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nmqwertyuio MINISTRY OF HEALTH

JUNE 2011

pasdfghjklzxcvbnmqwertyuiopasdfgh National Health Accounts, 2009

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TABLE OF CONTENTS

LIST OF ACRONYMS ............................................................................................................................ 4

ACKNOWLEDGEMENTS...................................................................................................................... 5

EXECUTIVE SUMMARY ....................................................................................................................... 6

1. BACKGROUND INFORMATION.................................................................................................... 7

1.1 SOCIO-ECONOMIC BACKGROUND ............................................................................................ 7

1.2 DEMOGRAPHIC AND HEALTH TRENDS ..................................................................................... 7

1.3 THE HEALTH SYSTEM ORGANIZATION IN SEYCHELLES ........................................................10

2. METHODOLOGY............................................................................................................................11

2.1 CONCEPT OF NHA AND NHA DEVELOPMENT IN SEYCHELLES ............................................11

2.2 PRIMARY DATA...........................................................................................................................12

2.3 SECONDARY DATA .....................................................................................................................12

2.4 DATA LIMITATIONS....................................................................................................................13

3. FINDINGS OF THE FIRST NHA......................................................................................................13

3.1 OVERVIEW ...................................................................................................................................13

3.1.1 GOVERNMENT BUDGET ALLOCATION, 2005 - 2009..........................................................14

3.1.2 COMPARING SEYCHELLES NHA INDICATORS WITH OTHER COUNTRIES.......................15

3.2 FINANCING SOURCES: WHERE DO THE FUNDS COME FROM? ..........................................16

3.3 FINANCING AGENTS: WHO MANAGES THE HEALTH FUNDS? ............................................16

3.4 HEALTH CARE PROVIDERS: WHO USES HEALTH FUNDS TO DELIVER CARE? ...................17

3.5 FUNCTIONS: SERVICES AND PRODUCTS PURCHASED WITH HEALTH FUNDS..................19

National Health Accounts, 2009

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4. POLICY IMPLICATIONS.................................................................................................................22 4.1 CONCLUSION AND RECOMMENDATIONS..............................................................................22 4.2 TOWARDS INSTITUTIONALIZATION ........................................................................................23

National Health Accounts, 2009

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LIST OF ACRONYMS

CEO ECSA-HC EPI GDP GNI GOS ICHA MOF MOH NAFT NCD NGOs NHA NIHSS NSB OECD OOP SACOS THE WHO AFRO WHO WHO/POA USAID

Chief Executive Officer Eastern and Southern African ? Health Community Expanded Program of Immunization Gross Domestic Product Gross National Income Government of Seychelles International Classification Health Accounts Ministry of Finance Ministry of Health National Aids Trust Fund Non-Communicable Diseases Non-Governmental Organisations National Health Accounts National Institute of Health and Social Studies National Statistics Bureau Organization for Economic Cooperation and Development Out-of-Packet State Assurance Company of Seychelles Total Health Expenditure World Health Organization African Region World Health Organization World Health Organization / Plan of Action United States Agency for International Development

National Health Accounts, 2009

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ACKNOWLEDGEMENTS

The Ministry of Health acknowledges the cooperation, commitment and support of the multi ? sectorial team comprising:

Name Dr. Cornelia Atsyor Dr. Shobha Hajarnis Mr. Jean Malbrook Mr. Joachim Didon Ms. Annie Dugasse Ms. Laura Ah-Time Mr. Guillaume Woodcock Mr. Terence Morel Mr. Guy Hoareau Mrs. Gemma Barbier

Mr. Henry Bastienne Mrs. Malcy Tambara Mrs. Eline Moses Ms. Josie Chetty Ms. Maggie Ah-Weng

Ms. Jane Victor Mr. Michael Charlette

Designation

Organization

Liaison Officer

World Health Organization

Director General ? Public Health

Ministry of Health

Economist

Ministry of Health

Principal Statistician

Ministry of Health

Policy Analyst

Ministry of Finance

CEO/NBS

National Bureau of Statistics

Senior Statistical Assistant

National Bureau of Statistics

Financial Controller

Ministry of Health

Finance Manager

Ministry of Health

Director ? Resource Planning & Ministry of Health

Development

Information & Promotion Officer

World Health Organization

Manager ? Overseas Treatment

Ministry of Health

Information & Communication Officer Civil Society ? LUNGOS

Pharmacist

Private Pharmacy

Insurance Officer Senior Research Officer

State Assurance Corporation of Seychelles Social Development Department

Director International Cooperation

Ministry of Health

Special thanks go to Mr. Netsanet W. Workie (Senior Health Economist, World Bank) and Mr. Driss Zine-Eddine El-Idrissi (Senior Health Economist, World Bank) who conducted the training and guided the multi-sectorial team on the NHA compilation exercise.

