Developing health accounts following SHA 2011: a situational analysis of countries in WHO Eastern Mediterranean Region

Background: National health accounts provide data for health-financing policy analysis, reforms and strategies to attain national health development goals and objectives such as universal health coverage. However, in the World Health Organization (WHO) Eastern Mediterranean Region there are many challenges, making it difficult for health accounts teams to provide timely reports and for policy-makers to use them to inform policy change. Aim: To undertake a situational analysis of health accounts in the Region and assess the health accounts production process. Additionally, the study looked at challenges facing health accounts teams in institutionalizing the health accounts process. Methods: The WHO Regional Office for the Eastern Mediterranean has been conducting country missions to its 22 countries to assist health accounts teams and assess the status of health accounts production and institutionalization. A survey administered at a regional training workshop in October 2018 examined the challenges and successes in health accounts production. Results: Three countries in the Region produce annual health accounts but most take several years between reports. Only 55% of the countries use System of Health Accounts (SHA) 2011 methodology while 27% still use SHA 1.0. The main challenges facing countries include a high turnover of employees involved in health accounts production, and time lag of data. Notable successes include policy changes based on health accounts findings. Conclusions: Few countries in the Region produce annual health accounts and many still use SHA 1.0. The commitment of a country's top management is vital to ensure successful health accounts production.