Monitoring Sustainable Development Goals
Financial protection is a key dimension of universal health coverage and needs to be monitored within the framework of the Sustainable Development Goals (SDGs).
Indicator 3.8.2 of the SDGs concerns the “lack of financial protection coverage” in health. This indicator captures the impact on a household’s living standard of any payments made to meet the costs of health services.
New financial protection estimates for 110 countries accounting for approximately 90% of the world population will be released jointly by the World Bank and the WHO during the first half of 2017.
3.8.2. Lack of financial protection coverage in health
Proportion of the population with large household expenditure on health as a share of total household expenditure or income (e.g. greater than 25%)
Method of estimation
Population weighted average number of people with large household expenditure on health as a share of total household expenditure or income (e.g. greater than 25%).
Disaggregation by income, sex, age, and geographic location, in accordance with the dissagregation principle of the SDGs. As this indicator relies on household surveys and as almost all surveys already collect data for important stratifiers, countries can already report on inequalities and their progressive reduction.
This indicator derives from methodologies dating back to the 1990s and which has been refined as part of joint framework developed by WHO and World Bank. This framework and its indicators followed a 3-year extensive and inclusive consultation process involving expert academics and international agencies.
Rationale and interpretation
Target 3.8 is defined as “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. It is a multi-dimensional concept comprised of two parts where each requires distinct indicators to effectively monitor progress such that: 3.8.1 monitors essential health services and 3.8.2 monitors financial protection in health.
More specifically, 3.8.2 measures the extent to which the cost of health services absorbs a large share of a household’s budget. The concern is with the cost of health services (including medicines and other health inputs) that has an impact on household’s living standard. Hence, there is a focus on high levels spending relative to household’s economic resources (e.g. devoting more than a quarter of income to health services).
Data on household consumption expenditure on health is readily available from routine household surveys conducted by national statistical offices (e.g. Budget Surveys, Income and Expenditure Surveys, Living Standards Measurement Surveys, Integrated Household Surveys). These surveys serve multiple sectors and are regularly used for the purposes of monitoring poverty as for the MDGs or calculating weights for the Consumer Price Index. Thus, data can be gathered in a cost-effective manner.
Countries generally construct household consumption expenditure aggregates by summing expenses on all United Nations COICOP (Classification of Individual Consumption According to Purpose) components where code 6 pertains to expenses on health.
For more information on availability of Household Surveys the following networks can be consulted:
- Asia and the Pacific, Africa: International Household Survey Network, The Living Standard Measurement Study.
- Latin America and the Caribbean: SEDLAC Base de Datos Socioeconomicos para America Latina y el Caribe.
- Europe, North America, Australia, New Zealand and Japan:
- Europe: Household Budget Surveys (HBSs) are conducted in all EU 28 Member States every 5 years.
- The United States of America: The Consumer Expenditure Survey is conducted annually since 1984.
- Canada: The Survey of household spending is annual since 1999.
- Australia: The Household Expenditure Survey is conducted every 6 years since 1984.
Varies across countries following nationally-led schedules of household surveys (annual to up to every 5 years).
Further information and related links
In June 2015, the WHO and World Bank Group launched a global report showing that, across 37 countries with comparable data between 2002 and 2012, 22 million people lack financial protection against the costs of health services as they are spending more than 25% of their total household expenditures on health.