National health accounts data from 1996 to 2010: a systematic review.

OBJECTIVE: To collect, compile and evaluate publicly available national health accounts (NHA) reports produced worldwide between 1996 and 2010. METHODS: We downloaded country-generated NHA reports from the World Health Organization global health expenditure database and the Organisation for Economic Co-operation and Development (OECD) StatExtract website. We also obtained reports from Abt Associates, through contacts in individual countries and through an online search. We compiled data in the four main types used in these reports: (i) financing source; (ii) financing agent; (iii) health function; and (iv) health provider. We combined and adjusted data to conform with OECD's first edition of A system of health accounts manual, (2000). FINDINGS: We identified 872 NHA reports from 117 countries containing a total of 2936 matrices for the four data types. Most countries did not provide complete health expenditure data: only 252 of the 872 reports contained data in all four types. Thirty-eight countries reported an average not-specified-by-kind value greater than 20% for all data types and years. Some countries reported substantial year-on-year changes in both the level and composition of health expenditure that were probably produced by data-generation processes. All study data are publicly available at http://vizhub.healthdata.org/nha/. CONCLUSION: Data from NHA reports on health expenditure are often incomplete and, in some cases, of questionable quality. Better data would help finance ministries allocate resources to health systems, assist health ministries in allocating capital within the health sector and enable researchers to make accurate comparisons between health systems.

Tracking development assistance for health to fragile states: 2005-2011.

BACKGROUND: Development assistance for health (DAH) has grown substantially, totaling more than $31.3 billion in 2013. However, the degree that countries with high concentrations of armed conflict, ethnic violence, inequality, debt, and corruption have received this health aid and how that assistance might be different from the funding provided to other countries has not been assessed. METHODS: We combine DAH estimates and a multidimensional fragile states index for 2005 through 2011. We disaggregate and compare total DAH disbursed for fragile states versus stable states. RESULTS: Between 2005 and 2011, DAH per person in fragile countries increased at an annualized rate of 5.4%. In 2011 DAH to fragile countries totaled $6.2 billion, which is $5.05 per person. This is 43% of total DAH that is traced to a country. Comparing low-income countries, funding channeled to fragile countries was $7.22 per person while stable countries received $11.15 per person. Relative to stable countries, donors preferred to provide more funding to low-income fragile countries that have refugees or ongoing external intervention but tended to avoid providing funding to countries with political gridlock, flawed elections, or economic decline. In 2011, Ethiopia received the most health aid of all fragile countries, while the United States provided the most funds to fragile countries. CONCLUSIONS: In 2011, 1.2 billion people lived in fragile countries. DAH can bolster health systems and might be especially valuable in providing long-term stability in fragile environments. While external health funding to these countries has increased since 2005, it is, in per person terms, almost half as much as the DAH provided to stable countries of comparable income levels.

Regional variation in the allocation of development assistance for health.

BACKGROUND: The Global Burden of Disease (GBD) 2010 Study has published disability-adjusted life year (DALY) data at both regional and country levels from 1990 to 2010. Concurrently, the Institute for Health Metrics and Evaluation (IHME) has published estimates of development assistance for health (DAH) at the country-disease level for this same period of time. FINDINGS: We use disease burden data from the GBD 2010 study and financing data from IHME to calculate ratios of DAH to DALYs across regions and diseases. We examine the magnitude of these ratios and how they have varied over time. We hypothesize that the variation in this ratio across regions would be relatively small. However, from 2006 to 2010, we find there was considerable variation in the levels of DAH per DALY across regions. For total funding, the relative standard deviation (standard deviation as a percentage of the mean) across regions was 50%. For DAH specific to HIV/AIDS, malaria and tuberculosis, the relative standard deviations were 50%, 200% and 60%, respectively. While these deviations are high, with the exception of malaria, they have decreased since the 1990s. CONCLUSIONS: There are no evident explanations for so much variation in funding across regions, especially holding the purpose of the funding constant. This suggests donors' allocation processes have not been particularly sensitive to disease burdens. To maximize health gains, donors should explicitly incorporate new disease burden data along with the relative costs and efficacy of interventions into their allocation process.

Vaccine resource tracking systems.

BACKGROUND: From 1999 to 2010, annual disbursements of development assistance for health for vaccinations increased from $0.5 billion to $2.0 billion (all financial values USD 2010). In its 2012 Global Vaccine Action Plan (GVAP), the World Health Assembly recommended establishing a comprehensive vaccination resource tracking system to better understand the source and recipients of these funds, and ultimately their impact on outcomes. This systematic review aims to respond to the GVAP recommendation in reviewing and assessing the state of the data and literature on vaccination resource tracking. METHODS: We scrutinized all relevant vaccination resource tracking systems identified in the literature and by practitioners in the field. We examined schemes used elsewhere in the health sector and by other sectors. Informant interviews were also conducted to determine what data exists and how it might be utilized. With this information, we completed a qualitative assessment of existing approaches to vaccination resources tracking. RESULTS: Tracking systems provide information about some vaccine-related activity in the majority of low- and middle-income countries. Data are generally available for the period of 2006-2010. Levels of granularity vary. Interviewees were concerned about the degree of rigor used to validate the data and the lack of verification. Data are often presented in tabular form, which may be unwieldy for non-technical audiences. CONCLUSIONS: The schemes currently in place to track the resources available for vaccinations were fairly advanced relative to other mechanisms in the health sector. Nonetheless, the coverage, validity, and accessibility of vaccination resource tracking data could be ameliorated. Establishing improved feedback loops and verification mechanisms that connect country-level administrators and the international organizations that support reporting efforts would enhance data quality.

Global health development assistance remained steady in 2013 but did not align with recipients' disease burden.

Tracking development assistance for health for low- and middle-income countries gives policy makers information about spending patterns and potential improvements in resource allocation. We tracked the flows of development assistance and explored the relationship between national income, disease burden, and assistance. We estimated that development assistance for health reached US$31.3 billion in 2013. Increased assistance from the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the GAVI Alliance; and bilateral agencies in the United Kingdom helped raise funding to the highest level to date. The largest portion of health assistance targeted HIV/AIDS (25 percent); 20 percent targeted maternal, newborn, and child health. Disease burden and economic development were significantly associated with development assistance for health, but many countries received considerably more or less aid than these indicators predicted. Five countries received more than five times their expected amount of health aid, and seven others received less than one-fifth their expected funding. The lack of alignment between disease burden, income, and funding reveals the potential for improvement in resource allocation.