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WHO Health Expenditure and Financing Indicators
The World Health Organization (WHO), through its Global Health Expenditure Database (GHED), tracks health expenditure and financing trends worldwide. This data is critical for monitoring progress towards Universal Health Coverage (UHC) and informing national health policies. Health expenditure includes all spending on providing health services, family planning, nutrition activities, and emergency aid designated for health.
The GHED uses the internationally recognized System of Health Accounts 2011 (SHA 2011) framework to ensure consistency and comparability across countries and years. By analyzing how funds are raised, pooled, and used, these indicators help assess the efficiency and equity of health systems.
WHO Health Expenditure and Financing Indicators: Global Averages (2019-2021) 🌍
| Indicator | Unit | 2019 | 2020 | 2021 |
| Current Health Expenditure (CHE) | % of Gross Domestic Product (GDP) | $9.6\%$ | $10.1\%$ | $10.0\%$ |
| CHE per capita | Current International $ (PPP) | $\approx 1,700$ | $\approx 1,760$ | $\approx 1,820$ |
| Domestic General Government Health Expenditure (GGHE-D) | % of CHE | $\approx 59.1\%$ | $\approx 61.1\%$ | $\approx 60.7\%$ |
| Out-of-Pocket Expenditure (OOPE) | % of CHE | $\approx 18.2\%$ | $\approx 17.5\%$ | $\approx 17.7\%$ |
| External Health Expenditure (EXT) | % of CHE | $\approx 0.9\%$ | $\approx 1.2\%$ | $\approx 1.2\%$ |
Key Health Expenditure and Financing Indicators
The following table summarizes some of the core health expenditure and financing indicators published by the WHO, classified by their relevance to key financial aspects of a health system:
| Indicator Category | Core Indicator | Unit/Format | Significance and Relevance |
| Total Expenditure | Current Health Expenditure (CHE) as % of Gross Domestic Product (GDP) | Percentage (%) | Shows the total resources a country channels to health, relative to its total wealth. High percentage indicates a large share of the economy is dedicated to health. |
| Current Health Expenditure (CHE) per capita | US$ (Current or PPP adjusted) | Represents the total expenditure on health per person, often expressed in US dollars (using the average exchange rate or Purchasing Power Parity) for international comparison. | |
| Public Spending | Domestic General Government Health Expenditure (GGHE-D) as % of CHE | Percentage (%) | The share of public funds (tax, compulsory social security) in total health spending. A higher share is often associated with greater financial protection. |
| Domestic General Government Health Expenditure (GGHE-D) as % of General Government Expenditure (GGE) | Percentage (%) | Measures the priority given to health within the government's total public spending budget. | |
| Private Spending | Domestic Private Health Expenditure (PVT-D) as % of CHE | Percentage (%) | The proportion of total health spending coming from non-governmental domestic sources (households, private insurance, non-profits, corporations). |
| Out-of-Pocket Expenditure (OOP) as % of CHE | Percentage (%) | The share of health spending paid for directly by households. A high OOP share indicates low financial protection and greater risk of catastrophic health spending. | |
| External Funding | External Health Expenditure (EXT) as % of CHE | Percentage (%) | The proportion of health spending financed by external sources (e.g., foreign governments, multilateral organizations, NGOs). Important for countries relying on development assistance. |
| Financial Protection | Population with household expenditures on health > 10% or > 25% of total household expenditure or income | Percentage (%) or Millions | Key UHC monitoring indicator (SDG 3.8.2). Measures the population facing catastrophic health spending, defined by high levels of household spending on health. |
Understanding the Indicators
These indicators provide insights into three essential functions of health financing:
1. Resource Mobilization
Indicators like CHE as % of GDP and CHE per capita quantify the sheer volume of financial resources being dedicated to health. They show a country's commitment and capacity to invest in its health sector relative to its economic status.
2. Resource Pooling
Indicators related to GGHE-D % of CHE and the components of PVT-D reveal the source of funds—whether predominantly from the government (e.g., taxes, compulsory insurance) or private sources (e.g., voluntary insurance, out-of-pocket payments). Strong pooling mechanisms, typically through government or compulsory schemes, distribute financial risk across the population and are essential for UHC.
