Transcript Institutionalisation of NHA in ECSA: Progress Report

Commonwealth Regional Health Community
for East, Central and Southern Africa.
3rd International NHA Conference, San Francisco
California
13-14 June 2003
Institutionalization of
National Health Accounts
in ECSA: Progress Report
`
Dr. Mark Bura
Health Systems Development Coordinator.
CRHCS.
1
First version of this paper was
presented at the 36 Conference of
Commonwealth Regional Health
Ministers Conference,
Entebbe, Uganda, 18-22 November
2002
2
Milestones in Institutionalisation of
NHA in ECSA
ONE
Popularisation of NHA by WHO, Harvard School of
Public Health from mid-nineties to date
6
TWO
Ten ECSA Countries bold enough to
undertake first NHA
 Kenya, Uganda, Tanzania, Malawi, Zambia,
 Mozambique, Zimbabwe, South Africa, Ethiopia
and Rwanda undertook their first NHA between
1995-2000
7
THREE
CRHCS/ECSA arrives
on the NHA scene.

November 2000: CRHCS established Health Care
Financing Programme
March 2001: trained CHF Coordinator in NHA
with USAID/REDSO support
April 2001 : ECSA/Health Care Financing Expert
Committee met first time and drafted a HCF
Strategic Plan in which NHA is included as major
activity over 4 years.
8
Training of core Regional and
national NHA promotersVERMONT
FOUR
NHA ECSA Network and Health
Ministers Resolution to
Institutionalise NHA.
 April 2001: NHA ECSA Network coordination
taken over by CRHCS
 September 2001: First ECSA NHA Executive
Sensitisation Workshop for Permanent
Secretaries MoH and Directors held in
Mombasa. They endorse NHA
FOUR CONT.
NHA ECSA Network and Health
Ministers Resolution to
Institutionalise NHA.
November 2001:
34th Regional Health Ministers Conference
makes a resolution to Institutionalise
11
ECSA Regional Training Courses
on NHA by CRHCS, WHO, SIDA,
USAID/REDSO, PHRplus etc.
NHA Country and CRHCS Activities
 November 2001: 1st ECSA NHA Regional
Training Workshop coordinated by CRHCS in
collaboration with USAID/REDSO and PHR plustook place in Lusaka Zambia.
 November 2001: Mauritius NHA process
launched with support of CRHCS in
collaboration with USAID/REDSO and PHR.
13
NHA Country and CRHCS Activities
cont.
 August 2002: Seychelles invited CRHCS to
launching of NHA process to date Seychelles
has established an NHA steering and working
committees
14
Partnership and collaboration
is good for NHA
CRHC forges Collaboration with
Partners and Donors
 June 2002: A Joint Donor Meeting to mobilize
resources for NHA in Sub-Saharan Africa took
place in Nairobi–CRHCS played a major role in
coordination and drafting the NHA Strategy in
Africa.
 November 2002: 2nd ECSA NHA Regional
Training Workshop was conducted by CRHCS
and WHO in Mutare Zimbabwe.
16
ECSA Countries are moving
fast with NHA Analysis.
2003:
 Zimbabwe, Kenya, Uganda, Tanzania and
Ethiopia are currently working on their 2nd NHA
analyses.
17
The Challenge of Training
NHA analysis in ECSA
 At this point in time NHA is a new concept in
Sub-Saharan Africa and other developing
countries in the World.
 None of the Sub-Saharan countries has
adequate expertise in NHA.
 WHO, Harvard School of Public Health
(Peter Berman and others) and PHRplus/Abt
Associates are the main fountain of
knowledge and skills in NHA currently
 CRHCS and WHO AFRO feels confident to
run and conduct NHA with just little technical
support from partners and donors. 18
The Challenge of Training
NHA analysis in ECSA cont.
 To date ECSA have collectively trained only
about 110, one to two weeks workshop
trainees. Of these trainees 95 are from 11
active CRHC member countries.
 A one month training course could be a basic
requirement for NHA analysis.
 A two week further training might be required
for focus on data collection and analysis –6-8
weeks course would be required to qualify as
an NHA practitioner
19
NHA Training in ECSA
TOTAL
Seychelles
Mauritius
Lesotho
Swaziland
Zimbabwe
Mozambique
Zambia
Malawi
Tanzania
Uganda
Kenya
95
2
6
0
7
12
10
12
12 13 17 8
One-two
week
workshop
attendances
Indicators:
Institutionalization of NHA in ECSACountry Activities
Seychelles
Mauritius
Swaziland
Lesotho
Zimbabwe
Mozambique
Zambia
Uganda
Malawi
Tanzania
Kenya
Decision to
start NHA
YES
YES
YES
?
YES
?
YES
YES
?
YES
YES
Committee
in place
YES
YES
YES
?
YES
YES
YES
YES
?
YES
YES
No of NHA
committee
meetings
8
3
3
?
8
3
>8
>4
?
6
2?
Indicators: Institutionalization of NHA in
ECSA cont.-Country Activities
17
Status of 1st
NHA analysis
DONE
DONE
DONE
DONE
Status of 2nd
NHA
03
03
03
03
Seychelles
13
Mauritius
12
Lesotho
Training: No
attending 1-2
week
workshops
Swaziland
YES
Zimbabwe
YES
Mozambique
YES
Zambia
YES
Malawi
ETHIOPIA
Tanzania
Uganda
Kenya
Resource
Mobilisation
YES
YES
?
?
YE
S
?
?
?
8
12
10
12
7
0
6
2
DONE
DONE
DONE
DONE
03
?
03
03
03
NHA Financing and
Collaboration in ECSA
Collaborators
+++
Training
resources
++
++++
+++
?
?
?
+
++
YES
YES
YES
YES
YES
YES
YES
Joint
meetings
+++
+
French
Cooperation
+++
YES
+
NORAD
++
YES
+
CIDA
+++
YES
Financial
resources
DANIDA
+++
YES
+++
DFID
++
YES
YES
YES
YES
YES
Technical
resources
EU
SIDA
WB/WBI
SARA/AED
WHO
PHRplus
USAID
Country
based
+
Policy Impact of NHA use in ECSA
 Though the results of 1st NHA analysis in ECSA




were received with mixed feeling, a few ECSA
countries have already put to use the outcome .
Kenya has decided to undertake 2nd NHA in order to
come up with more realistic estimates especially on
Household Expenditures
Tanzania used NHA results to reinforce coordination
of external resources and increase its attention of the
private sector.
Zambia confirmed the importance of the private
sectors and efforts are made to integrate both
sectors
Zambia is using NHA to improve allocate efficiency
particularly allocating more resources to preventive
services.
24
Conclusions
 NHA has been received by Policy makers in
ECSA and there is a strong political will to use
NHA as policy tool
 Member States and Donors are building up
efforts to institutionalize NHA
 Despite a strong political will there is a
challenging technical and resource gap
 There is a window opportunity for both MS
and Donors to leverage their efforts to
institutionalize and sustain of NHA in ECSA.
25
Thank You