ARBA MINCH UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF POSTGRADUATE STUDIES
HSM: GROUP ASSIGNMENT
Topics: Ethiopia Health Account Review

BY: Group three memberS

NAMES DEPARTMENT ID:NOs

Yoannes Buti Mayik EPI AND BIO PRPGMHS/025/17

Contents
ETHIOPIA HEALTH ACCOUNT REVIEW.........................................................................................................3
 INTRODUCTION.......................................................................................................................................3
BACKGROUND.........................................................................................................................................3
National Health Account..........................................................................................................................3
Objectives................................................................................................................................................3
METHODS....................................................................................................................................................4
Source of data.........................................................................................................................................4
Data management, Validation and mapping...........................................................................................4
Data analysis............................................................................................................................................4
Finding.........................................................................................................................................................5
Total health expenditure.........................................................................................................................5
Per capita expenditure............................................................................................................................5
Source of health financing.......................................................................................................................5
Ethiopia’s health sector has multiple financing sources......................................................................5
Management of Health Resources:.....................................................................................................6
Health expenditure By providers of health services in Ethiopia..........................................................6
Government Expenditure by Providers...............................................................................................6
Health expenditure by type of health service in Ethiopia....................................................................6
Sources of finance for the COVID-19 emergency response.................................................................7
Health Sector Transformation Plan (HSTP-I) from 2015/16 to 2019/20, achievement................................7
Conclusion...................................................................................................................................................7
ETHIOPIA HEALTH ACCOUNT REVIEW
INTRODUCTION
Health account: is an international accounting framework for systematically tracking health
spending. Time trends of overall health spending and its components guide future policies and
investments to make health systems more responsive to people’s needs. Ethiopia national
health accounts (NHAs), collect, map, and summarize data on a country’s national or regional
health expenditure. This report summarizes the results of the eighth NHA estimations, which
were conducted using data from the Ethiopian fiscal year 2012 (July 8, 2019 to July 7, 2020).

BACKGROUND
Ethiopia, with an estimated 99.7 million mid-year population in 2019/20, is Africa’s second-
most populous country and ranks 12th globally, with a projected population of 122.3 million in
2030 (CSA, 2013). Over 55% of Ethiopians are under the age of 20, and less than 25% live in
urban areas (CSA, 2013). . In the fiscal year 2019/20, real GDP increased by 6.1%, much more
than the 3.5% average growth forecast for Sub-Saharan Africa (World Economic Outlook
Update, June 2020).

National Health Account

National health account (NHA) is a methodical, comprehensive, and consistent examination of
resource flows within the health system over a specified time period. It is intended to capture
the full range of information contained in these resource flows and to reflect the main functions
of health care financing.

Objectives
 Quantifying total resources spent on health and the contribution of each stakeholder in
financing health care.

 Generating evidence on the association between health sector priorities and health
spending by level and types of health services.

 Understanding how health resources are disaggregated by financing agent, disease

category, and health programs.

 Creating internationally comparable health expenditure data.

 Documenting the magnitude and share of health expenditures in a broader

macroeconomic context, including its share of gross national product (GDP) and
government spending.

 Synthesizing health expenditure data and documenting policy implications for further
development of health financing in Ethiopia.
METHODS
The study updated system of health accounts (SHA 2011) framework. Health expenditures were
defined as expenditures for all activities whose primary purpose was to restore, improve, and
maintain health during the study period of 2019/20 and classified based on finance source,
provider and function.

Source of data
 Randomly selected 276 NGOs (112 international and 164 local) and donors (25) working
in Ethiopia’s health sector bilateral and multilateral.
 Government institutions (MOH, MOF, 32 universities and regional health bureaus).
 A stratified sample of 289 employers (28 parastatals and 261 private employers).
 Annual reports of the National Bank of Ethiopia (2019/20) for the GDP
 General household survey data primarily collected with a sample size of 5,900
households
 Development Partners (WHO, USAID, World Bank, UNICEF)

Data management, Validation and mapping

 Census and Survey Processing System (CSPro) was used for data entry and tabulation,
the datasets were then exported into Stata for further cleaning, validation, and
computations.
 Stata and MS Excel were used for the management of datasets collected from other
sources.
 The mapping involved assigning expenditures to their respective classifications within
the SHA 2011 framework

Data analysis
This study used health Account Production Tool (HAPT) in conjunction with STATA. HAPT has
ability to reduce complexity in the documentation and methodology of measuring financial
resource flows and it has has features for storing previous health account estimations,
customizing NHA codes, streamlining data collection and data importing, data mapping, double-
counting, application of consistent weights to data, and validation and automatic generation of
graphs and tables
Finding

Total health expenditure

Total health expenditure (THE) in Ethiopia was estimated at ETB127.47 billion (USD 3.63 billion)
in 2019/20, compared to ETB 72 billion (USD 3.1 billion) in 2016/17. It has shown an increase by
nearly 76% in nominal terms. However; the inflation-adjusted growth was only 16%.

