Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Health financing in Africa: Can we fill the gaps? Health Systems Research Symposium Laurel Hatt, MPH, PhD Health Systems 20/20 Project, Abt Associates Inc. Abt Associates Inc. In collaboration with: I Aga Khan Foundation I BearingPoint I Bitrán y Asociados I BRAC University I Broad Branch Associates I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health Objectives Review the current health financing situation in sub- Saharan Africa Analyze projected future financing gaps Highlight policy recommendations that emerged from recent expert consultations 2 Data and geographic scope Data sources: Health expenditure and population data from the WHO’s Global Health Observatory (2007 data) GDP per capita from the IMF’s World Economic Outlook database Geographic scope: 40 countries in sub-Saharan Africa Excluded South Africa and 5 countries with populations < 1 million 3 Overview of health financing indicators in sub-Saharan Africa today Average per capita spending on health: $41 Lowest in the world $33 if Nigeria excluded Private spending: 60% of total Out-of-pocket spending: 83% of private spending 4 Out-of-pocket spending accounts for 50% of total health spending in SSA Total health spending by source, 2007 Nigeria Côte d'Ivoire Sudan OOP Eritrea Public Other private Benin Kenya Mauritius DRC Burkina Faso Ghana Uganda Mauritania Ethiopia Lesotho Zimbabwe Gambia Madagascar Swaziland Malawi Namibia 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 5 100% Indicators for adequacy of resources for health Commission on Macroeconomics and Health (2001): $41/person in current dollars WHO High Level Taskforce on International Innovative Financing for Health Systems (2009): $54/person to meet health MDGs Abuja target (2001): 15% of government spending 6 Burundi DRC Liberia Guinea-Bissau Ethiopia Gambia Malawi Sierra Leone Eritrea Rwanda Niger Uganda Tanzania Togo Madagascar CAR Mozambique Guinea Burkina Faso Mali Lesotho Chad Ghana Benin Nigeria Kenya Senegal Zambia Mauritania Côte d'Ivoire Cameroon Sudan Zimbabwe Congo Swaziland Namibia Angola Mauritius Gabon Botswana Health expenditure ($US, 2007) Current levels of government health spending Government spending $100 $90 $80 $70 WHO target ($54) $60 $50 $40 $30 $20 $10 $0 <$250 $250-$499 Sources: WHOSIS database, IMF World Economic Outlook 2007, and author’s calculations $500-$999 $1000+ Country, sorted by per capita GDP in 2007 7 Burundi DRC Liberia Guinea-Bissau Ethiopia Gambia Malawi Sierra Leone Eritrea Rwanda Niger Uganda Tanzania Togo Madagascar CAR Mozambique Guinea Burkina Faso Mali Lesotho Chad Ghana Benin Nigeria Kenya Senegal Zambia Mauritania Côte d'Ivoire Cameroon Sudan Zimbabwe Congo Swaziland Namibia Angola Mauritius Gabon Botswana Health expenditure ($US, 2007) Current levels of government and private health spending Government spending $70 <$250 $250-$499 Sources: WHOSIS database, IMF World Economic Outlook 2007, and author’s calculations Private spending $100 $90 $80 WHO target ($54) $60 $50 $40 $30 $20 $10 $0 $500-$999 $1000+ Country, sorted by per capita GDP in 2007 8 Hypothetical levels of total spending if the Abuja target were met today Government spending Private spending Abuja shortfall $90 $80 $70 WHO target ($54) $60 $50 $40 $30 $20 $10 $0 Burundi DRC Liberia Guinea-Bissau Ethiopia Gambia Malawi Sierra Leone Eritrea Rwanda Niger Uganda Tanzania Togo Madagascar CAR Mozambique Guinea Burkina Faso Mali Lesotho Chad Ghana Benin Nigeria Kenya Senegal Zambia Mauritania Côte d'Ivoire Cameroon Sudan Zimbabwe Congo Swaziland Namibia Angola Mauritius Gabon Botswana Health expenditure ($US, 2007) $100 <$250 $250-$499 $500-$999 $1000+ Country, sorted by per capita GDP in 2007 Sources: WHOSIS database, IMF World Economic Outlook 2007, and author’s calculations 9 Most poor SSA governments will not meet the $54 target by 2020, even with optimistic assumptions FIGURE 3. PROJECTED AVERAGE PER CAPITA GOVERNMENT SPENDING ON HEALTH (US$), GROUPED BY GDP PER CAPITA IN 2007 Per capita government expenditure on health ($US) $160 OBSERVED PROJECTED $140 Assumptions: --Total government expenditures increase by 5% per year --Governments increase health spending by 1 perc. point per year until they reach the Abuja target --2% population growth or less $120 $100 GDP $1000+ $80 WHO target spending level of $54 per capita $60 GDP $500-$999 $40 GDP $250-$499 $20 GDP <$250 $2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Year Sources: WHO statistics, IMF World Economic Outlook database, and authors' calculations. Excludes S. Africa and countries with pop. < 1 million. 10 Adding in spending from households and other private sources FIGURE 4. PROJECTED AVERAGE PER CAPITA GOVERNMENT AND PRIVATE SPENDING ON HEALTH (US$), GROUPED BY GDP PER CAPITA IN 2007 $160 OBSERVED PROJECTED Per capita total expenditure on health ($US) $140 GDP $1000+ $120 $100 $80 GDP $500-$999 WHO target spending level of $54 per capita $60 GDP $250-$499 $40 GDP <$250 $20 $2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Year Sources: WHO statistics, IMF World Economic Outlook database, and authors' calculations. Excludes S. Africa and countries with pop. < 1 million. 11 Summary Compared to other regions, SSA has the lowest health spending levels and heavy dependence on out-of-pocket financing Even with optimistic assumptions, financing gaps are unlikely to be closed in the medium term Low per capita incomes in Africa Limited ability to collect taxes – small formal sector Donors already contribute 13% of total spending Health systems bottlenecks – low absorptive capacity, low budget execution 12 Can we fill the gaps? What are the “best bets” for increasing resources for health and leveraging existing health spending in sub-Saharan Africa? Roundtable discussion among experts convened by Health Systems 20/20 and Results for Development’s Health Financing Task Force Experts from World Bank, Brookings Institution, Georgetown University, IMF, UNICEF 13 Approaches to consider Leverage the private sector Increase access to capital, promote investment, improve regulation Explore new global health taxes Support innovative financing mechanisms to get new technologies to the market Improve efficiency of donor spending – coordination, onbudget spending Strengthen governance and public financial management Develop and strengthen health insurance systems Implement results-based financing 14 Thank you! “Toward Solving Health Financing Challenges in Africa – A Way Forward” is available at www.hs2020.org Abt Associates Inc. In collaboration with: I Aga Khan Foundation I BearingPoint I Bitrán y Asociados I BRAC University I Broad Branch Associates I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health