHO, 2011, National Health Accounts (NHA), Website, Geneva: WHO. http://www.who.int/nha/en/