November ISBN: (NLM Classification: W 74)

Transcription

1 WHO African Region Expenditure Atlas November 14

2 November 14 ISBN: (NLM Classification: W 74)

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4 Foreword Health financing and social protection remains key elements of the health system in particular,and health development in general in the African region. Appropriate health financing and social protection mechanisms will improve access to services and enable countries to achieve the targets set out in both international and African member states commitments to the agreed objectives such as the Millennium Developments Goals (MDG) and Universal Health Coverage (UHC). For countries to define appropriate policies to finance health care it is imperative to know the institutions or mechanisms that finance health care; the institutions that obtain and administer resources to pay; the entities that receive money in order to produce the required health care goods and services; and services and products purchased with health care funds. This Health Financing Atlas has used summarized data from countries National Health Account reports to show the health financing profile for each country. The Atlas presents key indicators, such as general government health expenditure as a share of gross domestic product, total health expenditure per capita,out-of-pocket payments as a share of total health expenditure, the extent to which countries are meeting or falling short of the Abuja target, and how some of these are linked to life expectancy and the maternal mortality ratio. These indicators help to inform policy-making and guide priority setting when developing national health strategies and operational plans. The publication shows that there has been progress made in the mobilisation of government resources over the past decade, but that are still exposed to impoverishment as a result of catastrophic health expenditures. African countries should therefore start thinking critically about the alternative and innovative financing mechanisms needed in order to further increase the public funding for health and reduce financial barriers to accessing health services. This is critical for achieving MDGs and UHC. I call upon Ministries of Health and Ministries of Financing to analyse the findings of their National Health Accounts and utilize those results to take appropriate decisions to ensure that health resources are used efficiently and to the benefit of the people who need them most. I would appreciate your suggestions for improving future editions of the WHO African Region Health Expenditure Atlas. I thank you. Dr Luis Gomes SAMBO WHO Regional Director for Africa WHO African Region Expenditure Atlas 3

5 Foreword Policy Highlight 1: Mobilization of government resources GGHE as a share of gross domestic product (): A study of 185 countries showed that GGHE as a share of increased with a country s income. Evidence further shows that when government expenditure on health is greater than 5 6% of, fewer have financial hardship in paying for the health services they need. We assessed the level of government health expenditure against the level of in the African Region from 2 to 12. Figure 1: Africa Region - GGHE as a share of gross domestic product () The data shows that there is progress in mobilization of government resources over the past ten years. In 2, no African country had GGHE as a share of gross domestic product () that was more than 5%, but by 7, four countries had achieved this target and this number had increased to 7 by 12 (See Figure 1). One of the challenges is that many African countries have limited capacities to raise public revenues including payroll tax collections for social health insurance mainly because of the large informal sector. The performance, accountability and administration of the tax system are often additional problems for many countries. Efforts to restructure the informal sector should be increased in order to mobilize more public revenues from taxes, since better public sector funding will facilitate the increase of resources for health and more specifically, enable countries to meet the target of 5% of GGHE as a percent of. In addition, the rising economic growth in Africa is an opportunity; Africa s economy grew by 4. in 13 and is projected to grow by 5.3% in 14. That provides an opportunity for increased government spending on health by African governments, spurred by the results achieved by African countries already engaged in mobilizing more money for health. 4 WHO African Region Expenditure Atlas

6 Policy Highlight 2: Availability and Efficient use of resources Total health expenditure per capita: The High Level Taskforce on Innovative International Financing for Health Systems (HLTF) estimated that by 9 a low income country needed to spend on average US$ 44 per capita to strengthen its health system and to provide an essential package of health services. In the table below, we categorized countries in three groups based on spending: less than US$, US$ US$ 44 and more than US$ 44. Figure 2: Africa Region - Total expenditure on health/capita at exchange rate in 2, 7 and Figure 2 shows that countries in the African region have made good progress in increasing the per capita expenditure on health; whereas in 2 only 11 countries were spending US$44 on health per capita, the number rose to 21 and 26 respectively in 7 and 12. However,, although several countries have an average expenditure of health of more than 44 $US per capita, their health indicators are not showing improvement; this requires an analysis on how efficiently they are using the available resource in addition to the prioritization of high impact interventions. If resources are spent more on large investments and supply, the impact on health will be less. Furthermore, 17 out of 45 countries have three indicators that are below the target recommended such as THE per capita>us$44; GGHE/>15% and GGHE as % >5% (see figure n 4); these countries should make a considerable effort to increase their budget for health. Additional to the per capita expenditure mentioned above, there is scope for governments to allocate more money for health from domestic sources. In this regard, the 1 Abuja Declaration urging African Union states to allocate at least 15% of national budgets to the health sector was a landmark. Unfortunately this target had been achieved by only six countries by 12 as shown in Table 1. It is important to note, however, that allocations to the health sector as a percentage of total government budget ranged from WHO African Region Expenditure Atlas 5

