health systems governance & financinghealth systems governance & financing prepared by b....
TRANSCRIPT
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Health System Financing in Guinea,
Liberia and Sierra Leone: Overview
David B Evans, Director
Health Systems Governance & Financing
Prepared by B. Mathivet & J. Kutzin using data from country health account studies & the Global Health Account Database
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Total Health Expenditure, per capita (PPP, int. $), 2000-2013 Rising, some faster than regional average
0
50
100
150
200
250
1998 2000 2002 2004 2006 2008 2010 2012 2014
Guinea Liberia Sierra Leone Median, 15 countries WCA
http://apps.who.int/gho/data/node.main.484?lang=en
$205: Sierra Leone
$102: Liberia
$67: Guinea
OOP due to health expenses: 67% Guinea 21% Liberia; 76% Sierra Leone
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Total Health Expenditure and External Funding
2000-2012
0
10
20
30
40
50
60
70Liberia
Domestic resources in USD at ER External resources in USD at ER
0
5
10
15
20
25
30
35Guinea
Domestic resources in USD at ER External resources in USD at ER
0
20
40
60
80
100
120Sierra Leone
Domestic resources in USD at ER External resources in USD at ER
4 |
Health Expenditure/capita, main components, 2012
0.00
20.00
40.00
60.00
80.00
100.00
120.00
140.00
160.00
Other HE / capita (USD atER)
OOPS / capita (USD at ER)
GGEH / capita (USD at ER)
5 |
0
50
100
150
200
250
300
350
400
450
500
550
600
650
0
5
10
15
20
25
Eritr
ea
Angola
Sao T
om
e a
nd P
rincip
e
Kenya
Chad
Cong
o
Nig
eria
Gu
inea
Equato
rial G
uin
ea
Ga
bon
Gu
inea-B
issau
Côte
d'Iv
oire
Bots
wa
na
Cam
ero
on
Mozam
biq
ue
Cabo
Verd
e
Senega
l
Gh
ana
Maurita
nia
Com
oro
s
Mauritius
Ugan
da
Ta
nzania
Benin
Nig
er
Sudan
Seychelle
s
Eth
iopia
Centr
al A
fric
an
Rep
ublic
Ga
mbia
Burk
ina F
aso
Sie
rra L
eone
Mali
Madaga
scar
DR
C
South
Afr
ica
Buru
ndi
Nam
ibia
Djib
outi
Lesoth
o
To
go
Za
mb
ia
Mala
wi
Sw
azila
nd
Lib
eria
Rw
an
da
GGHE as % GGE & GGHE per capita at ER (2012)
GGHE as % GGE (2012) GGHE per capita USD at ER (2012)
Low public spending
Abuja target: 15% of GGE dedicated to health
7%
12% 19%
86USD: per capita estimate for a basic benefit package
9USD 16USD
20USD
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Direct Out-of-Pocket Payments are
high
0
10
20
30
40
50
60
70
80
90
Sey
chel
les
Moz
ambi
que
Bot
swan
a
Nam
ibia
Sou
th A
fric
a
Sw
azila
nd
Mal
awi
Leso
tho
Gam
bia
Rw
anda
Cab
o V
erde
Libe
ria
Zam
bia
Con
go
Ang
ola
Bur
undi
Gha
na
Mad
agas
car
Tan
zani
a
DR
C
Mau
ritan
ia
Sen
egal
Bur
kina
Fas
o
Djib
outi
Tog
o
Eth
iopi
a
Gab
on
Gui
nea-
Bis
sau
Equ
ator
ial G
uine
a
Com
oros
Ben
in
Cen
tral
Afr
ican
Rep
ublic
Mau
ritiu
s
Ken
ya
Uga
nda
Sao
Tom
e an
d P
rinci
pe
Erit
rea
Cha
d
Nig
er
Côt
e d'
Ivoi
re
Mal
i
Cam
eroo
n
Nig
eria
Gui
nea
Sud
an
Sie
rra
Leon
e
Out of pocket expenditure as % of THE (2012)
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A point on ODA (2/2)
Source: OECD-DAC
0
20
40
60
80
100
120
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Liberia
Other (Million USD at ER)
MDG6, reproductive health and family planning (Million USD at ER)
0
20
40
60
80
100
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Sierra Leone
Other (Million USD at ER)
MDG6, reproductive health and family planning (Million USD at ER)
0
10
20
30
40
50
60
70
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Guinea
Other (Million USD at ER)
MDG6, reproductive health and family planning (Million USD at ER)
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A point on ODA (1/2)
Country MDG 6
Reproductive health &
family planning
Health policy & management
Other health purposes
Distribution of funding
Guinea 54% 16% 16% 14%
Liberia 43% 12% 11% 34%
Sierra Leone 29% 23% 18% 30%
Source: OECD-DAC, disbursements
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The economy, government and private capacity to
spend is weakened by Ebola
Slower growth
means lower
government
revenues
Many cannot go to
work, food prices
increased
> higher occurrence of
catastrophic health
expenditure expected
Disruption of health
services may trigger
higher and more severe
morbidity
> Greater burden for the
health system
Significant external
assistance is
required, long term,
broadly allocated to
all parts of health
and health systems
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The Macroeconomic Situation : Growth
0.0
5.0
10.0
15.0
20.0
25.0
2013 2014 2015 2016
Guinea - Gross domestic product, constant prices(%change) Previous Estim.