3. Financial Protection
The Out-of-Pocket (OOP) expenditure indicators are crucial measures of financial protection. High OOP payments force households to pay for care at the point of use, often leading to people forgoing necessary services or being pushed into poverty due to medical bills. A core goal of UHC is to minimize this component and reduce the number of people experiencing catastrophic health spending.
.jpg "The WHO Total Health Expenditure Indicator")
The WHO Total Health Expenditure Indicator
The World Health Organization (WHO) places significant emphasis on accurately measuring how much a nation spends on health. The indicator known as Total Health Expenditure (THE) is the fundamental measure used to track a country's commitment to its health system and monitor progress toward Universal Health Coverage (UHC).
Total Health Expenditure is a crucial figure because it captures the cumulative financial efforts of all actors—government, private entities, households, and international donors—to provide health-related goods and services. It acts as the 'bottom line' for global health spending comparisons.
What is Total Health Expenditure (THE)?
Total Health Expenditure is defined as the sum of all expenditure for the provision of health services, family planning activities, nutrition activities, and emergency aid designated for health. It is a comprehensive measure that includes both public and private spending but excludes capital investments (like building hospitals) and the provision of drinking water and sanitation.
To ensure consistency across countries, WHO utilizes the System of Health Accounts 2011 (SHA 2011) framework. This standardized methodology allows for comparable data on the financial flows within a health system.
Key Total Expenditure Indicators
WHO's Global Health Expenditure Database (GHED) employs several core indicators to present the Total Health Expenditure in relation to a country’s size and population:
| Core Indicator | Unit/Format | Definition and Rationale |
| Current Health Expenditure (CHE) as % of Gross Domestic Product (GDP) | Percentage ($\%$) | This is the most common and vital total expenditure indicator. It measures the level of resources allocated to health relative to a country's overall wealth. A higher percentage indicates a greater financial priority placed on health within the economy. |
| Current Health Expenditure (CHE) per capita | US$ (Current or PPP adjusted) | This metric shows the total expenditure on health per person in a country. It is expressed in US dollars, often adjusted for Purchasing Power Parity (PPP) to account for differences in the cost of goods and services, allowing for fair international comparison of absolute spending levels. |
| Total Health Expenditure (THE) as % of Total Government Expenditure (TGE) | Percentage ($\%$) | While not a total health expenditure indicator in isolation (as it only compares health spending to total government spending), this figure is important for contextualizing the national government's commitment to the health sector relative to other sectors (like education or defense). |
| Total Health Expenditure (THE) (Absolute Value) | National Currency Unit (NCU) or US$ | The absolute monetary value of total health spending. Useful for tracking year-on-year growth and investment trends within a single country's economy. |
The Significance of the Indicators
1. Economic Commitment (CHE % GDP):
Comparing health spending to the GDP provides a critical benchmark for national policy. High-income countries typically spend a much larger percentage of their GDP on health than low-income countries. However, rising health expenditure as a share of GDP does not automatically translate into better health outcomes; it must be coupled with efficient and equitable use of funds.
2. Absolute Investment (CHE per capita):
This indicator directly reflects the resources available per person for healthcare. A low per capita spending level often suggests that a health system may struggle to provide a basic package of essential services, regardless of how efficient it is. This is particularly relevant in low-income settings where WHO suggests a minimum investment is needed to cover basic, life-saving care.
3. Informing Universal Health Coverage (UHC):
Monitoring Total Health Expenditure is fundamental to the UHC agenda. By tracking the total resource envelope, policymakers can understand the capacity for service provision and ensure that new resources are pooled effectively (primarily through government and compulsory schemes) to reduce the reliance on catastrophic Out-of-Pocket (OOP) payments.
.jpg "The WHO Public Spending Indicator")
The WHO Public Spending Indicator
The World Health Organization (WHO) considers a robust, publicly-funded health system to be the most reliable path to achieving Universal Health Coverage (UHC). Therefore, monitoring a country's public spending on health is a critical component of global health accountability.
The key WHO indicator for public health financing is Domestic General Government Health Expenditure (GGHE-D). This metric reveals the priority a government places on health relative to its overall fiscal capacity and its total spending, providing crucial insights into the sustainability and equity of a nation's health financing.
What is Domestic General Government Health Expenditure (GGHE-D)?
Domestic General Government Health Expenditure (GGHE-D) represents the health spending financed by national, provincial, and local governments, including compulsory social security schemes (e.g., social health insurance).