National Health Accounts, 2009

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EXECUTIVE SUMMARY

This report provides detailed results of Seychelles first National Health Accounts (NHA) exercise, for the financial year 2009. The study was conducted to shed light on the distribution of funding for health care from public, private, and donor sources and to inform the government on health expenditure trends to improve health system management and resource allocation.

Seychelles has a pluralistic health care system, with different public and private providers and financing agents. The major health care provider is the Government (Ministry of Health). The health service is financed by the government of Seychelles, external sources (donors & rest of the world)1, parastatals and the private sector (households and NGOs). In 2009, Seychelles spent SR 353 million on health care. This is equivalent to 3.3 percent of GDP or SR4, 048 ( US$297) per capita Out of the Total Health Expenditure, 87 percent was financed by government, 7 percent by the private sector including household out-of-pocket payments, and 6 percent from international partners. 90 percent of the total health spending was managed by the Ministry of Health. The Seychelles Hospital received the highest amount with SR129,434,338 (36 percent of the total health spending), followed by Government Health Administration with SR 49,335,150 (14 percent), Public Health Centres with SR 48,996,026 (14 percent), and the Rest of the World as providers of Overseas Treatment accounted for SR 20,048,162 (7 percent) in 2009. In terms of functions, inpatient care took the lion's share with 43 percent of the total health spending; followed by outpatient care with 25 percent; and private dental care, private pharmaceutical and prevention and public health, each accounted for 3 percent of total expenditure. Of the total Out-of-Pocket expenditure of SR 18,347,256, 37 percent was spent on pharmaceuticals and appliances, 31 percent on overseas treatment, 25 percent on private doctors, and 7 percent on dental care.

Section one portrays the socio-economic background of the country and its situation in 2009 in terms of common indicators such as GNI per capita and GDP per capita. It also highlights the demographic and health trends through various indicators. It illustrates how the health system is organized.

This is followed by the concept of National Health Accounts, its development in Seychelles and the methodology used to conduct the 2009 National Health Accounts exercise.

In section three the document analyzes the findings of this exercise. It examines Government contributions in term of budget allocation to the health sector in relation to the National Budget as part of the African States commitment to the Abuja Declaration, 2001 which stipulates that15 percent of the National Budget should be committed to health sector. It evaluates the National Health Accounts results through the four basic matrices: financing sources, financing agents, health providers and health functions. These entities answer the questions:

Where does the money come from? Who manages and organizes the funds? Who uses the health fund to deliver care?; and What types of health services are being provided and to whom?

Lastly, it addresses the policy implications based on the findings, provides recommendations on areas that the government need to address, the challenges in the health system and the process towards institutionalization of National Health Accounts in Seychelles.

1 Bilateral & Multilateral agreement National Health Accounts, 2009

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1. BACKGROUND INFORMATION

1.1 SOCIO-ECONOMIC BACKGROUND

With its land area of 444 sq. km., the Republic of Seychelles consists of an archipelago of about 116 islands in the South-Western Indian Ocean more than 1,500 km from the East Coast of Africa, indicating its remoteness from the mainland continent. The country's exclusive economic zone, however, covers an area of 1.3 million sq. km. The main islands are Mah?, Praslin and La Digue and together they share the bulk of all economic activities. Victoria, the capital of Seychelles, is located on Mah?, the largest of the three main islands. Whilst the three main islands are permanently inhabited, the remaining islands are sparsely populated and on some, residence is not permanent.

The Republic of Seychelles achieved its independence from Britain on 29th June 1976. The first multi-party presidential and national assembly (parliamentary) elections were held in 1993. The constitution, adopted in 1993 guarantees fundamental human rights, ensures equal opportunity and protection for men and women, and provides for the separation of powers of the three branches of government (the Executive, the Legislative and the Judiciary). The National Assembly has 34 members, 25 of whom are elected and 9 nominated on a proportional basis.

Seychelles was not spared the impact of the severe world economic crisis of 2008. With the assistance of the IMF, it embarked on a Macroeconomic Reform Programme towards the end of 2008 to address the macroeconomic imbalances and its unsustainable debt burden, in order to sustain the past achievements in its socio-economic development.

