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National Health Accounts

A National Health Accounts (NHA) framework is one way to organize, tabulate, and present health sector expenditure information. The experience that the United States and the nations of the Organization for Economic Cooperation and Development (OECD) have had with the NHA methodology shows that the NHA matrices can highlight policy problems, enhance cross-country comparability, and thus increase the likelihood that data collection efforts will be repeated regularly.

The Harvard NHA software v.1 was developed in 1996. However, variants of the NHA methodology have been utilized in the United States and OECD countries for the past 20 years. NHA v.2 is available in spring 2001 from the PHR project or IHSP directly.

The NHA framework elaborated in this software package is designed to capture the totality of expenditure flow in the health sector. The framework does not include standard definitions and categories-these must be determined through a combination of national and international discussions and consensus about priorities. It does, however, provide an analytical framework consisting of three essential elements: First, it requires the calculation and presentation of national estimates through a "sources and uses" matrix. Second, it allows for extensive disaggregation of the sources of spending beyond the general categories of "public" and "private". Third, it provides a systematic framework for defining uses according to several important, and mutually exclusive, classifications.

The NHA software is thus a tool that can be used to organize, describe, and present expenditure data. In addition, the software is intended to support analysts and policymakers in their data collection and analysis and in their advocacy efforts with decision makers. The program's graphical capabilities allow policymakers to view the structure of health sector financing flows clearly and quickly.

The NHA software has now been used successfully by several countries in Latin America, Southern and Eastern Africa, and the Middle East-a total of about thirty countries.