1. National Health Accounts: What do they reveal in Côte d’Ivoire? Anne Juillet Health Systems 20/20, Abt Associates June 15, 2011 Global Health Conference Washington, DC

2. Introduction Context Until 2009, Côte d’Ivoire did not have a comprehensive system to determine funds available for service provision within the health sector Objective Estimate the contributions of different public and private stakeholders within the health sector Improve financial management Ensure that funding is effectively and adequately allocated; Provide data for decision-makers

3. Methodology National Health Accounts (NHA) Internationally recognized tool which synthesizes and monitors trends in health spending Integrates the collection, processing, and analysis of both primary (private enterprises, insurance companies, donors, and international NGOs) and secondary data (Ministry of Health, households, and national institutions) Examine health expenditures in Côte d’Ivoire in 2007 and 2008

4. Results Health sector’s programmatic priorities in Côte d’Ivoire: Responsible, equitable and effective health system in which all the inhabitants of Côte d’Ivoire have access to quality care throughout the entire country Specific requirements: 1- Restore the health system in post-conflict areas 2- Base system on primary health care at district level 3- Improve availability and accessibility of essential medicines including ARVs, blood products, and vaccines 4- Implement new mechanisms of financing based on national or community solidarity

5. Results Total expenditures on health increased by 9.9% between 2007 and 2008: 2007: US $1,164,133,665 ( or US $58/person ) 2008: US $1,368,600,860 ( or US $66/person ) Total spending on health in Côte d’Ivoire is much higher than in other sub-Saharan countries where the average is US $30/person

9. Out-of-pocket (OOP) spending represents 66% of THE in 2008

10. Risk sharing (insurance) schemes are underdeveloped and not widely available throughout the country

12. 8% THE is dedicated to public health services

13. Expenditures on contagious diseases represent 5.3% of THE

16. To improve the efficiency and effectiveness of health care delivery, Côte d’Ivoire should: Develop a national policy for supplies and distribution of essential medicines to reduce OOP spending Develop a national or community insurance system Give priority to delivery of space primary health care services and public health interventions Recommendations

17. Contacts Abt Associates, HealthSystems20/20 Abidjan, Côte d’Ivoire Anne JUILLET (ajuillet@abtremote.com) Désiré BOKO (desire.boko@abtremote.com) Ministryof Health, Finance Department Abidjan, Côte d’Ivoire Marina YO (yemath@yahoo.fr) Mathieu KOUASSI (mathieu_2k@yahoo.fr) Salif KONE (ksalif@yahoo.fr)

18. Thank you www.HealthSystems2020.org