Guinea - Gross domestic product, constant prices(%change) Current Estim.
Liberia - Gross domestic product, constant prices(% change) Previous Estim.
Liberia - Gross domestic product, constant prices(% change) Current Estim.
Sierra Leone - Gross domestic product, constantprices (% change) Previous Estim.
Sierra Leone - Gross domestic product, constantprices (% change) Current Estim.
Growth rate
Source: IMF World Economic Outlook Database (October 2014). Pre-crisis estimates extracted from Country Missions Reports 14/298, 14/299 & 14/300 released sept. 29th 2014.
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More on Macro Situation : inflation
5.0
6.0
7.0
8.0
9.0
10.0
11.0
12.0
13.0
2013 2014 2015 2016
Guinea - Inflation, average consumer prices(% change) Previous estim.
Guinea - Inflation, average consumer prices(% change) Current estim.
Liberia - Inflation, average consumer prices(% change) Previous estim.
Liberia - Inflation, average consumer prices(% change) Current estim.
Sierra Leone - Inflation, average consumerprices (% change) Previous estim.
Sierra Leone - Inflation, average consumerprices (% change) Current estim.
Inflation rate
Source: IMF World Economic Outlook Database (October 2014). Pre-crisis estimates extracted from Country Missions Reports 14/298, 14/299 & 14/300 released sept. 29th 2014.
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The Macroeconomic Situation: budget deficits
0.0
2.0
4.0
6.0
8.0
10.0
12.0
2013 2014 2015 2016
Guinea - Budget Deficit (%GDP) Previousestim.
Guinea - Budget Deficit (%GDP) Currentestim.
Liberia - Budget Deficit (%GDP) Previousestim.
Liberia - Budget Deficit (%GDP) Currentestim.
Sierra Leone - Budget Deficit (%GDP)Previous estim.
Sierra Leone - Budget Deficit (%GDP) Currentestim.
Budget deficit as % GDP
Source: IMF World Economic Outlook Database (October 2014). Pre-crisis estimates extracted from Country Missions Reports 14/298, 14/299 & 14/300 released sept. 29th 2014.
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Conclusions (Unwritten Implications)
Funds for health insufficient to ensure universal access to even a
minimum set of interventions except perhaps Sierra Leone
Don't have good picture of costs of "revitalizing" health systems
External funding has increased particularly in Liberia and Sierra
Leone, but very highly skewed to MDGs, particularly MDG 6 –
more needed
Government health expenditures low, insufficient to protect
people from financial consequences of illhealth – high out of
pocket payments
Macroeconomic projections determining how much countries can
spend in the future are not promising
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Spare Slides
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Communities are crucial to tackle
Ebola… …yet they have limited power when it comes to Health Financing.
Due to its small scale and voluntary nature, CBHI:
- Only covers a small portion of the population.
- Gives access to few benefits
- Does not provide incentives for broad health systems reforms.
> Only higher state budget allocation for health can bring greater financial
protection to all, and trigger positive changes in quality and efficiency
Small
pools
Low
financial
capacity
Small
benefit
packages
Low
attracti-
veness
Low rates,
voluntary
contribution