7 6% to 22% in 12 in the African Region. It is logical to consider the Abuja Declaration target together with the recommendation of the HLTF of reaching US$ 44 per capita THE. Over one third of the countries in the African Region have not managed to raise health spending to the level of US$ 44. Only, and have managed to meet both the Abuja and the HLTF targets as shown in Table 1. Table 1: THE against GGHE/ THE per capita GGHE/ >15% GGHE/ <15% >US$44 <US$44,,, (4 countries), (2 countries) Algeria, Angola, Botswana,, Cape Verde,, Côte divoire, Equatorial, Gabon,,,,,, Mauritius, Namibia, ia, STP,, Seychelles,, South Africa (22 countries),,, Central Africa Republic,,, DRC,,,,, Bissau,,,,, Tanzania (17 countries) In the future, with Africa still on a projected path of rising economic growth, the focus should turn to how the economic expansion will affect availability of funds for health. Will health expenditure grow faster, slower or at the same pace as per capita income? The answer to this question will necessarily vary from country to country, but as there are most probably going to be push factors, such as the rise in non-communicable diseases or in the ageing population, and pull factors, such as investment growth in high technology that will be similar to high income countries elsewhere, it is probable that many African countries will follow the same pattern of excess growth (health spending outpacing economic growth) that has been observed in high income countries. Looking at the very low levels of per capita spending and of total health expenditure as a share of in most African countries an increase in health expenditure would be a welcome outcome in most countries. However it should not turn away focus on strategic purchasing especially given the likelihood of the push and pull factors above. 6 WHO African Region Expenditure Atlas

8 Policy Highlight 3: Financial barriers to accessing health services Out-of-pocket payments as a share of total health expenditure: Evidence shows that catastrophic health expenditure and impoverishment remain low in countries where out-of-pocket expenditure is less than 2 of the total health expenditure. In addition, few are shown to be impoverished where out-of-pocket expenditure is less than 2 of the total health expenditure.in the African Region, only 1 countries out of 47 have an out-of-pocket (OOP) health expenditure as a percent of THE that was less than 2 in 12. Figure 3: Out of pocket expenditure as % of THE in 12 WHO African Region Expenditure Atlas 7

9 Twenty one (21) countries out of 47 have OOP that is more than 4 of THE, which presumes that are exposed to impoverishment caused by catastrophic health expenditure. Reducing financial barriers to accessing health services when needed is one of the top goals of Universal Health Coverage. In order to improve financial risk protection and expand population coverage, WHO/AFRO and AUC have proposed to countries to: (a) Develop comprehensive /improve policies and strategies for health financing to realize aggregate increase in funds for health and to enhance the quality of services and efficient utilization of funds to reduce out-of-pocket payments, at least for vulnerable populations and priority services. (b) Promote prepayment mechanisms to cover the whole population and introduce prepayment and pooling arrangements that share financial risks across the whole population. This includes mobilization of more resources for health through government revenues, tax funding and/or mandatory (i.e. social or national) health insurance premiums and/or subsidies. (c) Implement public equity funds to cover the health costs of people who are not able to contribute. GGHE as a percentof, the THE per capita and Abuja target: Considering the three indicators such as GGHE as a percent of > 5%, the THE per capita > 44 $US and the Abuja target of at least 15% of the national budget allocated to health sector, only 3 countries (, and ) out of 45 archived the three indicators in 12. If we add the fourth indicator of out-of-pocket payments as a share of total health expenditure less than 2, only met these four indicators in 12. Figure 4: THE per capita>us$44; GGHE/>15% and GGHE as % >5% in 12 8 WHO African Region Expenditure Atlas

10 This WHO African Region Expenditure Atlas shows how the limited availability of financial resources does not enable the countries to provide the quantity and quality of services needed and to subsidize some categories of the population and or interventions. Continuous evidence-based dialogue and collaboration between ministries of health and finance in development of plans and health financing strategies, mobilization and allocation of resources for the health sector, accountability and financial management is crucial as recommended in the Tunis declaration. Table 2: Spending on health and keys indicators of economic strength in the African Region (2, 7 and 12) GGHE as % of General government expenditure Out of pocket expenditure as % of THE Total expenditure on health / capita at exchange rate expenditure on health as % of Countries Algeria Angola Botswana Cabo Verde Central African Côte d Ivoire DRC Equatorial , Gabon WHO African Region Expenditure Atlas 9

11 GGHE as % Out of pocket Total expenditure of General expenditure as % on health / capita expenditure on government of THE at exchange rate health as % of expenditure Countries Mauritius Namibia ia Sao Tome Seychelles South Africa Tanzania WHO African Region Expenditure Atlas

12 Country profiles 12 Foreword Algeria Angola Botswana Cape Verde Democratic Republic of Côte d Ivoire (Ivory Coast) Equatorial Gabon Mauritius Namibia ia Seychelles South Africa WHO African Region Expenditure Atlas 11

13 HEALTH SYSTEM FINANCING COUNTRY PROFILE: Algeria, 12 Algeria spent 11 billion US$ 1 - $279 per capita Spending by - 15% spent by 15% 8 1% Algeria: Algeria: $5,31/capita 72 years 12 average of up-mid AFR income AFR up-mid income AFR up-mid income 45 Gov ernment expenditure on health countries: $6,42/capita countries: 63 years $433 4 health Algeria: 1 per AFR up-mid income countries: 258 per 1, live births $227 $191 $34 $247 $48 1 6% 2% expenditure () % Algeria Namibia Namibia Seychelles South Africa Algeria Among up-mid AFR countries: Angola Seychelles Seychelles Total government expenditure is high as a % of ((45%)) Botswana Mauritius South Africa Namibia South Africa Algeria Botswana Botswana Mauritius allocated to health is in the median range ((1)) Gabon Mauritius Gabon Angola Angola Gabon as a % of is high (()) % 1 15% 2% 6% 12 WHO African Region Expenditure Atlas

