WHO Health Resource Tracking

Platform
WHO/OECD/Eurostat collaboration
on the implementation of SHA 2011

Veneta Cherilova
World Health Organization
cherilovav@who.int
TAIEX - Workshop on Development of Health Accounts
1| November 2014
 WHO/OECD/Eurostat collaboration on the
implementation of SHA 2011
Global standard System of Health Accounts 2011 (SHA
2011), WHO/OECD/Eurostat
International Health Accounts Team (IHAT)
Health accounts indicators, methodological issues, developing
of implementation guidelines (financing, disease distribution,
capital, prevention)
OECD/WHO collaboration – health accounts networks
(WPRO and PAHO)
Collection of data – Joint questionnaires (EU, OECD)
GHED – Global Health Expenditure Database
http://who.int/health-accounts/ghed/en/

TAIEX - Workshop on Development of Health Accounts

2| November 2014
 High-level agreement on an
integrated resource tracking process
• Last February, WHO convened disease specific partners and
funders from UNAIDS and UNFPA, to Global Fund, GAVI,
Gates Foundation and WB, including WHO disease
departments
• Agreement to integrate all resource tracking work to
strengthen quality of results and rationalize costs
• Health accounts becomes the platform for tracking
disease/condition expenditures
– agreement extended to other finance tracking work

• Health accounts results become a public good

TAIEX - Workshop on Development of Health Accounts

3| November 2014
 New generation of health accounting
BEFORE NOW
•Health accounting (SHA 1.0) • Health Accounting (SHA 2011) - more
disaggregated data and policy analysis
•Project approach • Routine production
Time (T-2 or more) Time-1
"rounds“ Time trend analysis
Production Technical Technical Assistance with focus on
Assistance (TA) capacity building & institutionalization
• NHA launch and report • Annual Health Sector review and
report including health expenditures
• General Health Accounts + • Health accounts + Full distribution by
Disease Subaccounts all diseases
• User-defined excel sheets • Integrated health resource tracking
platform

TAIEX - Workshop on Development of Health Accounts

4| November 2014
 AIM OF THE WHO PLATFORM
 yearly health accounts production
– standard methodology (SHA 2011), including disease distribution
– two connected tools (to produce & to analyse)
– data is used for annual reviews and budget planning processes

 advantages
– better data quality (limited human manipulation)
– consistent & harmonized data: across time & countries; by
disease

TAIEX - Workshop on Development of Health Accounts

5| November 2014
WHO health resource tracking platform
Data use Demand
(HAAT) (HS reviews)

PROCESSED OWNERSHIP
RESULTS

OBJECTIVE:
Yearly detailed SHA 2011
(with exp. by disease)
year-1

Transparency Data collection

(metadata) and Data coding
(HAPT)

INSTITUTIONAL AUTOMATION
MEMORY
TAIEX - Workshop on Development of Health Accounts (& QCs)
6| November 2014
 PRODUCTION TOOL (HAPT)
HAPT offers an organized & sustainable tracking system
 built in SHA 2011 classifications
– countries can adjust as long as they remain within the framework
– expenditure by disease is now part of health accounts: specific and aggregate
data fit together

 systematic approach
– from setting up the accounts to collecting the data and mapping it, HAPT frames
the production and ensures consistency across the years; high user-friendliness

 sustainable approach (eliminates redundant steps)

– replication of health accounts studies (stability over time)
– memorization of mapping between national records coding to SHA 2011 coding
=> allows for automatic mapping next years

TAIEX - Workshop on Development of Health Accounts

7| November 2014
 BETTER HEALTH ACCOUNTS
 With HAPT, country teams can produce health accounts
faster (aim is 20% of a full time equivalent person, i.e.,
2.5 months)
 produce health accounts every year (y-1 possibly provisional)
• yearly reporting improves results (the routine of the production
strengthens capacities and knowledge)
• as record data is coded quickly, the team can focus on more
difficult estimates (e.g., NGOs one year; factors of provision
following year; etc.)
• shifts efforts from collecting and reporting the data to using the
data for national purposes

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8| November 2014
 AUTOMATION OF THE PROCESS
1. The tool keeps in memory the mapping between national
records codes and SHA 2011 codes:
 the tool uses its memory to map future years’ data
• e.g., MoH expenditure reports: use the budget codes, which are unique and
standard across the years, to map the 1000s of expenditure lines the first
year; following years are mapped using the first year’s coding

