External resources for health (% of total expenditure on health)

Definition: External resources for health are funds or services in kind that are provided by entities not part of the country in question. The resources may come from international organizations, other countries through bilateral arrangements, or foreign nongovernmental organizations. These resources are part of total health expenditure.

Description: The map below shows how External resources for health (% of total expenditure on health) varies by country. The shade of the country corresponds to the magnitude of the indicator. The darker the shade, the higher the value. The country with the highest value in the world is Malawi, with a value of 87.77. The country with the lowest value in the world is Singapore, with a value of 0.00.

Source: World Health Organization Global Health Expenditure database (see http://apps.who.int/nha/database for the most recent updates).

See also: Country ranking, Time series comparison

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Development Relevance: Health systems - the combined arrangements of institutions and actions whose primary purpose is to promote, restore, or maintain health (World Health Organization, World Health Report 2000) - are increasingly being recognized as key to combating disease and improving the health status of populations. The World Bank's Healthy Development: Strategy for Health, Nutrition, and Population Results emphasizes the need to strengthen health systems, which are weak in many countries, in order to increase the effectiveness of programs aimed at reducing specific diseases and further reduce morbidity and mortality. To evaluate health systems, the World Health Organization (WHO) has recommended that key components - such as financing, service delivery, workforce, governance, and information - be monitored using several key indicators. The data are a subset of the key indicators. Monitoring health systems allows the effectiveness, efficiency, and equity of different health system models to be compared. Health system data also help identify weaknesses and strengths and areas that need investment, such as additional health facilities, better health information systems, or better trained human resources.

Limitations and Exceptions: Country data may differ in terms of definitions, data collection methods population coverage and estimation methods used. In countries where the fiscal year spans two calendar years, expenditure data have been allocated to the later year (for example, 2009 data cover fiscal year 2008/09). Many low-income countries use Demographic and Health Surveys or Multiple Indicator Cluster Surveys funded by donors to obtain health system data. External resources for health are disbursements to recipient countries as reported by donors, lagged one year to account for the delay between disbursement and expenditure. Except where a reliable full national health account study has been done, most data are from the Organisation for Economic Co-operation and Development Development Assistance Committee's Creditor Reporting System database, which compiles data from government expenditure accounts, government records on external assistance, routine surveys of external financing assistance, and special services. Because of the variety of sources, caution should be used in interpreting the data.

Original Source Notes: In some cases, the sum of public and private expenditures on health may not add up to 100% because of rounding. All the indicators refer to expenditures by financing agent except external resources which is a financing source. When the number is smaller than 0.05%, the percentage may appear as zero. In countries where the fiscal year begins in July, expenditure data have been allocated to the later calendar year (for example, 2008 data will cover the fiscal year 2007–08), unless otherwise stated for the country. For 2008, the use of yearly average exchange rates (compared to year-end exchange rates) may not fully represent the impact of the global financial crisis.

Statistical Concept and Methodology: Health expenditure data are broken down into public and private expenditures. In general, low-income economies have a higher share of private health expenditure than do middle- and high-income countries, and out-of-pocket expenditure (direct payments by households to providers) makes up the largest proportion of private expenditures. High out-of-pocket expenditures may discourage people from accessing preventive or curative care and can impoverish households that cannot afford needed care. Health financing data are collected through national health accounts, which systematically, comprehensively, and consistently monitoring health system resource flows. To establish a national health account, countries must define the boundaries of the health system and classify health expenditure information along several dimensions, including sources of financing, providers of health services, functional use of health expenditures, and beneficiaries of expenditures. The accounting system can then provide an accurate picture of resource envelopes and financial flows and allow analysis of the equity and efficiency of financing to inform policy.

Aggregation method: Weighted average

Periodicity: Annual