14 HEALTH SYSTEM FINANCING COUNTRY PROFILE: Angola, 12 Angola spent 4. billion US$ 9 2% - $19 per capita Spending by - 27% spent by 27% 62% 11% Angola: Angola: $5,482/capita 52 years 12 average of up-mid AFR income AFR up-mid income AFR up-mid income 45 Gov ernment expenditure on health countries: $6,42/capita countries: 63 years $433 4 health Angola: 61 per AFR up-mid income countries: 258 per 1, live births $153 $95 $41 $247 $48 1 6% 2% expenditure () % Algeria Namibia Namibia Seychelles South Africa Algeria Among up-mid AFR countries: Angola Seychelles Seychelles Total government expenditure is high as a % of ((39%)) Botswana Mauritius South Africa Namibia South Africa Algeria Botswana Botswana Mauritius allocated to health is low ((6%)) Gabon Mauritius Gabon Angola Angola Gabon as a % of is low ((2%)) % 1 15% 2% 6% WHO African Region Expenditure Atlas 13

15 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 332 million US$ 6 32% - $33 per capita Spending by - 4 spent by 4 51% : : $737/capita 57 years 12 average of low AFR income 35 Gov ernment expenditure on health countries: $527/capita countries: 54 years health $31 3 $31 : 41 per 25 countries: 655 per 15 $16 $14 $13 $ % 5% expenditure () % Among low AFR countries: Total government expenditure is in the median range as a % of ((22%)) allocated to health is in the median range ((1)) as a % of is in the medain range ((2%)) % 1 15% 2 25% 2% 6% 14 WHO African Region Expenditure Atlas

16 HEALTH SYSTEM FINANCING COUNTRY PROFILE: Botswana, 12 Botswana spent 77 million US$ 8 - $384 per capita Spending by - 6% spent by 6% 56% 3 Botswana: Botswana: $7,238/capita 61 years 12 average of up-mid AFR income AFR up-mid income AFR up-mid income 45 Gov ernment expenditure on health countries: $6,42/capita countries: 63 years $433 4 health $42 Botswana: 19 per AFR up-mid income countries: 258 per 1, live births $227 $22 $247 $48 12% 1 6% 2% expenditure () % Algeria Namibia Namibia Seychelles South Africa Algeria Among up-mid AFR countries: Angola Botswana Seychelles Mauritius Seychelles South Africa Total government expenditure is in the median range as a % of ((37%)) Namibia South Africa Algeria Botswana Botswana Mauritius allocated to health is low (()) Gabon Mauritius Gabon Angola Angola Gabon as a % of is in the medain range ((3%)) % 1 15% 2% 6% WHO African Region Expenditure Atlas 15

17 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 622 million US$ 69% 31% - $38 per capita Spending by - 36% spent by 36% 5 9% : : $612/capita 52 years 12 average of low AFR income 45 Gov ernment expenditure on health countries: $527/capita countries: 54 years 4 health $38 35 : 56 per 3 25 $31 $21 countries: 655 per 15 1 $14 $13 $ % expenditure () % Among low AFR countries: Total government expenditure is high as a % of ((2)) allocated to health is in the median range ((12%)) as a % of is high ((3%)) % 1 15% 2 25% 2% 6% 16 WHO African Region Expenditure Atlas

18 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 197 million US$ 5 46% - $ per capita Spending by - 2 spent by 2 59% 12% : : $246/capita 5 years 12 average of low AFR income 35 Gov ernment expenditure on health countries: $527/capita countries: 54 years health 3 $31 25 : 97 per $18 countries: 655 per $11 $5 $13 $12 12% expenditure () % Among low AFR countries: Total government expenditure is high as a % of ((35%)) allocated to health is high ((1)) as a % of is high ((5%)) % 1 15% 2 25% 2% 6% WHO African Region Expenditure Atlas 17

19 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 Cabo Verde Republic of spent 71 million US$ 72% 2 - $144 per capita Spending by - 21% spent by 21% 77% 1% Cabo Verde Republic of: Cabo Verde Republic of: $3,7/capita 71 years 12 average of low-mid AFR income 16 Gov ernment expenditure on health countries: $1,482/capita countries: 56 years 14 health $138 : 94 per countries: 483 per 1, live births $17 $29 $86 $48 $33 11% 5% expenditure () % Among low-mid AFR countries: Total government expenditure is in the median range as a % of ((3)) ia ia allocated to health is in the median range ((9%)) ia as a % of is in the medain range ((3%)) % 1 15% 2 25% 2% 6% 1 18 WHO African Region Expenditure Atlas

20 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 1.3 billion US$ 91% 9% - $59 per capita Spending by - 63% spent by 63% 3 : : $1,151/capita 51 years 12 average of low-mid AFR income 9 Gov ernment expenditure on health countries: $1,482/capita countries: 56 years $86 8 health : 6 per countries: 483 per 1, live births $58 $36 $19 $48 $33 1 6% 2% expenditure () % Among low-mid AFR countries: Total government expenditure is low as a % of ((2)) ia ia allocated to health is in the median range ((9%)) ia as a % of is low ((2%)) % 1 15% 2 25% 2% 6% 1 WHO African Region Expenditure Atlas 19

21 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 Central African Republic spent 8 million US$ 71% 29% - $18 per capita Spending by - 46% spent by 46% 5 5% Expenditure by governmen Central African Republic: Central African Republic: $473/capita 48 years 12 average of low AFR income Total ex penditure on health countries 35 Gov ernment ex penditure on health countries: $527/capita countries: 54 years health 3 25 : 85 per countries: 655 per 15 1 $18 $9 $8 $31 $13 $ % expenditure () % Among low AFR countries: Total government expenditure is low as a % of ((17%)) allocated to health is in the median range ((11%)) as a % of is low ((2%)) % 1 15% 2 25% 2% 6% WHO African Region Expenditure Atlas

