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Nmqwertyuioministry of HEALTH Jklzxcvbnmrtyuiopasdfghjklzxcvbnm qwertyuiopasdfghjklzxcvbnmqwertyREPUBLIC OF SEYCHELLES uiopasdfghjklzxcvbnmqwertyuiopasd Public Disclosure Authorized fghjklzxcvbnmqwertyuiopasdfghjklzx cvbnmqwertyuiopasdfghjklzxcvbnmq wertyuiopasdfghjklzxcvbn Public Disclosure Authorized mqwertyuiopasdfghjklzxcvbnmqwertSEYCHELLES FIRST NATIONAL HEALTH ACCOUNTS 2009 yuiopasdfghjklzxcvbnmqwertyuiopas dfghjklzxcvbnmqwertyuiopasdfghjklzPublic Disclosure Authorized xcvb nmqwertyuiopasdfghjklzxcvbnm qwertyuiopasdfghjklzxcvbnmrtyuiop asdfghjklzxcvbnmqwertyuiopasdfghj Public Disclosure Authorized klzxcvbnmqwertyuiopasdfghjklzxcvb nmqwertyuio MINISTRY OF HEALTH JUNE 2011 pasdfghjklzxcvbnmqwertyuiopasdfghNational Health Accounts, 2009 1 | P a g e jklzxcvbnmqwertyuiopasdfghjklzxcv TABLE OF CONTENTS LIST OF ACRONYMS ............................................................................................................................ 4 ACKNOWLEDGEMENTS ...................................................................................................................... 5 EXECUTIVE SUMMARY ....................................................................................................................... 6 1. BACKGROUND INFORMATION .................................................................................................... 7 1.1 SOCIO-ECONOMIC BACKGROUND ............................................................................................ 7 1.2 DEMOGRAPHIC AND HEALTH TRENDS ..................................................................................... 7 1.3 THE HEALTH SYSTEM ORGANIZATION IN SEYCHELLES ........................................................ 10 2. METHODOLOGY ............................................................................................................................ 11 2.1 CONCEPT OF NHA AND NHA DEVELOPMENT IN SEYCHELLES ............................................ 11 2.2 PRIMARY DATA ........................................................................................................................... 12 2.3 SECONDARY DATA ..................................................................................................................... 12 2.4 DATA LIMITATIONS .................................................................................................................... 13 3. FINDINGS OF THE FIRST NHA...................................................................................................... 13 3.1 OVERVIEW ................................................................................................................................... 13 3.1.1 GOVERNMENT BUDGET ALLOCATION, 2005 - 2009.......................................................... 14 3.1.2 COMPARING SEYCHELLES NHA INDICATORS WITH OTHER COUNTRIES ....................... 15 3.2 FINANCING SOURCES: WHERE DO THE FUNDS COME FROM? .......................................... 16 3.3 FINANCING AGENTS: WHO MANAGES THE HEALTH FUNDS? ............................................ 16 3.4 HEALTH CARE PROVIDERS: WHO USES HEALTH FUNDS TO DELIVER CARE? ................... 17 3.5 FUNCTIONS: SERVICES AND PRODUCTS PURCHASED WITH HEALTH FUNDS .................. 19 National Health Accounts, 2009 2 | P a g e 4. POLICY IMPLICATIONS ................................................................................................................. 22 4.1 CONCLUSION AND RECOMMENDATIONS .............................................................................. 22 4.2 TOWARDS INSTITUTIONALIZATION ........................................................................................ 23 National Health Accounts, 2009 3 | P a g e LIST OF ACRONYMS CEO Chief Executive Officer ECSA-HC Eastern and Southern African – Health Community EPI Expanded Program of Immunization GDP Gross Domestic Product GNI Gross National Income GOS Government of Seychelles ICHA International Classification Health Accounts MOF Ministry of Finance MOH Ministry of Health NAFT National Aids Trust Fund NCD Non-Communicable Diseases NGOs Non-Governmental Organisations NHA National Health Accounts NIHSS National Institute of Health and Social Studies NSB National Statistics Bureau OECD Organization for Economic Cooperation and Development OOP Out-of-Packet SACOS State Assurance Company of Seychelles THE Total Health Expenditure WHO AFRO World Health Organization African Region WHO World Health Organization WHO/POA World Health Organization / Plan of Action USAID United States Agency for International Development National Health Accounts, 2009 4 | P a g e ACKNOWLEDGEMENTS The Ministry of Health acknowledges the cooperation, commitment and support of the multi – sectorial team comprising: Name Designation Organization Dr. Cornelia Atsyor Liaison