Guide To Producing Reproductive Health Subaccounts within the National Health Accounts Framework


In September 2000, the countries of the world adopted the Millennium Declaration, a collective commitment to accelerate progress on human development, setting out eight Millennium Development Goals, which they pledged to achieve by 2015. It has been widely acknowledged that these goals can only be reached if there are significant improvements in reproductive health (RH), especially in the poorest developing countries. Most families in these countries still havemore children than they want. Women especially suffer from the lack of means to control their fertility, and many die young from causes related to maternal health.

Halfway to 2015, a number of countries have been identified as not being on track to meet the MDGs. National and international organizations are asking how efforts to achieve the MDGs and related targets can be made more effective. One way is to improve understanding and management of competing financial resources for health. Decision-makers need to know whether their country has sufficient resources to achieve its health goals. If there is a funding gap, can external resources fill it? And where are the resources going? In particular, what resources are earmarked for RH?

Often, governments do not have the technical instruments they need to plan budgets that would allow them to achieve their RH goals. Civil society also lacks information about where money is going, and is thus unable to lobby successfully for national and international funds to fill the gaps. The challenge is, thus, to obtain information that will lead to more effective use of the resources available. Considerable value would be added if resource monitoring were done in a comprehensive and consistent way, with standard definitions that allow for internationally comparable time trends.

The national health accounts (N.H.A.) methodology is an internationally accepted tool that provides a comprehensive estimate of all national health expenditures. An NHA subaccount is a more detailed reporting of spending levels and patterns for a particular component of health care, such as RH services. Subaccounts report expenditures in accordance with the NHA framework but with a focus on specific relevant categories. In the case of RH subaccounts, this includes the main RH activities, such as antenatal care, delivery, family planning and other RH services. The RH subaccount provides an overview of the financing flows in the RH programme, highlighting the origin of the resources, the pooling and purchasing mechanisms, the resources used by the RH providers and the services consumed by the population.

RH subaccount results can be used in various ways to inform RH policy and programming. Because the subaccount methodology uses the internationally recognized NHA framework, its findings can be compared across countries. If a country prepares estimations for a number of years, the results can be used to track trends in expenditure, to monitor patterns of resource use over time, and to evaluate how resource use relates to the achievement of RH programme goals. Current expenditure data can be compared with projections of funds required to address reproductive mortality and morbidity, in order to inform financing strategies.

This guide has benefited from the participation and contributions of numerous RH and NHA experts, and from experiences with use of the methodology in three countries. Particular efforts have been made to ensure that it is consistent with existing WHO guidelines on producing national health accounts.Intended for both NHA country experts and novices, this guide aims to help countries obtain a clearer picture of resource flows in reproductive health programmes through regular estimations that can inform the policy process.

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