22 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 388 million US$ 8 12% - $31 per capita Spending by - 53% spent by 53% 45% 2% : : $885/capita 48 years 12 average of low AFR income 4 Gov ernment expenditure on health countries: $527/capita countries: 54 years 35 health 3 $31 25 $26 : 1, per countries: 655 per 15 1 $14 $12 $13 $ % expenditure () % Among low AFR countries: Total government expenditure is in the median range as a % of ((27%)) allocated to health is low ((6%)) as a % of is low ((2%)) % 1 15% 2 25% 2% 6% WHO African Region Expenditure Atlas 21

23 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 27 million US$ 73% 27% - $38 per capita Spending by - 4 spent by 4 56% : : $831/capita 6 years 12 average of low AFR income 45 Gov ernment expenditure on health countries: $527/capita countries: 54 years 4 health 35 $36 3 $31 : 34 per 25 $ countries: 655 per 15 1 $16 $13 $ % 5% expenditure () % Among low AFR countries: Total government expenditure is in the median range as a % of ((26%)) allocated to health is low ((1)) as a % of is in the medain range ((3%)) % 1 15% 2 25% 2% 6% 22 WHO African Region Expenditure Atlas

24 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 433 million US$ 92% - $1 per capita Spending by - 25% spent by 25% 7 1% : : $3,154/capita 55 years 12 average of low-mid AFR income 1 Gov ernment expenditure on health countries: $1,482/capita countries: 56 years $94 9 health $ $69 : 58 per 6 countries: 483 per 1, live births $48 $33 $24 6% 2% expenditure () % Among low-mid AFR countries: Total government expenditure is high as a % of ((36%)) ia allocated to health is low ((6%)) ia ia as a % of is in the medain range ((2%)) % 1 15% 2 25% 2% 6% 1 WHO African Region Expenditure Atlas 23

25 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 1.7 billion US$ 91% 9% - $88 per capita Spending by - 56% spent by 56% 27% 17% : : $1,244/capita 5 years 12 average of low-mid AFR income 1 Gov ernment expenditure on health countries: $1,482/capita countries: 56 years 11 health 1 9 $85 $86 8 : 47 per $48 $48 countries: 483 per 1, $33 3 live births $ % 1 6% 2% expenditure () % Among low-mid AFR countries: Total government expenditure is low as a % of ((2)) ia ia allocated to health is in the median range (()) ia as a % of is low ((2%)) % 1 15% 2 25% 2% 6% 1 24 WHO African Region Expenditure Atlas

26 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 Democratic Republic of the spent 998 million US$ $15 per capita Spending by - 32% spent by 32% 51% Democratic Republic of the : Democratic Republic of the : $272/capita 49 years 12 average of low AFR income 35 Gov ernment expenditure on health countries: $527/capita countries: 54 years health 3 $31 25 Democratic Republic of the : 67 per countries: 655 per $13 $7 $4 $13 $ % expenditure () % Democratic Republic of the Cong Democratic Republic of the Cong 5% 1 15% 2 25% Democratic Republic of the Cong 2% 6% Among low AFR countries: Total government expenditure is in the median range as a % of ((22%)) allocated to health is high ((13%)) as a % of is high ((3%)) WHO African Region Expenditure Atlas 25

27 HEALTH SYSTEM FINANCING COUNTRY PROFILE: Equatorial, 12 Equatorial spent 838 million US$ 99% 1% - $1,138 per capita Spending by - 4 spent by 4 5 2% Equatorial : Equatorial : $24,36/capita 53 years 12 average of hi AFR income AFR hi income AFR hi income 1, Gov ernment expenditure on health countries: countries: 53 years $24,36/capita health 1, $848 8 Equatorial : 28 per AFR hi income countries: 28 per 6 4 $46 $369 $1,138 $618 $495 12% expenditure () % Among hi AFR countries: Total government expenditure is in the median range as a % of ((37%)) Equatorial Equatorial Equatorial allocated to health is in the median range ((7%)) as a % of is in the medain range ((3%)) % 1 15% 2 25% 3 35% 4 2% 6% 112% WHO African Region Expenditure Atlas

28 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 9 million US$ 75% 25% - $15 per capita Spending by - 53% spent by 53% 47% : : $564/capita 66 years 12 average of low AFR income 35 Gov ernment expenditure on health countries: $527/capita countries: 54 years health 3 $31 25 : 28 per countries: 655 per $12 $6 $13 $12 3% 2% 1% expenditure () % Among low AFR countries: Total government expenditure is high as a % of ((3)) allocated to health is low (()) as a % of is low ((1%)) % 1 15% 2 25% 2% 6% WHO African Region Expenditure Atlas 27

29 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 1.6 billion US$ $18 per capita Spending by - 41% spent by 41% 4 1 : : $458/capita 54 years 12 average of low AFR income 35 Gov ernment expenditure on health countries: $527/capita countries: 54 years health 3 $31 25 : 47 per countries: 655 per $13 $6 $5 $13 $12 12% expenditure () % Among low AFR countries: Total government expenditure is low as a % of ((17%)) allocated to health is in the median range ((11%)) as a % of is low ((2%)) % 1 15% 2 25% 2% 6% 28 WHO African Region Expenditure Atlas