2. The tool offers built-in standard survey questionnaires

 questionnaires are adjusted based on each countries’ specificities
• list of data sources; adjusted classifications such as public/private hospitals
 returned questionnaires are imported into the tool, with partial
mapping (again limits human manipulation)

TAIEX - Workshop on Development of Health Accounts

9| November 2014
 TAIEX - Workshop on Development of Health Accounts
10 | November 2014
 QUALITY CHECKS
Quality checks are on-going as HA are produced
1) if the coding entered is impossible/highly unlikely (e.g.,
diabetes mellitus drugs in cancer diagnosis), the tool
blocks or warns against the combination
2) Also, a quality check module to be added :
• Qualitative evaluation of the results: warns against low or high
shares, and invites for verification (e.g., 100% of TB expenditures
are spent by households)

3) Checking and Elimination of possible double counts

TAIEX - Workshop on Development of Health Accounts

11 | November 2014
 ADDITIONAL VALIDATION
 Validate against previous years
– Conversion of old SHA 1.0 studies

 Compare to averages of regions / income level

HEALTH ACCOUNTS REPORTS

 The traditional reports are replaced with module 6 : flow
of funds chart + standard tables + metadata + QCs

TAIEX - Workshop on Development of Health Accounts

12 | November 2014
 Standard tables
( Possibility to filter by diseases )
Classification of diseases / conditions: DIS.1.1 HIV/AIDS
Health HC.6 HC.7 All HC
care HC.6.1 HC.6.2 HC.7.1
functions HC.7.1.1 HC.7.1.2 HC.7.1.3
Governanc
e, and
Information, health Governanc
education system e and
and Immunisatio and Health Monitoring Procuremen
counseling n financing system Planning & & t & supply
Preventive programme programme adm inistra administrati Managemen Evaluation managemen
Health care providers care s s tion on t (M&E) t
HP.1 Hospitals 8.25 8.25 11.92 11.92 3.58 5.96 2.38 20.17
HP.1.1 General 8.25 8.25 11.92 11.92 3.58 5.96 2.38 20.17
hospitals
HP.1.1.2 Private 4.13 4.13 5.96 5.96 1.79 2.98 1.19 10.08
Hospitals
HP.1.1.nec Other 4.13 4.13 5.96 5.96 1.79 2.98 1.19 10.08
General
hospitals
HP.6 Providers 802 457.83 802
of
preventive
care
HP.8 Rest of 363.5 363.5 363.5
econom y
HP.8.2 All other 363.5 363.5 363.5
industries
as
secondary
providers
of health
care
All HP 1,173.75 829.58 344.17 11.92 11.92 3.58 5.96 2.38 1,185.67

TAIEX - Workshop on Development of Health Accounts

13 | November 2014
 AUTOMATED METADATA REPORT
• New health accounts reports
• complete auditability = INSTITUTIONAL MEMORY
1) Classifications reported and classes used

2) Sources consulted ; how data was collected (survey or records)

3) Sources used
• # of sources used, and # of data points per source; provides a first qualitative evaluation
of the data
• “Comment” field per source (details about the source – feedback on data collection; on
the adjustments made on the data received and why; on the possible data excluded and
why)

4) Comments and description of split rules used per source

• assumptions and estimation methods used; can be shared with others for discussion
TAIEX - Workshop on Development of Health Accounts
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DISEASE EXPENDITURE TRACKING
 technically more rigorous than tracking expenditure on one
disease only: standard way to allocate shared expenditures
such as health facility expenditures where interventions are
being delivered
 ensures consistency with total health expenditure

 minimizes multiple parallel data collection initiatives at country

(labour intensive)
Þ good value for money (more technically rigorous estimates, less
costly)
This approach supports Paris, Accra, Busan Declarations on aid
effectiveness

TAIEX - Workshop on Development of Health Accounts

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 DISEASE CLASSIFICATION
Infectious and parasitic diseases
HIV/AIDS
Tuberculosis
Malaria
Respiratory infections
Diarrheal diseases
Neglected tropical diseases
Vaccine preventable diseases
Other infectious and parasitic diseases (n.e.c.)
Reproductive health
Maternal conditions
Perinatal conditions
Contraceptive management (family planning)
Other reproductive health conditions (n.e.c.)
Nutritional deficiencies
Noncommunicable diseases
Neoplasms
Endocrine disorders
Cardiovascular diseases
Mental disorders
Other noncommunicable diseases (n.e.c.)
Injuries
Non-disease specific
Other diseases / conditions (n.e.c.)

