Summary
The goal of the Asian Development Bank (ADB) Strengthening Capacity for Health Sector Governance Reforms project was to strengthen governance and accountability for health financing by providing support in budget reform, provincial planning and budgeting, financial management, human resources for health planning and management, and health information systems. ThinkWell provided technical support and capacity building to the Ministry of Health (MOH) in the production of National Health Accounts (NHA), a standardized and internationally recognized methodology to measure health expenditure. ThinkWell also supported the development of a national health accounts production processes and worked with the MOH, the Ministry of Finance, World Health Organization, the World Bank, and other partners to strengthen the use of NHA results to inform resource mobilization, policy development, planning, and resource allocation.
Breaking New Ground
Health accounts had been produced in Laos since 2010, but findings were never fully integrated into existing processes of policy development and implementation. The project identified and implemented innovative ways to ensure that health accounts were produced and disseminated to maximize policy use. ThinkWell conducted key informant interviews, workshops, and policy dialogues to build an understanding of the policy relevance and limitations of health accounts. In addition, we applied innovative tools such as data visualization to maximize the impact of health accounts’ results.
Challenges
The Ministry of Health’s (MOH) technical team that was responsible for health accounts production faced challenges including data availability and quality. The focus on data collection limited the time available for analysis, presentation, and dissemination of findings. The project therefore established innovative processes to collect data and strengthened the capacity of provinces to prepare, provide, and use health account data for policy and planning.
Approach
ThinkWell applied a mix of technical support and capacity building to the Department of Finance within the MOH to strengthen capacity to systematically collect, analyze, and present data. We also provided advice on how to increase the government and development partners’ use of health account data for advocacy and policy use.
Lao National Health Accounts Report 2013-2016
The report presented findings of the National Health Accounts (NHA) 2013-2016 in Lao PDR. The NHA’s preparation was led by the Health Financing Policy Division, Department of Finance, MOH, with support from ADB, ThinkWell, and the World Health Organization. ThinkWell provided technical guidance and support during the report’s development. The MOH intended to conduct NHA on an annual basis starting in 2018 and have full ownership over the production of NHA. The report also includes selected results of the NHA 2011-2012 to increase the number of data points for the trend analysis. The NHA’s key findings show that (i) total health expenditure more than doubled between 2011-2016, (ii) subnational health spending increased compared to central government, reflecting the government’s decentralization approach, (iii) out-of-pocket expenditure was still the largest source of health spending etc. The report also included recommendations highlighting that efforts are needed to (i) achieve the expected result of the first phase of the Health Sector Reform, (ii) reduce household out-of-pocket expenditure and reach the national target, (ii) strengthen allocation of funding at provincial level and (iv) strengthen the collection process of financial information.