30 HEALTH SYSTEM FINANCING COUNTRY PROFILE: Gabon, 12 Gabon spent 648 million US$ 99% 1% - $397 per capita Spending by - 41% spent by 41% 51% 7% Gabon: Gabon: $11,431/capita 62 years 12 average of up-mid AFR income AFR up-mid income AFR up-mid income 5 Gov ernment expenditure on health countries: $6,42/capita countries: 63 years 45 health $ $351 Gabon: 26 per AFR up-mid income countries: 258 per 1, live births $18 $145 $247 $48 6% 2% expenditure () % Algeria Namibia Namibia Seychelles South Africa Algeria Among up-mid AFR countries: Angola Seychelles Seychelles Total government expenditure is low as a % of ((25%)) Botswana Mauritius South Africa Namibia South Africa Algeria Botswana Botswana Mauritius allocated to health is low ((7%)) Gabon Mauritius Gabon Angola Angola Gabon as a % of is low ((2%)) % 1 15% 2% 6% WHO African Region Expenditure Atlas 29

31 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 46 million US$ 51% 49% - $26 per capita Spending by - spent by 66% 1 : : $512/capita 6 years 12 average of low AFR income 35 Gov ernment expenditure on health countries: $527/capita countries: 54 years health 3 25 $27 $31 : 4 per $18 countries: 655 per $4 $13 $12 11% 5% expenditure () % Among low AFR countries: Total government expenditure is high as a % of ((29%)) allocated to health is in the median range ((11%)) as a % of is high ((3%)) % 1 15% 2 25% 2% 6% 3 WHO African Region Expenditure Atlas

32 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 2.1 billion US$ 89% 11% - $83 per capita Spending by - 29% spent by 29% 57% 1 : : $1,65/capita 6 years 12 average of low-mid AFR income 9 Gov ernment expenditure on health countries: $1,482/capita countries: 56 years $86 8 health $ : 35 per 5 $47 $48 4 countries: 483 per 1, live births 3 $23 $ % expenditure () % Among low-mid AFR countries: Total government expenditure is in the median range as a % of ((3)) ia ia allocated to health is in the median range ((1)) ia as a % of is in the medain range ((3%)) % 1 15% 2 25% 2% 6% 1 WHO African Region Expenditure Atlas 31

33 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 367 million US$ $32 per capita Spending by - 67% spent by 67% 2 5% : : $58/capita 52 years 12 average of low AFR income 35 Gov ernment expenditure on health countries: $527/capita countries: 54 years health 3 $28 25 $31 : 68 per $19 countries: 655 per $8 $13 $12 11% 5% expenditure () % Among low AFR countries: Total government expenditure is in the median range as a % of ((26%)) allocated to health is low ((7%)) as a % of is low ((2%)) % 1 15% 2 25% 2% 6% 32 WHO African Region Expenditure Atlas

34 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 5 million US$ 66% 3 - $3 per capita Spending by - 43% spent by 43% 23% 3 : : $57/capita 49 years 12 average of low AFR income 8 Gov ernment expenditure on health countries: $527/capita countries: 54 years 7 health 6 : 1, per 5 4 countries: 655 per 3 1 $29 $12 $7 $31 $12 $13 12% 1 6% 2% expenditure () % Among low AFR countries: Total government expenditure is low as a % of ((17%)) allocated to health is low (()) as a % of is low ((1%)) % 1 15% 2 25% 2% 6% WHO African Region Expenditure Atlas 33

35 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 1.9 billion US$ 5 42% - $45 per capita Spending by - 4 spent by : : $94/capita 6 years 12 average of low AFR income 4 Gov ernment expenditure on health countries: $527/capita countries: 54 years $39 health 35 3 : 53 per 25 $31 countries: 655 per 15 1 $18 $15 $13 $12 12% 1 6% 2% expenditure () % Among low AFR countries: Total government expenditure is high as a % of ((31%)) allocated to health is low ((6%)) as a % of is low ((2%)) % 1 15% 2 25% 2% 6% 34 WHO African Region Expenditure Atlas

36 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 283 million US$ $138 per capita Spending by - 15% spent by 15% 79% 7% : : $1,193/capita 48 years 12 average of low-mid AFR income 14 Gov ernment expenditure on health countries: $1,482/capita countries: 56 years $134 health 1 1 $15 : 53 per 8 $86 countries: 483 per 1, live births 6 4 $ $48 $33 12% expenditure () % Among low-mid AFR countries: Total government expenditure is high as a % of ((63%)) ia allocated to health is high ((1)) ia ia as a % of is high ((9%)) % 1 15% 2 25% 2% 6% 1 WHO African Region Expenditure Atlas 35

37 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 274 million US$ 65% 35% - $65 per capita Spending by - 21% spent by 21% 3 49% : : $422/capita 56 years 12 average of low AFR income 6 Gov ernment expenditure on health countries: $527/capita countries: 54 years $58 health 5 4 : 99 per 3 $31 countries: 655 per 1 $17 $12 $12 $ % expenditure () % Among low AFR countries: Total government expenditure is in the median range as a % of ((2)) allocated to health is high ((19%)) as a % of is high ((5%)) % 1 15% 2 25% 2% 6% 36 WHO African Region Expenditure Atlas

38 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 46 million US$ 79% 21% - $18 per capita Spending by - 31% spent by 31% 61% : : $443/capita 65 years 12 average of low AFR income 35 Gov ernment expenditure on health countries: $527/capita countries: 54 years health 3 $31 25 : 44 per countries: 655 per $17 $1 $5 $13 $12 12% expenditure () % Among low AFR countries: Total government expenditure is low as a % of ((2)) allocated to health is high ((13%)) as a % of is in the medain range ((2%)) % 1 15% 2 25% 2% 6% WHO African Region Expenditure Atlas 37