Officer World Health Organization Dr. Shobha Hajarnis Director General – Public Health Ministry of Health Mr. Jean Malbrook Economist Ministry of Health Mr. Joachim Didon Principal Statistician Ministry of Health Ms. Annie Dugasse Policy Analyst Ministry of Finance Ms. Laura Ah-Time CEO/NBS National Bureau of Statistics Mr. Guillaume Woodcock Senior Statistical Assistant National Bureau of Statistics Mr. Terence Morel Financial Controller Ministry of Health Mr. Guy Hoareau Finance Manager Ministry of Health Mrs. Gemma Barbier Director – Resource Planning & Ministry of Health Development Mr. Henry Bastienne Information & Promotion Officer World Health Organization Mrs. Malcy Tambara Manager – Overseas Treatment Ministry of Health Mrs. Eline Moses Information & Communication Officer Civil Society – LUNGOS Ms. Josie Chetty Pharmacist Private Pharmacy Ms. Maggie Ah-Weng Insurance Officer State Assurance Corporation of Seychelles Ms. Jane Victor Senior Research Officer Social Development Department Mr. Michael Charlette Director International Cooperation Ministry of Health Special thanks go to Mr. Netsanet W. Workie (Senior Health Economist, World Bank) and Mr. Driss Zine-Eddine El-Idrissi (Senior Health Economist, World Bank) who conducted the training and guided the multi-sectorial team on the NHA compilation exercise. National Health Accounts, 2009 5 | P a g e EXECUTIVE SUMMARY This report provides detailed results of Seychelles first National Health Accounts (NHA) exercise, for the financial year 2009. The study was conducted to shed light on the distribution of funding for health care from public, private, and donor sources and to inform the government on health expenditure trends to improve health system management and resource allocation. Seychelles has a pluralistic health care system, with different public and private providers and financing agents. The major health care provider is the Government (Ministry of Health). The health service is financed by the government of Seychelles, external sources (donors & rest of the world)1, parastatals and the private sector (households and NGOs). In 2009, Seychelles spent SR 353 million on health care. This is equivalent to 3.3 percent of GDP or SR4, 048 ( US$297) per capita Out of the Total Health Expenditure, 87 percent was financed by government, 7 percent by the private sector including household out-of-pocket payments, and 6 percent from international partners. 90 percent of the total health spending was managed by the Ministry of Health. The Seychelles Hospital received the highest amount with SR129,434,338 (36 percent of the total health spending), followed by Government Health Administration with SR 49,335,150 (14 percent), Public Health Centres with SR 48,996,026 (14 percent), and the Rest of the World as providers of Overseas Treatment accounted for SR 20,048,162 (7 percent) in 2009. In terms of functions, inpatient care took the lion’s share with 43 percent of the total health spending; followed by outpatient care with 25 percent; and private dental care, private pharmaceutical and prevention and public health, each accounted for 3 percent of total expenditure. Of the total Out-of-Pocket expenditure of SR 18,347,256, 37 percent was spent on pharmaceuticals and appliances, 31 percent on overseas treatment, 25 percent on private doctors, and 7 percent on dental care. Section one portrays the socio-economic background of the country and its situation in 2009 in terms of common indicators such as GNI per capita and GDP per capita. It also highlights the demographic and health trends through various indicators. It illustrates how the health system is organized. This is followed by the concept of National Health Accounts, its development in Seychelles and the methodology used to conduct the 2009 National Health Accounts exercise. In section three the document analyzes the findings of this exercise. It examines Government contributions in term of budget allocation to the health sector in relation to the National Budget as part of the African States commitment to the Abuja Declaration, 2001 which stipulates that15 percent of the National Budget should be committed to health sector. It evaluates the National Health Accounts results through the four basic matrices: financing sources, financing agents, health providers and health functions. These entities answer the questions: Where does the money come from? Who manages and organizes the funds? Who uses the health fund to deliver care?; and What types of health services are being provided and to whom? Lastly, it addresses the policy implications based on the findings, provides recommendations on areas that the government need to address, the challenges in the health system and the process towards institutionalization of National
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