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Celebrating NHA's 10th Anniversary at the 4th Global NHA Symposium

Participants attentive during morning plenaryParticipants from 64 countries traveled to Barcelona, Spain to attend the 4th Global Symposium on National Health Accounts (NHA), July 7-8, 2005. Sponsored by the U.S. Agency for International Development (USAID) through its Partners for Health Reformplus (PHRplus) project, and the Swedish International Development Cooperation Agency (Sida) through the Swedish Institute for Health Economics (IHE), the Symposium drew positive reviews from its nearly 170 participants.

The event, held in conjunction with the biennial International Health Economics Association (iHEA) conference, celebrated 10 years of countries conducting NHA analyses. Also a working meeting, this year’s Symposium focused on the following topics:

  • Global NHA findings and trends
  • NHA subanalyses in priority areas such as HIV/AIDS, malaria, child health, reproductive health, and dengue fever
  • The role of regional NHA networks in institutionalizing the methodology
  • Six regional NHA network overviews, with selected country presentations

As in past years, participants came from diverse backgrounds: policymakers, country experts, health economists, university professors, and international donor representatives. Growth in Symposium attendance – from 106 participants representing 38 countries in 1999 to this year's 170 participants from 64 countries – is evidence of the increasing global interest and use of NHA as a comprehensive and successful tool for both measuring health expenditures and impacting policy change.

Keynote address by Honorable Charity Ngilu, Minister of Health of KenyaThis year's theme, “Involving Leaders, Impacting Policy: Tracking Investment in Priority Health Care,” resonated throughout the Symposium. In an opening-day keynote speech, the Kenyan Minister of Health, the Honorable Charity Ngilu, pointed to a 33% increase in her ministry's 2005-2006 budget as a result of findings from the general NHA as well as the HIV/AIDS subanalysis, completed and disseminated in Nairobi in early 2005. The Minister encouraged other countries to make NHA part of their ministries’ planning and resource allocation process.

What's Next for NHA?

As in past years, topics such as methodological developments, institutionalization of NHA, identifying essential linkages, and encouraging increased use and ownership of data were discussed. However, this year’s agenda broadened the discussion by offering sessions on NHA approaches and subanalysis-work; anticipating next steps for NHA.

In the opening day's second keynote address, Dr. Paul DeLay, director of evaluation for the Joint United Nations Programme on HIV/AIDS (UNAIDS), emphasized the policy value of the recently developed NHA subanalyses, which address priority health care. He also summarized the Symposium on day two, highlighting observations made by participants and presenters on the next steps in NHA's growth and improvement. He stressed the need to build NHA into broader health information systems by encouraging NHA institutionalization and clarifying the strengths, weaknesses, and comparative advantages of health account methodologies such as Public Expenditure Reviews (PER) and Medium Term Expenditure Frameworks (MTEF). For further institutionalizing NHA, Delay proposed expanding the role of subanalyses by developing models and better defining the boundaries for subanalyses.

Delay's concluding remarks underlined the need for improved standardization of instruments, perhaps by developing and/or improving existing software to facilitate the use of data and/or exhibit better graphics. Dr. Delay also recommended that local training capacity sites be identified to encourage sustainability and institutionalization of NHA and that regional NHA networks be strengthened to allow for increased and improved cross-country comparisons and meta-analyses of data.

Professor Joseph Newhouse of Harvard University discusses his keynote address with symposium participantsIn the second day's keynote address, Dr. Joseph Newhouse of Harvard University encouraged participants to broaden their vision of NHA as a policy tool. He noted that an area for immediate action is for countries to look beyond the NHA numbers and examine what their expenditures are buying in terms of health outcomes, outputs, and quality. He emphasized the need to expand NHA to measure time used in the production of health services and to link NHA with outputs, outcomes, and impact (effectiveness, equity, efficiency). Time is an important non-market input NHA must begin to account for as it evolves and matures. Dr. Newhouse also encouraged participants to consider the inferences found in comparing spending across time and space in the aim to expand NHA data use. He emphasized the continued need to identify ways to increase use of data.

In closing remarks, Karen Cavanaugh of USAID and Peter Iveroth of Sida recognized and thanked the participants, presenters, and organizers for the success of the Symposium. They echoed many presenters’ thoughts and comments by emphasizing the importance of discussing and developing NHA not only for national policy purposes but also for international comparability.

At the conclusion of the Symposium, USAID convened a meeting attended by country and donor representatives to discuss potential follow-up steps for donors to support NHA in response to the needs and challenges identified in the Symposium. The notes from this meeting can be accessed here.

NHA Symposium Sponsorship

The Symposium co-sponsors, Sida-funded IHE and USAID-funded PHRplus project, thank participants and funders for continued interest and participation in the Symposium. The presence of many participants at the Symposium was made possible by the generous sponsorship provided by collaborating organizations such as: UNAIDS, the World Health Organization, the World Bank, Novartis, Open Society Institute, and Soros Foundation. Their continued support allowed this year’s Symposium to serve as a forum for a valuable discussion of the sustained use and advancement of NHA globally.

Presentations and the Participant List from the 4th NHA Symposium

A copy of the program, agenda, and participant list is posted here and NHA presentations can be downloaded from the agenda.

For more information about this year's Symposium, please e-mail Lillian Kidane at lillian_kidane@abtassoc.com.

The 5th Global NHA Symposium organized by Sida/IHE, will be held in Sweden in 2007.


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