39 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 39 million US$ 46% 5 - $25 per capita Spending by - 13% spent by 13% 77% 11% : : $268/capita 47 years 12 average of low AFR income 35 Gov ernment expenditure on health countries: $527/capita countries: 54 years $33 health 3 $31 25 $25 : 51 per countries: 655 per $4 $13 $ % expenditure () % Among low AFR countries: Total government expenditure is high as a % of ((39%)) allocated to health is high ((1)) as a % of is high ((7%)) % 1 15% 2 25% 2% 6% 38 WHO African Region Expenditure Atlas

40 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 626 million US$ 69% 31% - $42 per capita Spending by - 61% spent by 61% 39% : : $724/capita 53 years 12 average of low AFR income 5 Gov ernment expenditure on health countries: $527/capita countries: 54 years 45 health : 83 per countries: 655 per $39 $24 $15 $31 $12 $ % expenditure () % Among low AFR countries: Total government expenditure is low as a % of ((1)) allocated to health is high ((13%)) as a % of is in the medain range ((2%)) % 1 15% 2 25% 2% 6% WHO African Region Expenditure Atlas 39

41 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 196 million US$ 92% - $52 per capita Spending by - 3 spent by 3 6 2% : : $89/capita 58 years 12 average of low-mid AFR income 9 Gov ernment expenditure on health countries: $1,482/capita countries: 56 years $86 8 health 7 6 : 55 per 5 $51 $48 4 countries: 483 per 1, live births 3 $32 $17 $ % expenditure () % Among low-mid AFR countries: Total government expenditure is high as a % of ((41%)) ia allocated to health is high ((1)) ia ia as a % of is high (()) % 1 15% 2 25% 2% 6% 1 4 WHO African Region Expenditure Atlas

42 HEALTH SYSTEM FINANCING COUNTRY PROFILE: Mauritius, 12 Mauritius spent 551 million US$ 1 - $444 per capita Spending by - 47% spent by 47% 49% Mauritius: Mauritius: $9,238/capita 73 years 12 average of up-mid AFR income AFR up-mid income AFR up-mid income 45 Gov ernment expenditure on health countries: $6,42/capita countries: 63 years $433 4 health $44 Mauritius: 36 per AFR up-mid income countries: 258 per 1, live births $189 $198 $247 $48 12% 1 6% 2% expenditure () % Algeria Namibia Namibia Seychelles South Africa Algeria Among up-mid AFR countries: Angola Seychelles Seychelles Total government expenditure is low as a % of ((23%)) Botswana Mauritius South Africa Namibia South Africa Algeria Botswana Botswana Mauritius allocated to health is in the median range ((1)) Gabon Mauritius Gabon Angola Angola Gabon as a % of is low ((2%)) % 1 15% 2% 6% WHO African Region Expenditure Atlas 41

43 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 937 million US$ 4 56% - $37 per capita Spending by - 5% spent by 5% 4 51% : : $579/capita 49 years 12 average of low AFR income 35 Gov ernment expenditure on health countries: $527/capita countries: 54 years health 3 25 $27 $31 : 55 per countries: 655 per $12 $13 $12 $1 2 12% expenditure () % Among low AFR countries: Total government expenditure is high as a % of ((32%)) allocated to health is low ((9%)) as a % of is in the medain range ((3%)) % 1 15% 2 25% 2% 6% 42 WHO African Region Expenditure Atlas

44 HEALTH SYSTEM FINANCING COUNTRY PROFILE: Namibia, 12 Namibia spent 1.1 billion US$ 92% - $473 per capita Spending by - 7% spent by 7% 62% 31% Namibia: Namibia: $5,668/capita 57 years 12 average of up-mid AFR income AFR up-mid income AFR up-mid income 5 Gov ernment expenditure on health countries: $6,42/capita countries: 63 years 45 health $445 $ Namibia: 18 per AFR up-mid income countries: 258 per 1, live births $274 $3 $247 $48 12% expenditure () % Algeria Namibia Namibia Seychelles South Africa Algeria Among up-mid AFR countries: Angola Botswana Seychelles Mauritius Seychelles South Africa Total government expenditure is in the median range as a % of ((37%)) Namibia South Africa Algeria Botswana Botswana Mauritius allocated to health is high ((1)) Gabon Mauritius Gabon Angola Angola Gabon as a % of is high ((5%)) % 1 15% 2% 6% WHO African Region Expenditure Atlas 43

45 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 437 million US$ $25 per capita Spending by - 53% spent by 53% 4 7% : : $356/capita 57 years 12 average of low AFR income 35 Gov ernment expenditure on health countries: $527/capita countries: 54 years health 3 $31 : 8 per 25 $24 countries: 655 per $13 $9 $13 $ % expenditure () % Among low AFR countries: Total government expenditure is in the median range as a % of ((2)) allocated to health is in the median range ((1)) as a % of is in the medain range ((3%)) % 1 15% 2 25% 2% 6% 44 WHO African Region Expenditure Atlas

46 HEALTH SYSTEM FINANCING COUNTRY PROFILE: ia, 12 ia spent 16 billion US$ 95% 5% - $94 per capita Spending by - 66% spent by 66% 31% 3% ia: ia: $1,555/capita 54 years 12 average of low-mid AFR income 1 Gov ernment expenditure on health countries: $1,482/capita countries: 56 years $94 9 health $ ia: 84 per countries: 483 per 1, live births $62 $29 $48 $33 1 6% 2% expenditure () % Among low-mid AFR countries: Total government expenditure is in the median range as a % of ((2)) ia allocated to health is low ((7%)) ia ia as a % of is low ((2%)) % 1 15% 2 25% 2% 6% 1 WHO African Region Expenditure Atlas 45

