Background:
The magnitude, efficiency and equity in health financing determine the pace at which individual countries are able to achieve national health development objectives and the Millennium Development Goals (MDGs). The fifty-sixth WHO Regional Committee for Africa resolution on health financing urges member states to strengthen or develop comprehensive health financing policies. The objectives of this article are to present analyses of health financing trends and a key informant survey conducted in Eritrea to harvest the views of relevant government ministries to inform development a national health financing policy (NHFP).
Methods:
This is a descriptive study with two dimensions. First, an analysis of 1996-2008 health expenditure trends using national health accounts (NHA) estimates from WHO NHA Database. Second, a questionnaire was prepared and administered to 16 senior staff (Directors) in the Ministry of Health (MOH), Labour Department, Civil Service Administration, Eritrean Confederation of Workers (ENWC), National Insurance Corporation of Eritrea (NICE) and Ministry of Local Government (MOLG). Those respondents were purposively selected by the MOH as key informants. The main weakness of this study was that its scope was very limited. It did not include Ministry of Finance; health development partners in the country; and representatives of other stakeholder groups, e.g. civil society organizations, non-governmental organizations and private sector.
Results:
Health financing trends analysis revealed that: (i) Eritrea total health expenditure (THE) as a percentage of GDP increased from 4.4% in 1996 to 6.4% in 2002 and there after decreased to 3.1% in the year 2008; (ii) government expenditure on health as a percentage of general government expenditure of 3.7% in 2000 and 3.0% in 2008 was lower than the African Region average of 8.2% and 9.6% respectively; (iii) total per capita expenditure on health reached a peak in 1997 at US$11 and decreased to a low of US$8 in 2003 and then increased to US$10 in 2008; (iv) per capita Eritrean government expenditure on health of US$4 in 2000 and 2008 was lower than the African Region average of US$15 in 2000 and US$83 in 2008; (v) private expenditure on health (all from out-of-pocket payments) decreased from 51.6% in 1996 to a minimum of 35.0% in 1999 and then increased to a maximum of 63.9% in 2002 before decreasing again to 55.1% in 2008; and (vi) external resources spent on health as a percentage of THE grew steadily from 17.7% in 1996 to 60.8% in 2008.Key informant survey analysis showed that (i) key phrases for inclusion in the vision of Eritrean health financing policy (NHFP) are equitable and accessible quality health services (6/16), and improve efficiency or reduce waste (3/16); and (ii) NHFP objective should include securing adequate funding (15/16), ensuring efficiency (14/16), ensuring equitable financial access (13/16), protection from financial catastrophe (11/16), and ensuring provider payment mechanisms create positive incentives to service providers (11/16); among others.
Conclusion:
The development of NHFP ought to be informed by evidence from NHA and stakeholder views, among other evidence.
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