National Health Accounts (NHA) 2011 Report – Executive Summary

Decision makers need to know how much the entire nation is spending on health care, what goods and services are being delivered and who is paying for services. Improving evidence for health financing policy development and implementation is one of the priority areas of the Regional Strategy on Health Financing. National Health Accounts (NHA) is an internationally accepted policy tool for collecting, cataloguing and presenting financial data required for effective health policy formulation, implementation and monitoring. It aims to facilitate appropriate and effective health policy- and decision making with reliable data and information on health financing and expenditure.

The NHA is an internationally recognized framework that measures and tracks the use of total-public, private (including household), and donor- health care expenditures in a country. It does so by offering a transparent and consistent way of describing health expenditures in term of financing sources and the application of their resources. In other words, NHA track the flow of funds from one health care dimension to another, such as from Ministry of Health to each health provider and health service program. In doing so, NHA answers questions like the following:

  • Who in the country finances health services?
  • How much do they spend? On what types of services?
  • How are funds, including donors’ funds, used across different health services, interventions and activities?

The importance of NHA is well recognized in most of the international organizations, specifically the World Health Organization and the World Bank. Currently, over 100 countries in the world have established comprehensive NHA systems that meet the international standards and classifications. These countries systematically produce NHA reports for policy discussions and assessment of their health financing arrangements. NHA work in countries helped to identify the major health financing concerns such as increasing out of pocket payments in total health financing and develop country specific strategies to reduce and monitor excessive financial burden on low households. These include rural cooperative medical services (China), health care funds for the poor (Viet Nam) and indigenous health insurance programme (Philippines). In South-East Asia most countries have established the NHA and/or expressed interest in developing NHA.

As a part of NHA development, the Ministry of Health, with the technical assistance from WHO, conducted the first-ever NHA study for the Maldives. In January 7, 2013, the Ministry of Health and the World Health Organization conducted a national dissemination workshop that aims to promote further the development of NHA suited to the Maldives settings and present the finding of the NHA Survey 2011.

It was chaired by the Honorable Minister of Health and attended by 70 participants from different national and international stakeholders in the country. Observers from the World Bank, UNFPA, UNDP, UNOPS and the Government of the Maldives have also participated and contributed to the workshop discussions. The participants discussed the NHA methodology and tools used in the Maldives, lessons learned from the survey process; NHA 2011 Survey findings and health financing policy implications and options for public health within the broader national development agenda.