Health financing profile 2017 Nepal Context: Macroeconomic situation Population (million) General financing GDP (billion current US$) GDP per capita (current US$) GDP annual growth (%) Total government revenue* as % of GDP Population living below poverty line at $1.90 a day (2011 PPP) (% of population) Health financing CHE as % of GDP CHE per capita (current US$) GGHE-D as % of GDP GGHE-D per capita (current US$) Out-of-pocket payment as % of CHE 2015 2015 2015 2015 2015 6.15 44.42 1.11 8.05 60.41 2016 2016 2016 2016 2010 21.14 729.53 0.6 18.7 % of GGE
Government spending on health 28.98
2016
Fig. 3: Domestic general government health expenditure on health (GGHE-D) as a % of general government expenditure (GGE), 2002–2015 14 12 10 8 6 4 2 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
14.99
CHE: current expenditure on health; GDP: gross domestic product; GGHE-D: domestic general government health expenditure * Total taxes and other revenues received by the national government (excluding grants)
Spending per person on health ($), by source Fig. 4: Current health expenditure (CHE), domestic general government health expenditure (GGHE-D), out-of-pocket (OOP) payment, per capita US$, 2000–2015 250 200 Per capita in US$ 150 100 50 0
Since 2000, how has health financing changed? Overall spending on health Fig. 1: Current expenditure on health as a % of GDP, 2000–2015 10 9 8 7 6.15 5.68 5.82 6 4.97 5.08 5.17 4.62 4.55 4.51 4.45 4.45 4.44 5 4.04 4.19 4.35 4 3.57 3 2 1 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 GGHE-D + External resource PVT-D CHE
% of GDP
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
CHE
GGHE-D
OOP
CHE: current expenditure on health; GDP: gross domestic product; GGHE-D: domestic general government health expenditure; PVT-D: domestic private health expenditure *PVT-D refers to spending on health including voluntary health insurance schemes, enterprise financing schemes and household out-of-pocket payment
Share of OOP expenditure (%) Fig. 5: OOP payment as a % of current expenditure on health, 2000–2015 90 80 70 60 % of CHE 50 40 30 20 10
Sources of health revenue Fig. 2: Share of revenues for health as a % of current expenditure on health, 2000–2015 90 80 70 60 50 40 30 20 10 0
% of CHE
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 GGHE-D PVT-DE XT
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
CHE: current expenditure on health; GGHE-D: domestic general government health expenditure; PVT-D: domestic private health expenditure; EXT: external health expenditure
Funding for health by donors Fig. 6: External health expenditure (EXT) as a % of current health expenditure (CHE), 2000–2015 30 25 20 % of CHE 15
Key messages ~~
Current health expenditure (CHE) as a share of gross domestic product (GDP) has continuously increased from 2006 to 2016, mostly driven by out-of-pocket (OOP) spending. Government spending on health has remained low during the entire period. Out-of-pocket (OOP) expenditure has remained almost flat in the past decade. External funds for health, have been decreasing in relative terms, in the recent years Financial hardship, more than 10.7% of people, or a total of more than 3 million people, had a burden expenditure on health larger than 10% of their total expenses. Additionally, 1.67% of the population was pushed below the poverty line of PPP$ 1.90 per capita per day.
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10 5 0
~~
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
How many households experience financial hardship from health-care expenditure? Table 1 Catastrophic health expenditure and impoverishment due to health spending, Nepal, 2014–2015 Catastrophic expenditure Impoverishment due to OOP Poverty line = PPP$ 3.10 3.44 0.97
Sources 1. Economic Survey, Ministry of Finance, Nepal; 2016 2. World Development Indicators, World Bank website, 2017 Global development indicators. In: The World Bank [website]; 2017 (https://data.worldbank.org/indicator/, accessed 23 November 2017). 3. Indicators and data: In: WHO Global Health Expenditure database [online database] updated 20 November 2017 (http:// apps.who.int/nha/database/Select/Indicators/en, accessed 23 November 2017). 4. Vinyals i Torres, L. et al. Assessment of the Government Health Financing System in Nepal: Suggestion for Reform. Deutsche Gesellschaft fur Internationale Zusammenarbeit (GIZ) GmbH; 2014, page 6
Population
Threshold Threshold Poverty line = 10% = 25% = PPP$ 1.90 10.71 3.03 2.41 0.68 1.67 0.47
% Headcount (million)
Source: Nepal: Living Standards Measurement Survey (LSMS) (annual household survey), 2014–15. Calculations by staff of the WHO Regional Office for South-East Asia.
Health financing flows Fig. 7: Health financing flow External partners I/NGOs Central & Regional offices/ agencies Centres
Public providers District (public) Health offices District hospitals, PHCCs & HPs
MoH MoF MoFALD Local bodies (Village Councils, Municipalities, District Coordination Committees
Departments Regional offices Side business (e.g. rental services)
Budget allocation
Central, regional, zonal hospitals
Private providers Hospitals Not for profit For profit Clinics/ pharmacies Informal providers Overseas treatment
SHSDC (Health Insurance) (MoH supported )
Tax & nontax collection
Enrollees’ contribution Reimbursement to users
CBHI (few local areas) (MoH supported)
Population Users
Users fee Transfer to users Legend:
Firms / Companies
Contribution on behalf of employees
Private insurance
Financing source Financial agents Providers Fund collection / Allocation
Source: Adapted from Vinyals i Torres, L. et al; 2014, page 6; updated based on recent structure by WHO SEARO and WCO Nepal.