Per capita expenditure

Ethiopia’s per capita health expenditure has grown steadily over the past two decades, from
USD 4.50 in 1995/96 to USD 36.40 (including COVID 19 spending) in 2019/20. Which is still low
compared to the USD 43 average per capita health expenditure among low income African
countries, and it is far less than the $86 per capita spending the WHO recommended for
delivery of essential health services (Jowett et al. 2016).

Per Capita Health Expenditure, 1995/96–2019/20

Source of health financing

Ethiopia’s health sector has multiple financing sources

 Government: Government spending increased by 18% in real terms, from ETB 23.1
billion (USD 1 billion) in 2016/17 to ETB 41.04 billion (USD 1.17 billion) in 2019/20.
 Domestic resources: Domestic sources’ overall contribution to the THE (government,
household out-of-pocket expenditure, CBHI (voluntary prepayment), and other private)
has increased slightly from 65% in 2016/17 to 66% in 2019/20.
 Donors (rest of the world): Donor spending increased from USD 1.09 billion in 2016/17
to USD 1.23 billion USD in 2019/20
 Household OOP: OOP payments continue to play a significant role in Ethiopia in 2019/20
(30.54% of total financing, which is 2% of the GDP).
  CBHI (voluntary prepayment): CBHI contribution to the THE has increased from 0.35% in
2016/17 to 0.9% in 2019/20
 Private employer and others: contributed only 2.5% of the THE in 2019/20, slightly
higher than the 2.1% in 2016/17.

Management of Health Resources:

 Government: The share of THE managed by the government decreased slightly from
52% to 47% between 2016/17 and 2019/20.
 Donors and NGOs: The share managed by donors and NGOs increased slightly from 15%
to 20.3% between 2016/17 and 2019/20.
 Household (OOPs): funding managed by households OOP has decreased from 33.7% in
2013/14 to 30.2% in 2016/17 and 30.5% in 2019/20.
 Private sector and insurance: funding managed by insurance companies and private
employers remained limited.

Health expenditure By providers of health services in Ethiopia

 Primary health care unit (primary hospitals, health centers, and health posts) accounted
for 44% of THE.
 General and tertiary public hospital spending constituted about 10.7% of THE.
 Private clinics and hospitals spending was 15.1%.
 Expenditure on providers of governance and health administration has to increased 20%
of THE.

Government Expenditure by Providers

 In 2019/20, 38% of total recurrent government health spending went to public hospitals
(tertiary hospitals accounted for 16%, primary hospitals for 12%, and general hospitals
for 10%).
 33% went to public health centers and health posts.
 26% of the recurrent government resources go to health system governance.
 2.8% for Providers of ancillary services.

Health expenditure by type of health service in Ethiopia.

The 2019/20 health account findings show that about half of government recurrent spending
(56.1%) was directed to curative health care services.12 The second-largest share went to
health system governance (24.2%), followed by preventive care (17.3%). Medical goods (non-
specified by function) accounted for 2.0% and 0.3% of the government’s recurrent health
spending respectively.
Sources of finance for the COVID-19 emergency response
 The total (recurrent and capital) COVID-19 expenditure in Ethiopia was estimated at Birr 6.6
billion (US$ 189.4 million), which accounted for 5.2% of THE.
 The source of COVID-19 expenditure was primarily government with 50%.
 Development partners with 42%.
 8% was from private corporations and others that included but was not limited to
manufacturers, importers, service providers, and new entrepreneurs

Health Sector Transformation Plan (HSTP-I) from 2015/16 to 2019/20, achievement

 Significant gains in population health and improving access to and utilization of health
services.
 Health outcome indicators improved, with significant reductions in morbidity and
mortality associated with major communicable diseases, such as HIV, tuberculosis, and
malaria.
 Increased births attended by skilled health workers from 5% in 2005 to 50% in 2019.
 Reduced the under-five mortality rate from 123 to 77 per 100,000 live births during the
same period (Mini DHS, 2019).
 Reduced maternal mortality from 676 in 2011 to 401 deaths per 100,000 live births in
2017 (HSTPII).

Conclusion
 The Ethiopian NHA for fiscal year 2019/20 shows that the health financing system is
dependent on external sources and that government spending on health. However,
despite its growth it is still low.
 Although THE increased compared to the previous NHA rounds, resources were still
inadequate to provide the basic package of cost-effective interventions, the essential
healthcare package, and meet the Abuja target.
 Sources of financing continue to be fragmented and not effectively pooled.
 There was an inefficient allocation of health resources across programs, as the program
areas focused on infectious and parasitic diseases and reproductive health were
responsible for two-thirds of health spending.