47 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 757 million US$ 53% 47% - $66 per capita Spending by - 21% spent by 21% 57% 22% : : $6/capita 59 years 12 average of low AFR income 7 Gov ernment expenditure on health countries: $527/capita countries: 54 years health 6 $61 5 : 54 per 4 3 $35 $31 countries: 655 per 1 $13 $12 $13 25% 2 15% 1 5% expenditure () % Among low AFR countries: Total government expenditure is in the median range as a % of ((2)) allocated to health is high ((22%)) as a % of is high ((6%)) % 1 15% 2 25% 2% 6% 46 WHO African Region Expenditure Atlas

48 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 21 million US$ 57% 43% - $19 per capita Spending by - 52% spent by 52% 32% 17% Sao Tome and Principe: Sao Tome and Principe: $1,386/capita 68 years 12 average of low-mid AFR income 14 Gov ernment expenditure on health countries: $1,482/capita countries: 56 years health 1 $11 1 : per countries: 483 per 1, live births $57 $35 $86 $48 $33 11% 5% expenditure () % Among low-mid AFR countries: Total government expenditure is high as a % of ((45%)) ia allocated to health is low ((6%)) ia ia as a % of is in the medain range ((2%)) % 1 15% 2 25% 2% 6% 1 WHO African Region Expenditure Atlas 47

49 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 73 million US$ 81% 19% - $51 per capita Spending by - 3 spent by 3 56% 1 : : $1,32/capita 62 years 12 average of low-mid AFR income 9 Gov ernment expenditure on health countries: $1,482/capita countries: 56 years $86 8 health : 41 per countries: 483 per 1, live births $49 $28 $17 $48 $33 11% 5% expenditure () % Among low-mid AFR countries: Total government expenditure is in the median range as a % of ((29%)) ia ia allocated to health is in the median range ((1)) ia as a % of is in the medain range ((3%)) % 1 15% 2 25% 2% 6% 1 48 WHO African Region Expenditure Atlas

50 HEALTH SYSTEM FINANCING COUNTRY PROFILE: Seychelles, 12 Seychelles spent 48 million US$ 92% - $521 per capita Spending by - 2% spent by 2% 93% Seychelles: Seychelles: $11,178/capita 73 years 12 average of up-mid AFR income AFR up-mid income AFR up-mid income 6 Gov ernment expenditure on health countries: $6,42/capita countries: 63 years Seychelles: per AFR up-mid income countries: 258 per 1, live births health $531 $495 $13 $433 $247 $48 11% 5% expenditure () % Algeria Namibia Namibia Seychelles South Africa Algeria Among up-mid AFR countries: Angola Seychelles Seychelles Total government expenditure is high as a % of ((4)) Botswana Mauritius South Africa Namibia South Africa Algeria Botswana Botswana Mauritius allocated to health is high ((11%)) Gabon Mauritius Gabon Angola Angola Gabon as a % of is high (()) % 1 15% 2% 6% WHO African Region Expenditure Atlas 49

51 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 572 million US$ 87% 13% - $96 per capita Spending by - 76% spent by 76% 17% 7% : : $635/capita 49 years 12 average of low AFR income 9 Gov ernment expenditure on health countries: $527/capita countries: 54 years 8 health $79 : 97 per countries: 655 per $6 $13 $31 $12 $13 12% expenditure () % Among low AFR countries: Total government expenditure is low as a % of ((2)) allocated to health is in the median range ((12%)) as a % of is in the medain range ((2%)) % 1 15% 2 25% 2% 6% 5 WHO African Region Expenditure Atlas

52 HEALTH SYSTEM FINANCING COUNTRY PROFILE: South Africa, 12 South Africa spent 34 billion US$ 9 2% - $645 per capita Spending by - 7% spent by 7% 4 45% South Africa: South Africa: $7,336/capita 54 years 12 average of up-mid AFR income AFR up-mid income AFR up-mid income 7 Gov ernment expenditure on health countries: $6,42/capita countries: 63 years $646 health 6 5 South Africa: 41 per AFR up-mid income countries: 258 per 1, live births $31 $46 $433 $247 $48 11% 5% expenditure () % Algeria Namibia Namibia Seychelles South Africa Algeria Among up-mid AFR countries: Angola Seychelles Seychelles Total government expenditure is low as a % of ((33%)) Botswana Mauritius South Africa Namibia South Africa Algeria Botswana Botswana Mauritius allocated to health is high ((13%)) Gabon Mauritius Gabon Angola Angola Gabon as a % of is in the medain range (()) % 1 15% 2% 6% WHO African Region Expenditure Atlas 51

53 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 297 million US$ $27 per capita Spending by - 57% spent by 57% 39% 5% : : $1,74/capita years 12 average of low-mid AFR income 9 Gov ernment expenditure on health countries: $1,482/capita countries: 56 years $86 8 health : per countries: 483 per 1, live births $48 $33 $ 5% 3% 2% 1% expenditure () % Among low-mid AFR countries: Total government expenditure is low as a % of ((25%)) ia allocated to health is low (()) ia ia as a % of is low ((1%)) % 1 15% 2 25% 2% 6% 1 52 WHO African Region Expenditure Atlas

54 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 319 million US$ 7 22% - $259 per capita Spending by - 11% spent by 11% 7 15% : : $3,42/capita 49 years 12 average of low-mid AFR income 3 Gov ernment expenditure on health countries: $1,482/capita countries: 56 years health 25 $253 $187 : 4 per 15 countries: 483 per 1, live births 1 5 $28 $86 $48 $ % expenditure () % Among low-mid AFR countries: Total government expenditure is in the median range as a % of ((35%)) ia allocated to health is high ((1)) ia ia as a % of is high ((6%)) % 1 15% 2 25% 2% 6% 1 WHO African Region Expenditure Atlas 53

