The Global Fund has invested approximately $4.5 million since 2012 to support health accounts through partnerships with WHO and country grants. This funding supports training and capacity building by WHO in shifting over 60 countries to the System of Health Accounts (SHA 2011), allowing distribution of expenditures by disease to be tracked. Over 70 health account exercises have been conducted. Health accounts data help inform grant management, performance indicators, results reporting, replenishment cases, and allocation. Three priority areas are distribution of expenditures by disease, government health expenditures without external resources, and comprehensive pharmaceutical expenditure breakdowns. Examples from Jamaica and Georgia illustrate how this data can be used.

1. Health Accounts
2 December 2016
Tallinn, Estonia

2. Global Fund and WHO Collaboration on Health Accounts
• The Global Fund through its partnership with WHO and country grants invests in a Health Accounts.
Since 2012 approximately $4.5millon investment
• Global Fund financing to for health accounts is twofold:
- Financing directly to the WHO for training and capacity building
- Board Policy: GF support of up to 50K USD per disease through grants (150K USD consolidated)
• Financed the WHO in supporting more than 60 countries to shift to the System of Health Accounts (SHA
2011) with distribution of expenditure by disease accounts. There are now more than 70 Health Accounts
exercises conducted.
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Background:

3. Why are Global Fund supporting health accounts?
• With the launch of the ‘New Funding Model’, the Global Fund has fully transitioned from a grant centered
approach to supporting national strategies; resulting in a shift of focus to national results, leveraging of
domestic resources, and strategic investment in priority funding gaps to maximize impact.
• This focus is further enhanced in the Global Fund Strategy 2017-22, entailing a substantive demand for
comprehensive data on costs and financing of national strategies to support development and
implementation of policies to further Global Fund objectives, setting strategic targets, monitoring their
performance, and reporting progress.
• Further, The Global Fund’s Policy: Sustainability, Transition and Co-financing lays out how the Global
Fund supports countries as they move toward domestically funded systems and national disease
responses
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4. Why are Global Fund supporting health accounts?
Data support key operational and strategic functions
Grant Management: Country dialogue on health financing strategies; sustainability, transition and co-
financing; monitoring implementation of co-financing policies; assessment of funding landscape and financial
gaps of programs; generating evidence for advocacy and engagement on domestic financing at different
levels
Corporate Key Performance Indicators: Measurement and reporting on strategic and implementation
KPIs on domestic financing
Results Reporting: Program finance data is a critical input for contextualizing Global Fund’s contribution to
the national results (reported through the new ‘Results Framework’ from 2017)
Investment Case for Replenishment: Provides the necessary data to build the investment case for
successive replenishments
Refining Global Fund Allocation: Provides data for contextual considerations to support and inform
qualitative adjustment of the Allocation
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5. Three priority areas to inform health financing policy
1. Distribution of expenditure by disease account
Availability of institutional mechanisms for routine tracking of health and disease expenditures is key to
sustainability of Global Fund programs through generation of evidence for engaging the political
leadership, supporting decision making by Ministries of Finance and advocacy by civil society
2. Data on government health expenditure without external resources
Separate out external resources (aid, loans, debt forgiveness, debt cancellation) distributed by
governments. tracking these financial flows over time can capture trends associated or consistent with
aid volatility, additionality and fungibility as well as the potential implications for sustainability
3. Comprehensive breakdown of pharmaceutical expenditure data
Information on the consumption of medicines can be used to better estimate out of pocket expenditure
by disease, set policy, improve drug safety, and drive investment decisions
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6. Distribution of expenditure by disease account - Jamaica
Last years Jamaica produced NASA (National Aids Spending Assessment), now considering doing health
accounts.
Such a change is important for GF because it will answer how the funding for the HIV response ‘’sits’’ and
compare within the rest of the health expenditures a country has
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7. Pharmaceutical expenditure data - Georgia
40 percent of spending on health in Georgia goes towards pharmaceuticals. This is very high by
regional and global standards: OECD countries spend on average about 17 percent of total health
expenditure on drugs; a typical range for middle income countries would be between 20 and 30 percent.
And still very little is known about pharmaceutical consumption patterns in Georgia
Hence in January 2017 we plan to start an assessment that will look into Improving Access to and
Affordability of Medicines in Georgia. In detail it will look at main issues: Pharmaceutical price survey,
External reference pricing study, Market research on consumption patterns, Pharmaceutical procurement
study. In relevance to GF we will first explore how TB drugs flow in the systems. Focus will be on private
retailers. We aim to answer questions like: are drugs sold for TB used for TB and if being used for TB, to
where is this then being sold (e.g. is it that these drugs are being bought by other wholesalers/pharmacies
just to feed into the private hospitals?)
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8. Thank you
Comments and suggestions
Geir Lie – geir.lie@theglobalfund.org
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