Gross National Income (GNI) per capita declined from US $9,343 in 2008 to US $7,760 in 2009, a decline of 16.9%, while the GDP per capita declined by 15% between 2008 and 2009. The inflation rate increased from 5.3% in 2007 to 37.0% in 2008 and 31.7% in 20092. With a Human Development Index of 0.845, Seychelles is grouped among 45 "high human development" nations with a figure between 0.800 and 0.900. Among these, Seychelles is placed 19th, while its global rank is 57th out of 182 countries, including those with "very high human development" ? also called "developed countries".

Although Seychelles is categorized as a middle income country, with a high Human Development Index, the economy is very vulnerable to external economic shocks such as the rise in world fuel and food prices which impacted on the fragile economy. With the commitment of the government, it has been possible to sustain the impacts of these shocks through appropriate policy measures.

1.2 DEMOGRAPHIC AND HEALTH TRENDS

The mid-year population estimate for 2009 was 87,298. There were 24,142 households in 25 districts. The average household size dropped from 5 in 1971 to 3.7 persons in 2010. Adult literacy is high, stable at 96% over the years3. A demographic transition of an upward population shift from a younger to an older population is occurring since 1971 leading to increasing ageing population ratio and with concomitant epidemiological transition to non-infectious diseases. Table 1 below shows some of the basic demographic and health trends in Seychelles from 1990 to 2009.

2 National Statistics Bureau Bulletin 3 NSB Bulletin "Population Statistics and Vital Statistics No.1 of 2010" National Health Accounts, 2009

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Table 1: Demographic and Health Trends

1990 1995

Population

69,507 75,304

Life expectancy (average both sexes)

67.7

72

Under 5 Mortality Rate, per 1,000 live births 14.8 20.2

Infant Mortality Rate, per 1,000 live births

13.0 18.3

Immunization (%)

86

97

Maternal Mortality Ratio, per 100,000 live

births

0

68

Skilled delivery (%)

98

99

Contraceptive Prevalence Rate

n/a n/a

Adolescent Fertility Rate*

61

59

Prenatal care

n/a n/a

Source: Epidemiology & Statistics Section ? Ministry of Health

Note: * (Births per 1,000 women aged 15 ? 19)

2000 81,131

72.7 9.2 9.9 97

0 99 n/a 55 99.7

2005 82,852

71.9 11.1

9.8 100

65 99 n/a 59 99.9

2006 84,600

72.2 10.9

9.5 100

0 99 38 54 99.8

2007 85,032

72.9 12.7 10.7 100

0 100

36 63 99.2

2008 86,956

73.1 14.9 12.9 100

65 100

35 63 99.8

2009 87,298

72.8 12.7 10.8 100

0 99 36 73 99.8

The Government of Seychelles provides free basic health service to the entire population. This is enshrined in the Constitution of the Republic of Seychelles and the Health Policy Declaration, which underscores the principles of basic human rights and equality equity.

The government health expenditure was 8.6 percent of the general government expenditure in 2009. A three-tier health care system exists with the bulk of highly specialized treatment provided overseas and almost fully funded by government. In 2009, the government spent SR 9.9 million on overseas treatment.

Seychelles has achieved impressive health care indicators and is on track for most of the Millennium Development Goals. Health outcome indicators compare favourably with many other small islands states and OECD countries.

As presented in Table 1 above, life expectancy at birth for both sexes is 73 years; under five mortality is 12.7 per 1,000 live births and no maternal deaths were recorded in 2009. Since 2000 a total of four maternal deaths are registered, one maternal death in each year for 2002, 2004, 2005 and 2008.

In the last nine years, the infant mortality rate averaged at 11 per 1,000 live births. This translates to

an average of 16 infant deaths per year. Neonatal death accounts for 75 percent of infant mortality in Seychelles (50 percent early neonatal death ? in the first week and 25 percent late neonatal death ? weeks 2 to 4), Targeted neonatal strategies and interventions can lead to further reduction in infant mortality and accelerate progress towards

Box 1. Recently the Government introduced MDG plus targets. Targets for the health MDGs include:

MD Goals + 4 and 5: Reduce the prevalence of pregnant women involved in risky behaviour that endangers the life of their unborn child

the achievement of MDG 4. It has been MD Goal+ 6: Reduce prevalence rates of HIV in

recommended that the Ministry of Health diagnose

MARP

and understand the reasons for the high neonatal

mortality and introduce appropriate measures to reduce this.

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