NHA Activities in Yemen
Successful nationwide implementation of decentralized planning and management of a health care reform strategy will depend upon accurate and timely financial information about how money is flowing through the health care system, the amounts that are provided from different sources, the amounts that are paid to different providers, on different types of inputs, and for diverse categories of services. This information is particularly necessary for assessing how the strategy is being implemented in the public health sector, for monitoring how and the degree to which the decentralized system is managing and using public health budget transfers, for analyzing the potential impact of alternative public policies and programs and for developing future multi-year investment plans for the health sector. It is also critically important that financial information be collected and reported for financial flows that occur outside government channels.
Information from the first round of Yemen's National Health Accounts (NHA) estimates (1998) found that out-of-pocket spending by Yemenis accounted for about 60% of all spending in the health sector. This factor accounts for the recent rapid growth in the importance of private medical practice and of private pharmacies throughout the country. Future trends in the growth of the private sector will have important impacts on the cost-effectiveness and other important dimensions of public sector spending, particularly if public sector utilization drops while spending is constant or increasing. NHA can give policy-relevant data on the dimensions of financial flows throughout the sector, and can provide policymakers an important perspective on the interactive effects of resource flows to the private and public sectors.
PHRplus, in collaboration with the Ministry of Public Health and Population's Health Policy and Technical Support Unit and the World Health Organization (WHO) held two workshops on National Health Accounts in January 2004 in Sana'a. The goal of the first workshop was to inform a variety of stakeholders - the ministries implicated in health expenditures, the private sector, and the donor community - about the NHA framework and the process in Yemen, results from the first NHA report (1998), experience from other countries utilizing NHA as a tool for policymaking, and how NHA fits into the current policy reform agenda in Yemen. The second day was a roundtable discussion with the NHA team and the donors supporting NHA activities in Yemen. The group discussed future plans for conducting NHA, roles, responsibilities, and resources available. As a result, PHRplus is assisting in the development of an NHA/Yemen workplan with the newly configured NHA team, WHO, and the European Commission. PHRplus will continue to provide technical support to these activities over the next few years.