Tracking primary health-care spending in selected countries. System of Health Accounts 2011 methodology

Overview

While countries aim for the common goal of universal health coverage (‎UHC)‎, many shared challenges (‎including resource limitations and competing priorities)‎. Addressing these challenges require evidence informed decisions on rational use of scarce resources and optimal resource allocations and reallocations. Investing in primary health care (‎PHC)‎ improves equity in access to needed services and increases system efficiency with a limited resource to meet increasing and changing health needs. The System of Health Accounts (‎SHA)‎ 2011 framework facilitates tracking of spending, including PHC related spending, but this cannot be accomplished without clearly defining PHC boundaries. To address this gap, WHO proposed a global measure of PHC to benchmark and track PHC spending globally, using the SHA 2011 framework. This is important descriptive measure which should be used for international comparison and may serve as PHC spending benchmarks for individual countries and policy-makers. However, they are less useful as normative measures for assessing PHC consumption effectiveness or efficiency, or for adequately tracking key PHC policy and financing reform impacts at a national level. Country-specific PHC definition and measures are needed for such deeper analysis and strategic planning. Four countries were selected for case studies aiming at collecting the evidence to support better tracking of PHC spending/consumption, and linking this with policy objectives and health outcomes at the national and potentially the regional/subregional level. The measures of PHC spending corresponding to the de jure and de facto PHC definitions differed significantly from both the global measures and an optimal (‎or desirable)‎ country-specific PHC spending measure. Methodological coherence, data quality and granularity need further exploration.