Transcript Presentation Title

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):
$54/person to meet health MDGs
 Abuja target (2001): 15% of government spending
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Burundi
DRC
Liberia
Guinea-Bissau
Ethiopia
Gambia
Malawi
Sierra Leone
Eritrea
Rwanda
Niger
Uganda
Tanzania
Togo
Madagascar
CAR
Mozambique
Guinea
Burkina Faso
Mali
Lesotho
Chad
Ghana
Benin
Nigeria
Kenya
Senegal
Zambia
Mauritania
Côte d'Ivoire
Cameroon
Sudan
Zimbabwe
Congo
Swaziland
Namibia
Angola
Mauritius
Gabon
Botswana
Health expenditure ($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
$1000+
Country, sorted by per capita GDP in 2007
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Burundi
DRC
Liberia
Guinea-Bissau
Ethiopia
Gambia
Malawi
Sierra Leone
Eritrea
Rwanda
Niger
Uganda
Tanzania
Togo
Madagascar
CAR
Mozambique
Guinea
Burkina Faso
Mali
Lesotho
Chad
Ghana
Benin
Nigeria
Kenya
Senegal
Zambia
Mauritania
Côte d'Ivoire
Cameroon
Sudan
Zimbabwe
Congo
Swaziland
Namibia
Angola
Mauritius
Gabon
Botswana
Health expenditure ($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
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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
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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
$2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Year
Sources: WHO statistics, IMF World Economic Outlook database, and authors' calculations. Excludes S. Africa and countries with pop. < 1
million.
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Adding in spending from households and other
private sources
FIGURE 4. PROJECTED AVERAGE PER CAPITA GOVERNMENT AND PRIVATE SPENDING
ON HEALTH (US$), 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.
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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
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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
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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
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


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
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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