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NHA

Using National Health Accounts to Inform Health Sector Decision Making in Egypt

Egypt pioneered the use of the National Health Accounts (NHA) methodology in the Middle East region in the early 1990s. NHA estimations track the flow of funds (public, private, and donor contributions) through the health sector. The Ministry of Health and Population (MOHP) views NHA as an important component of its health sector reform strategy providing data to help health system decision makers improve resource allocation. Health Systems 20/20 is putting special emphasis on efforts to ensure sustainability and institutionalization of NHA-related activities going forward.

NHA 2007/2008

In late 2009, the MOHP Department of Planning (DOP), with assistance from Health Systems 20/20, finalized the NHA 2007/2008 analyses, submitted the findings to H.E.the Minister of Health, and discussed policy implications with MOHP senior officials and USAID. The final NHA 2007/2008 report was presented at the MOHP's annual Sharm El Sheikh Health Sector Reform Conference in October 2010. “This National Health Accounts report provides critical information that will be extremely useful as we continue our efforts to reform the health sector,” said Dr. Hatem Al Gably, the former Minister of Health and Population, who spoke at the event. The report identified several policy-relevant findings; for example, out-of-pocket spending remains the single largest source of financing, increasing from 51 percent to 60 percent of total health spending over the past 15 years.

NHA 2008/2009

The MOHP, in coordination with Health Systems 20/20, conducted a comprehensive NHA analysis for 2008/2009. Main findings were discussed in a workshop attended by more than 140 professionals including Egyptian government planners, hospital managers, private sector representatives, journalists, and donors. Data collection was comprised of the following activities: 

• Household Health Expenditure and Utilization Survey: Health Systems 20/20 subcontracted with the Egyptian organization Central Agency for Public Mobilization and Statistics (CAPMAS) to conduct a household survey covering 12,000 households. The survey provided comprehensive information on the type and frequency of health services used, the level and distribution of out-of-pocket spending on health care, and the factors that influence the use of and expenditures on health care. The partnership with CAPMAS served to promote Egypt’s ability to replicate NHA estimations in the future.
• Hospital Costing Studies: Health Systems 20/20, in conjunction with the DOP, conducted a costing study at a sample of seven hospitals selected from different governorates including pediatric, oncology, and psychology facilities. The study assessed costs, provider time allocation, and various productivity measures. Health Systems 20/20 provided on-the-job training on hospital costing to DOP staff so that the central-level DOP team is now able to conduct hospital costings and train DOP staff at the governorate level. 
• Survey of NGOs andCompanies: Health Systems 20/20 worked with CAPMAS to conduct a survey of NGOs and public and private firms to estimate their financial contribution to the Egyptian health sector.
• Expenditure Tracking System: Health Systems 20/20 developed an expenditure tracking system to track government program spending by activity at the national, governorate, district, and facility level. Information derived from this activity was utilized in the 2008/2009 NHA and as a tool to plan and improve program efficiencies.