Opeing Address at the Advocacy Seminar on National Health Accounts

ADB Technical Assistance for Strengthening Evidence-based Policy Making in the Pacific: Support for Development of National Health Accounts.  

Tuesday 27th October 2009  -  9.00am,    Holiday Inn, Suva

Permanent Secretaries and  Heads of Departments
Representatives from donor partners in health,
Representatives from private healthcare providers,
Representatives from civil society groups,
Invited guests,
Ladies and gentlemen.

It is my pleasure to be here this morning to open this advocacy seminar for National Health Accounts or NHA.  I thank you all for taking your time to learn more about NHA and the ADB funded technical assistance that is being provided to Fiji to institutionalise National Health Accounts as this is a project that I have a keen interest in.

Health services have expanded over the recent decades in line with changes in disease patterns with predominance of lifestyle related diseases, population growth, technologic development and increasing expectation of the population. Additionally over the recent decades health expenditures have increased at a rate faster than the growth of the national economy nonetheless health has received a relatively steady share of the government budget.

The fundamental role of the Fiji health care system is to ensure that the citizens of Fiji enjoy a system that is accessible, affordable, equitable and of high quality.

Over the years the quality of health care has been affected by shortage of financial resources for preventive and curative care, shortage of pharmaceuticals and medical supplies, lack of appropriate maintenance leading to deteriorating health facilities and equipment and lack of proper and safe transportation aside from the perennial problem of shortage of human resources.

Currently the financial sources for health care in Fiji are general taxation for the public health sector, commercial health insurance and out of pocket payment, mainly for private health sector and a small proportion from donation

Although the government budget allocation to health has increased in dollar terms, the proportion of GDP allocated to health has remained low at around 3% compared to the 10% in OECD countries and of neighboring Pacific nations such as Tonga and Samoa at around 5-6%. To translate this into dollar terms Government would have to inject an additional allocation of $100M+ to the health sector in order to achieve the 5% of GDP.

There has been renewed interest globally by key institutions such as the IMF, World Bank and WHO to address the rising health inequalities due to poverty, rising cost of health care and the lack of proper evidence to inform policy formulation particularly in developing countries.

In 2003 WHO commissioned a consultant to work on exploring possible options for health care financing in Fiji including the scope for a social health insurance scheme. The proper building blocks for the establishment of a social health insurance scheme are not there for Fiji and the consensus view is to strengthen the current tax-based system and to reduce the proportion of out of pocket payments.

The Peoples Charter for Change, Peace and Progress (2008) has “meeting health care needs” as one of its eleven pillars. It has identified the adequate resourcing for health by government as a key action that must be taken with due priority and urgency

The need for improved policy formulation and a better informed and improved health financing option was emphasized.

Noting the need for evidence based policymaking: ADB recently endorsed Technical Assistance for Strengthening Evidence-based Policy Making in the Pacific: Support for Development of National Health Accounts. The study will be carried out in Fiji, Vanuatu and Micronesia.

In the WHO definition, National Health Accounts or NHAs constitute a systematic, comprehensive, and consistent monitoring of resource flows in a country’s health system.

A reliable NHA system provides information for policy design and implementation, policy dialogue, and the monitoring and evaluation of health care interventions. They provide the evidence to help policy-makers, nongovernmental stakeholders, and managers to make better decisions to improve health system performance.

Fiji first had its opportunity to produce its first National Health Account for 2005 in the year 2007. This effort was not sustained due to inadequate capacity within the Ministry of Health or Government to produce further reports and so the current ADB project is timely.

In preparation for the ADB supported project on National Health Accounts, a consultation on the System of Health Accounts in the Pacific was held in Nadi from the 12th -14th of May 2009. Members of the Pacific Island States provided an update on their various states of collection and publication of health expenditure data in their countries. Furthermore the accepted methodology for global standard accounting framework for statistics on health expenditure and financing was adopted.

I would like to sincerely acknowledge the assistance to Fiji from the ADB and WHO to not only produce the 2006-2007 National Health Accounts but to ensure that the collection of data and production of these reports becomes an ongoing activity. This is the first of a series of workshops aimed at ensuring local expertise and capacity building and is an indication of the lessons learnt from the first round of NHA.

The routine production of NHAs is vital to enable Government’s decision making on the best ways to  -

• improve health care financing for 2010-2015,
• ensure the efficient performance of the current tax based system of financing
• ensure the financial sustainability of priority health programmes; and
• reduce out of pocket payments for health services

I would like to thank you again  for your presence today as you are all considered important stakeholders in ensuring Government’s ability to make well informed decisions on the future of health care financing and health service provision. The project team is required to gather a large amount of data and I request your support as this is vital in ensuring the quality of the data collected that will in turn impact on the quality of health policy decisions on made by Government.

May God continue to bless us all.

 Dr Neil Sharma.
Minister of Health