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Transcript of Commonwealth Regional Health Community for East, Central and Southern Africa. 3 rd International NHA...
Commonwealth Regional Health Community for East, Central and Southern Africa.
3rd International NHA Conference, San Francisco, California13-14 June 2003
Institutionalization of National Health Accounts in ECSA: Progress Report` Dr. Mark Bura
Health Systems Development Coordinator.CRHCS. 1
First version of this paper was presented at the 36 Conference of Commonwealth Regional Health Ministers Conference,
Entebbe, Uganda, 18-22 November 2002
2
Milestones in Institutionalisation of NHA in ECSA
ONE
Popularisation of NHA by WHO, Harvard School of Public Health from mid-nineties to date
6
TWO
Ten ECSA Countries bold enough to undertake first NHA Kenya, Uganda, Tanzania, Malawi, Zambia, Mozambique, Zimbabwe, South Africa, Ethiopia
and Rwanda undertook their first NHA between 1995-2000
7
THREECRHCS/ECSA arrives on the NHA scene.
November 2000: CRHCS established Health Care Financing ProgrammeMarch 2001: trained CHF Coordinator in NHA with USAID/REDSO supportApril 2001 : ECSA/Health Care Financing Expert Committee met first time and drafted a HCF Strategic Plan in which NHA is included as major activity over 4 years.
8
FOUR
NHA ECSA Network and Health Ministers Resolution to Institutionalise NHA.
April 2001: NHA ECSA Network coordination taken over by CRHCS
September 2001: First ECSA NHA Executive Sensitisation Workshop for Permanent Secretaries MoH and Directors held in Mombasa. They endorse NHA
10
FOUR CONT.
NHA ECSA Network and Health Ministers Resolution to Institutionalise NHA.November 2001:
34th Regional Health Ministers Conference makes a resolution to Institutionalise
11
NHA Country and CRHCS Activities
November 2001: 1st ECSA NHA Regional Training Workshop coordinated by CRHCS in collaboration with USAID/REDSO and PHR plus- took place in Lusaka Zambia.
November 2001: Mauritius NHA process launched with support of CRHCS in collaboration with USAID/REDSO and PHR.
13
NHA Country and CRHCS Activities cont.
August 2002: Seychelles invited CRHCS to launching of NHA process to date Seychelles has established an NHA steering and working committees
14
CRHC forges Collaboration with Partners and Donors June 2002: A Joint Donor Meeting to mobilize
resources for NHA in Sub-Saharan Africa took place in Nairobi–CRHCS played a major role in coordination and drafting the NHA Strategy in Africa.
November 2002: 2nd ECSA NHA Regional Training Workshop was conducted by CRHCS and WHO in Mutare Zimbabwe.
16
ECSA Countries are moving fast with NHA Analysis.
2003: Zimbabwe, Kenya, Uganda, Tanzania and
Ethiopia are currently working on their 2nd NHA analyses.
17
The Challenge of Training NHA analysis in ECSA At this point in time NHA is a new concept in
Sub-Saharan Africa and other developing countries in the World.
None of the Sub-Saharan countries has adequate expertise in NHA.
WHO, Harvard School of Public Health (Peter Berman and others) and PHRplus/Abt Associates are the main fountain of knowledge and skills in NHA currently
CRHCS and WHO AFRO feels confident to run and conduct NHA with just little technical support from partners and donors. 18
The Challenge of Training NHA analysis in ECSA cont.
To date ECSA have collectively trained only about 110, one to two weeks workshop trainees. Of these trainees 95 are from 11 active CRHC member countries.
A one month training course could be a basic requirement for NHA analysis.
A two week further training might be required for focus on data collection and analysis –6-8 weeks course would be required to qualify as an NHA practitioner
19
NHA Training in ECSA
Kenya
Uganda
Tanzania
Malaw
i
Zam
bia
Mozam
bique
Zim
babwe
Sw
aziland
Lesotho
Mauritius
Seychelles
TO
TA
L
One-two week workshop
attendances
12 13 17 8 12 10 12 7 0 6 2 95
Indicators: Institutionalization of NHA in ECSA-Country Activities
Kenya
Uganda
Tanzania
Malaw
i
Zam
bia
Mozam
bique
Zim
babwe
Sw
aziland
Lesotho
Mauritius
Seychelles
Decision to start NHA
YES YES YES ?
YES ? YES YES ? YES YES
Committee in place
YES YES YES ? YES YES YES YES ? YES YES
No of NHA committee meetings
8 3 3 ? 8 3 >8 >4 ? 6 2?
Indicators: Institutionalization of NHA in ECSA cont.-Country Activities
Kenya
Uganda
Tanzania
ETHIO
PIA
Malaw
i
Zambia
Mozam
bique
Zimbabw
e
Swaziland
Lesotho
Mauritius
Seychelles
Resource Mobilisation
YES YES YES YES YES YES ? ? YES
? ? ?
Training: No attending 1-2 week workshops
12 13 17 8 12 10 12 7 0 6 2
Status of 1st NHA analysis
DONE DONE DONE DONE DONE DONE DONE DONE 03 ? 03 03
Status of 2nd NHA
03 03 03 03 03
NHA Financing and Collaboration in ECSA Collaborators
USA
ID
PHR
plus
WH
O
SAR
A/A
ED
WB
/WB
I
SIDA
EU DFID
DA
NID
A
CID
A
NO
RA
D
French C
ooperation
Country based
YES
YES
YES
YES
YES
YES
YES
YES
YES
Technical resources
++ +++ +++
Financial resources
+++ + ++ + +++ +++ +++ + ++ + +
Training resources
++ ++++ +++ ? ? ?
Joint meetings
YES
YES
YES
YES
YES
YES
YES
Policy Impact of NHA use in ECSA
Though the results of 1st NHA analysis in ECSA were received with mixed feeling, a few ECSA countries have already put to use the outcome .
Kenya has decided to undertake 2nd NHA in order to come up with more realistic estimates especially on Household Expenditures
Tanzania used NHA results to reinforce coordination of external resources and increase its attention of the private sector.
Zambia confirmed the importance of the private sectors and efforts are made to integrate both sectors
Zambia is using NHA to improve allocate efficiency particularly allocating more resources to preventive services. 24
Conclusions
NHA has been received by Policy makers in ECSA and there is a strong political will to use NHA as policy tool
Member States and Donors are building up efforts to institutionalize NHA
Despite a strong political will there is a challenging technical and resource gap
There is a window opportunity for both MS and Donors to leverage their efforts to institutionalize and sustain of NHA in ECSA.
25