This is a core indicator of health financing systems.
Most indicators presented in NHA involve a measurement at the level of purchaser/payer of health services. This is, however, an indicator which refers to the origin of the resources used to purchase health services. It is the only information about the sources of funds provided in these tables. The other indicators - GGHE, PvtHE etc. - are financing agents, the entities where the use of the funds are controlled.
Some of these external sources will be channeled through the government's budget, some through insurance agencies, some through the private or NGO sectors. As such, these funds cannot simply be added to those reported in the earlier breakdowns.
In the special case where external agencies act as domestic NGOs in providing or purchasing health care in a recipient country, they would be included as financing agents as well as a source. We provide here only the source level measurement.
The analysis of financing sources contributes to identify the distribution of the financing burden of health services. This indicator contributes to assess sustainability of financing.
Definition:
External resources for health expressed as a percentage of total expenditure on health.
Method of measurement
National health accounts (NHA) indicators are based on expenditure information collected within an internationally recognized framework.
This indicator traces the financing flows from external sources who provide the funds to public and private financing agents. It includes in kind and in cash resources provided as loans and grants.
NHA strategy is to track records of transactions, without double counting and in order to reaching a comprehensive coverage. These resources are accounted for in the same period and amount when they are used by the financing agent. Loans are treated to be accounted only once.
External funds are valued at recipients' market value
Monetary and non monetary transactions are accounted for at purchasers value.
Guides to producing national health accounts exist. (OECD, 2000; WHO-World Bank-USAID, 2003).
M&E Framework:
Input
Method of estimation:
Care needs to be taken in interpreting external resource figures. Most are taken from the OECD DAC/CRS database except where a reliable full national health account study has been done. They are disbursements to recipient countries as reported by donors, lagged one year to account for the delay between disbursement and expenditure. Before 2002, disbursement data is not available and commitments are used. In countries where the fiscal year begins in July, expenditure data have been allocated to the later calendar year (for example, 2008 data will cover the fiscal year 200708), unless otherwise stated for the country.
These data are generated from sources that WHO has been collecting for over ten years. The most comprehensive and consistent data on health financing is generated from national health accounts. Not all countries have or update national health accounts and in these instances, data is obtained through technical contacts in-country or from publicly-available documents and reports and harmonized to the NHA framework. Missing values are estimated using various accounting techniques depending on the data available for each country.
The preferred data sources are NHA reports, OECD-DAC, reports by International funding agencies such as Global Fund.
Other possible data sources include country reports on external sources by institution or from MoF.
WHO sends estimates to the respective Ministries of Health every year for validation.
Method of estimation of global and regional aggregates:
Sum of general government expenditure on health for all countries divided by sum of total government expenditure for all countries by relevant group. WHO region, income-group and global expenditure estimates are calculated using absolute amounts in national currency units converted to Purchasing Power Parity (PPP) equivalents unless otherwise noted. Regions are based on WHO regions, income groups on the World Bank classification and the global aggregate based on all WHO Member States.
Other possible data sources:
Administrative reporting systems
Preferred data sources:
National Health Accounts
Unit of Measure:
N/A
Expected frequency of data dissemination:
Annual
Expected frequency of data collection:
Annual
Comments:
When the number is smaller than 0.05% the percentage may appear as zero.
Financing sources involve a separate level of measurement to the previous indicators reported here, thus, this indicator cannot be added to those expressed as financing agents, providers or health goods and services.
External resources are at this time the only source reported by WHO, thus it does not reflect the total origin of the THE.
Frequent valuation at recipient country may differ to the valuation by the country providing the funds.
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