Measuring primary healthcare expenditure in low-income and lower middle-income countries

Abstract

Primary healthcare (PHC) is considered as the pathway to Universal Health Coverage (UHC) and to achieving sustainable development goals. Measuring PHC expenditure is a critical first step to understanding why some countries improve access to health services, provide financial risk protection and achieve UHC. In this paper, we tested and examined different measurement options using the System of Health Accounts (SHA) 2011 for systematic monitoring of PHC expenditure. We used the ‘first-contact’ approach to PHC and applied it to the healthcare function or healthcare provider classifications of SHA 2011. Data comes from 36 recent low-income and middle-income countries health accounts 2011–2016. Country spending on PHC varies largely, across countries and across definition options. For example, PHC expenditure ranges from US$15 to US$60 per capita. The sensitivity analysis highlighted the weight of including or excluding medical goods. The correlation analysis comparing countries ranking is strong between options. The study identified the major challenges in developing standard monitoring of PHC expenditure. One, there is a lack of clear operational definition for PHC, suggesting that a global standard definition would not replace the need for country context specific definition. Two, there is insufficient data granularity both because the standard framework does not offer it and because quality data breakdown is unavailable.

Guide posts for investment in primary health care and projected resource needs in 67 low-income and middle-income countries: a modelling study

“…This approach is consistent with others in the literature, such as the methodology used by WHO to estimate current PHC expenditure, based on the system of health accounts, which uses a functional classification of services provided to monitor PHC expenditure. 3 Another advantage of this approach is that the explicit definition of PHC interventions within a country's essential service package can be aligned with the prin ciple of progressive realisation of UHC (ie, increasing access to an expanding PHC intervention package over time). 11 Recognising the variation in PHC interventions among countries, we propose three measures of PHC, which represent a successive expansion of the scope of interventions (table 1).…”

“…Measure 1 includes preventive public health interventions and general outpatient services, and is thus largely consistent with the measure put forth for monitoring current expen diture as per the national health accounts framework. 3 Measure 2 broadens the scope of interventions by including non-specialised inpatient services, including uncomplicated deliveries and immediate neonatal care; it also captures a broader range of costs related to supportive health systems and health security, including compliance with the international health regulations. 14 Measure 3 goes further in capturing broader cross-sectoral investments that are important for health outcomes, such as water and sanitation, air quality improvements, road safety, and food safety, as well as broader health security (including animal health and zoonotic disease control).…”

“…2 Yet, only half of government spending in health across low-income and middle-income countries (LMICs) is currently allocated to primary care and public health interventions-ie, PHC services. 3 Ensuring quality PHC services should not be considered a low-cost strategy: investing in accessible health systems that provide a comprehensive set of interventions to all those in need can bring enormous benefits but will require significant financial investments. Among the commitments made at the Global Conference on Primary Health Care in October, 2018, countries and other stakeholders pledged to ensure adequate financing of primary health care in the Declaration of Astana.…”

“…7 Estimates of current PHC expenditure range between US$15 and $60 per capita in LMICs, depending on the definition applied. 3 At the country level, information on current spending can be compared against needs-based targets and projected costs for expanding service delivery, to inform resource allocation decisions.…”

Pharmaceutical promotion and guided‐prescription in low‐ and middle‐income countries: A need for new regulations

“…tries with a Gross National Income (GNI) per capita-calculated using the World Bank Atlas method-of ≤$1,025 in and between $1,026 and $3,995 in 2018, respectively (Vande Maele et al, 2019), are attractive to private pharmaceutical industry. Reasons for pharmaceutical industry growth in LMICs include a big number of pharmacies, large population, increasing drug expenditure per capita, and, most importantly, poor active monitoring of pharmaceutical marketing activities (Faisal, Ahmad, Thurasamy, & Ahmed, 2019).…”