Int'l agencies providing training in national health accounts

THE HEALTH reform agenda in several Caribbean countries is set to receive a major boost from a training initiative in health accounting designed to generate reliable and valid estimates of expenditure and better inform the countries' health policy-making agendas.

The initiative represents part of PAHO's 'Shared Agenda' programme in which the organisation collaborates with its national and international partners on health promotion programmes. It is being undertaken in partnership with the World Bank, the IDB/Jose Luis Bobadilla Inter-American Network, the United States Agency for International Development (USAID), and supported by the Mexican Health Foundation (FUNSALUD).

Participants

Some 40 participants representing eight Caribbean countries and Mexico are to benefit from a training course on the 'Development of National Health Accounts (NHAs)' to be held at the Caribbean Programme Co-ordination (CPC), Office of the Pan American Health Organisation (PAHO) September 10-14. The countries involved are Barbados, Belize, Commonwealth of Dominica, Guyana, Jamaica, Mexico, Trinidad and Tobago, St. Vincent and the Grenadines and Suriname. The other countries of the English-speaking Caribbean will participate in a subsequent training course to be held in 2002. The training course is part of a wider training initiative being undertaken in two phases over the next 24 months aimed at strengthening the NHA capacity of Caribbean countries.

The opening session on Monday, September 10, will be attended by a range of personalities from the health and financial sectors and the foreign missions based in Barbados. Those scheduled to address the session will be the Minister of Health for Barbados, Senator Philip Goddard, PAHO's Caribbean Programme Co-ordinator (CPC) Mrs. Veta Brown, the Representative of the Inter-American Development Bank in Barbados, Mr. Jeremy Gould, and the acting director of Projects, Caribbean Development Bank, Dr. Jeffery Dellimore.

Reflecting on the significance of the initiative to Caribbean countries, PAHO's advisor on Health Systems Development Ms. Marilyn Entwistle said that national health accounts can be an essential input into sound policy judgement. "The main objective of NHA is to describe the flow of resources and expenditures within the health care system," Ms. Entwistle said.

The extensive training agenda includes a demonstration of how NHA can contribute to the analysis of health financing at the national level and to the development of reform strategies; the NHA macro-economic and macro-social accounting methodology; and the NHA approach in undertaking disease-specific analyses. Participants in the first training course will subsequently undertake preliminary calculations of the national health accounts in their own countries and later share these results at a regional workshop in 2002.

Relevance

Explaining the relevance of National Health Accounts to the policy-making process, Ms. Entwistle said that the estimates generated during health accounting can help policymakers determine the level of efficiency of the health care system, and so identify areas of under or overspending. "Efficiency in national health accounting helps countries to respond to such questions as how well resources were being used to meet the health needs of individuals, families and communities and to justify further allocations on health interventions," she said.

Increasing importance appears to be ascribed by donor agencies and institutions to NHA efficiency and transparency, according to the Inter-Agency on National Health Accounts, the website that provides users with up-to-date information about public and private spending on health services in Latin America and the Caribbean.

Although interest in NHA activities has been growing in the Caribbean, NHA efforts in this region have until now been sporadic, transitory and carried out in isolation. The PAHO-led training intervention signals a new dimension in the region's health reform agenda, and is consistent with the Caribbean Co-operation in Health II (CCH II) initiative which includes the strengthening of health systems and services in the region among its eight priority health issues to be addressed over the next decade.

Increased activities have occurred in this area since March of this year. At that time the CPC office established a Steering Committee to promote the implementation of NHA activities in the English-speaking Caribbean. The NHA Steering Committee comprises of representatives of a range of national, regional and international agencies and organisations. These are:

Local and central offices of PAHO

Inter-American Development Bank

The Caribbean Development Bank

The Eastern Caribbean Central Bank

CARICOM Secretariat

The Organisation of Eastern Caribbean States

The Ministry of Health, Jamaica

The Ministry of Finance, Barbados

The University of the West Indies

Following a two-day meeting of the Steering Committee in Barbados in March, an action plan was drafted for the development of NHA in the Caribbean. The five-day workshop which opens on Monday, represents a key element in the Action Plan.

"As the initiative progresses it will not only depend on external support from organisations and institutions like PAHO," Ms. Entwistle affirmed, "but from the inputs from the Ministries of Health and the countries' ownership, also on efforts to incorporate the data into routine health information data systems," she maintained.

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