55 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 271 million US$ 82% 1 - $41 per capita Spending by - 41% spent by 41% 51% 7% : : $472/capita 59 years 12 average of low AFR income 4 Gov ernment expenditure on health countries: $527/capita countries: 54 years $38 35 health 3 $31 25 : 35 per $19 countries: 655 per 15 1 $15 $13 $ % expenditure () % Among low AFR countries: Total government expenditure is high as a % of ((29%)) allocated to health is high ((15%)) as a % of is high (()) % 1 15% 2 25% 2% 6% 54 WHO African Region Expenditure Atlas

56 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 1.6 billion US$ 71% 29% - $44 per capita Spending by - 49% spent by 49% 2 27% : : $547/capita 52 years 12 average of low AFR income 5 Gov ernment expenditure on health countries: $527/capita countries: 54 years 45 health : 43 per $39 $31 countries: 655 per 15 1 $19 $9 $12 $ % 5% expenditure () % Among low AFR countries: Total government expenditure is low as a % of ((19%)) allocated to health is in the median range ((1)) as a % of is in the medain range ((2%)) % 1 15% 2 25% 2% 6% WHO African Region Expenditure Atlas 55

57 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 United Republic of Tanzania spent 2. billion US$ 62% 3 - $41 per capita Spending by - 32% spent by 32% 39% 29% United Republic of Tanzania: United Republic of Tanzania: $591/capita 55 years 12 average of low AFR income 4 Gov ernment expenditure on health countries: $527/capita countries: 54 years $38 35 health 3 $31 25 United Republic of Tanzania: 79 per countries: 655 per 15 1 $15 $12 $13 $ % expenditure () % Among low AFR countries: Total government expenditure is in the median range as a % of ((27%)) allocated to health is in the median range ((1)) as a % of is in the medain range ((3%)) % 1 15% 2 25% 2% 6% 56 WHO African Region Expenditure Atlas

58 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent 1.4 billion US$ 6 32% - $96 per capita Spending by - 2 spent by % : : $1,469/capita 48 years 12 average of low-mid AFR income 9 Gov ernment expenditure on health countries: $1,482/capita countries: 56 years $86 $86 8 health 7 : 47 per 6 5 $55 $48 4 countries: 483 per 1, live births 3 $21 $ % expenditure () % Among low-mid AFR countries: Total government expenditure is low as a % of ((26%)) ia allocated to health is high (()) ia ia as a % of is high (()) % 1 15% 2 25% 2% 6% 1 WHO African Region Expenditure Atlas 57

59 HEALTH SYSTEM FINANCING COUNTRY PROFILE:, 12 spent billion US$ - $ per capita Spending by - spent by : : $/capita 49 years 12 average of low AFR income 32 Gov ernment expenditure on health countries: $527/capita countries: 54 years 3 health : 79 per countries: 655 per $31 $13 $ expenditure () % Among low AFR countries: Total government expenditure is low as a % of (()) allocated to health is low (()) as a % of is low (()) % 1 15% 2 25% 2% 6% 58 WHO African Region Expenditure Atlas

60 Foreword Expenditure on health is about WHO BUYS HEALTH CARE. Households are the main private sector actor. private sector actors include non-profit institutions, private insurances, and enterprises. Expenditures on health are financed by domestic resources (government funds and private sector funds), and by funding from abroad (external resources). This is about WHO FUNDS HEALTH CARE. is the sum of resources made available by all non-resident institutional units, which are used for payments of health goods and services. PER CAPITA EXPENDITURE IN US$ (constant 1 US$) illustrates the trends on spending per person in constant US$, since 1995, in total expenditure on health, and for two purchasers of health care, government 1 and. The trends are adjusted to only show the real change in expenditure, and correct for fluctuations due to inflation (data is in constant 1 US$). The last year of the series can be compared to the average value, for that year, of expenditures on health by countries belonging to the same geographical 2 and income 3 group as the selected country (square marks). GOVERNMENT RESOURCES ALLOCATED TO HEALTH highlights efforts by government 4 to allocate resources to health as compared to their total spending envelope. Two trends are shown: allocation of total expenditure going to health (blue line) and allocation of expenditure only funded out of domestic resources - before receiving aid going to health (red bars). GENERAL GOVERNMENT EXPENDITURE ON HEALTH AS SHARE (%) OF is a set of 3 graphs that describes aspects of the fiscal context of countries and situates them within their geographical 1 and income 2 group. The first graph describes government s realized capacity to spend in any given year ( expenditure % ); the second graph highlights the allocative decision by governments to spend on health ( expenditure on health % expenditure); and the third graph is the product of the first two graphs and evaluates general government expenditure on health in terms of country s income (% ). 1 Government is the sum of outlays for health maintenance, restoration or enhancement paid for in cash or supplied in kind by government entities, such as the Ministry of Health, other ministries, parastatal organizations, social security agencies (without double-counting the government transfers to social security and to extra-budgetary funds). Includes transfer payments to to offset medical care costs and extra-budgetary funds to finance health services and goods. The revenue base of these entities may comprise multiple sources, including external funds. 2 WHO regions link 3 World Bank income groups link 4 Government expenditures (total or for health) include expenditure by government entities, such as the Ministry of Health, other ministries, parastatal organizations, and social security agencies. It includes all compulsory health insurance (including private insurances that are publicly mandated and funded through compulsory contributions). WHO African Region Expenditure Atlas 59

61 Department of Health Systems Financing Health Systems Services Worl Health Organization