TAIEX - Workshop on Development of Health Accounts

16 | November 2014
 ANALYSIS TOOL (HAAT)

1. Collates health expenditure data of different

years for time trend analysis
– connected production and analysis tools : quickly able to analyse
results

2. Can upload non health expenditure data

– brings health expenditure and non health expenditure together
into the analysis:
• helps position health expenditure in terms of macroeconomic information
(%GDP; %GGE)
• helps analyse health expenditure with health outcomes (e.g., TB expenditure
per new TB cases)

TAIEX - Workshop on Development of Health Accounts

17 | November 2014
 HAAT reports by diseases
Distribution of current expenditure by disease - Tajikistan - million Somoni

HIV/AIDS
Tuberculosis
Malaria
Respiratory infections
Diarrheal diseases
Vaccine preventable diseases
Other infectious and parasitic diseases (n.e.c.)
Maternal conditions
Perinatal conditions
Contraceptive management (family planning)
2013 Other reproductive health conditions (n.e.c.)
Nutritional deficiencies
Neoplasms
Endocrine disorders
Cardiovascular diseases
Mental disorders
Other noncommunicable diseases (n.e.c.)
Injuries
Other diseases / conditions (n.e.c.)

0 500 1,000 1,500 2,000 2,500 3,000

TAIEX - Workshop on Development of Health Accounts

18 | November 2014
 HAAT reports by diseases

Total Current Expenditure, Million Somoni - Tajikistan

200
180
160
140
120
100
80
60
40
20
0
2013

2013

2013

2013

2013
HIV/AIDS Tuberculosis Malaria Vaccine preventable Contraceptive man-
diseases agement (family plan-
ning)

From domestic sources From external sources From private sources

TAIEX - Workshop on Development of Health Accounts

19 | November 2014
 Current expenditure on Tuberculosis in Tajikistan: Origins
of Funds (million US$)
9
8
7
6
5
4
3
2
1
0
2013

Government funding External funding Private funding

0%
Current expenditure on Tuberculosis in Current expenditure on Tuberculosis by
0%

Tajikistan in 2013: origins of funds (%) input Tajikistan - 2013

5% 7% Compensation of employees

Government funding 6% Health care services

5%
Bilateral donors
Pharmaceuticals
24% Development banks
4%
Global Fund Training
16%
GAVI 59%
other external funding Other non-health care services (n.e.c.)
Private funding 7%
63% Non-health care goods
0%
Other items of spending on inputs

4% Other factors of health care provision

(n.e.c.)

TAIEX - Workshop on Development of Health Accounts

20 | November 2014
 WHO TECHNICAL SUPPORT
 Target is institutionalised resource tracking in countries
– we build capacity (rather than produce the work for the team)
– we provide 2 years of TA:
• 1st year on SHA 2011 and HAPT (3 visits + extensive remote support);
• 2nd year on institutionalisation of data collection & use (1 visit + remote TA)
=> template workplans for team to plan their 2 years

 2013 & 2014 : supported countries (funding from GF, COIA, Gates,
GAVI):
– funding for production at country level;
– funding for TA and development of platform at WHO level

 large # TA requests: train consultants/ToR (consultants or HA team lead)

TAIEX - Workshop on Development of Health Accounts

21 | November 2014
 1 year COMPLETED ONGOING STARTING/PLANNING
(2nd or more years) (1st year) (1ST year)
1. Benin 1. China 1. Armenia
2. Burkina Faso 2. Côte d'Ivoire 2. Aruba, St Marteen, Curacao
3. Burundi 3. Gambia 3. Bolivia
4. Cameroon 4. Lao People’s Dem Rep 4. Colombia
5. Comoros 5. Mauritania 5. El Salvador
6. DRC 6. Nigeria 6. Guyana
7. Ghana 7. Senegal 7. Honduras
8. Haiti 8. Seychelles 8. Indonesia
9. Liberia 9. Sierra Leone 9. Kazakhstan
10. Malawi 10. STP 10. Madagascar
11. Niger 11. Tajikistan 11. Nicaragua
12. Tanzania 12. Thailand 12. Paraguay
13. Cambodia 13. Zambia 13. Peru
14. Mozambique 14. Zimbabwe 14. South Africa
15. Philippines 15. Egypt 15. Suriname
16. Uganda 16. India 16. Tunisia
17. Mali 17. Macedonia
18. Sri Lanka
16 countries 18 countries producing 17 countries preparing
institutionalizing (total = 34) (total = 51)

TAIEX - Workshop on Development of Health Accounts

22 | November 2014