Crucially, the term "Domestic" means it only includes funds generated from the country's own public revenue (taxes, social contributions, etc.). It excludes external resources (like foreign aid or grants) spent by the government, giving a clearer picture of the national financial commitment.
Core WHO Public Spending Indicators
WHO’s Global Health Expenditure Database (GHED) uses three principal indicators derived from GGHE-D to analyze a government's commitment to health:
| Core Indicator | Short Name | Definition and Significance |
| GGHE-D as a % of Current Health Expenditure (CHE) | GGHE-D % CHE | Measures the share of total health spending financed by the domestic government. A high percentage indicates a strong reliance on public pooling mechanisms, which are essential for financial protection and UHC. |
| GGHE-D as a % of Gross Domestic Product (GDP) | GGHE-D % GDP | Measures the total size of the domestic public health sector relative to the national economy. This indicates a government’s direct commitment to health as a share of the country’s overall wealth. |
| GGHE-D as a % of General Government Expenditure (GGE) | GGHE-D % GGE | Measures the priority given to health within the entire public budget. It compares health spending to total public expenditure (including defense, education, etc.) and is a key measure of political priority. |
Why Public Spending is a Foundation for UHC
Strong domestic public financing is the bedrock of equitable health systems, directly influencing financial protection for citizens.
Minimizing Out-of-Pocket (OOP) Payments: When the government funds a larger share of the total health expenditure (high GGHE-D % CHE), citizens are shielded from paying for care directly at the point of use. This is the mechanism that prevents high medical bills from causing financial hardship or poverty, a core goal of UHC.
Government Priority (GGHE-D % GGE): The ratio of GGHE-D to General Government Expenditure (GGE) reflects the political will to fund health. WHO notes that a low value may indicate that health is not a primary priority in government spending decisions, potentially leading to under-resourced public health services.
Sustainability and Resilience: Relying on domestic revenue provides a more stable and predictable source of funding than external aid or volatile private payments. This resilience is vital for long-term health system planning, especially during public health emergencies like pandemics.
In essence, the WHO public spending indicators shift the focus from merely "how much is spent" to "who pays" and "what priority the government assigns" to the health of its citizens. The trend toward increasing all three GGHE-D indicators is a necessary step for any country striving to provide guaranteed, affordable access to essential healthcare for all.
.jpg "The WHO's Private Spending Indicators")
The WHO's Private Spending Indicators
The World Health Organization (WHO) uses specific indicators for private health expenditure to track a crucial metric for public health policy: the financial burden placed directly on households. While private spending is a major component of a country's total health system, a high reliance on it—especially on direct payments—is a primary barrier to achieving Universal Health Coverage (UHC).
What is Domestic Private Health Expenditure (PVT-D)?
Domestic Private Health Expenditure (PVT-D) represents the health spending funded by private domestic entities. It's the counterpoint to government spending and is categorized into two main components:
Out-of-Pocket (OOP) Payments: Direct payments made by households to health providers at the time services are rendered. This includes co-payments, user fees, and the cost of medicines.
Private Prepayment Schemes: Spending on private health insurance premiums and health spending by private, non-profit organizations (e.g., NGOs, charities) and private corporations (e.g., spending on occupational health services).
The WHO's monitoring framework primarily focuses on Out-of-Pocket (OOP) expenditure because it directly measures the level of financial risk faced by citizens.
Core WHO Private Spending Indicators
The key WHO indicators for private health spending, drawn from the Global Health Expenditure Database (GHED), measure its size and, more importantly, its threat to financial protection.
| Core Indicator | Short Name | Definition and Significance |
| Out-of-Pocket Expenditure as a % of Current Health Expenditure | OOP % CHE | Measures the share of total health spending directly paid by households. This is the most critical indicator of financial protection; high values indicate a severe risk of catastrophic and impoverishing health spending. |
| Domestic Private Health Expenditure as a % of Current Health Expenditure | PVT-D % CHE | Measures the total share of health spending financed by all private domestic sources (households, firms, non-profits). A high share means the health system relies heavily on non-government funds. |
| Out-of-Pocket Expenditure per capita (Current US$) | OOP per capita | Measures the average amount a person spends directly on health care in a year. This allows for direct international comparison of the household cost burden. |
Why High Private Spending is a Barrier to UHC
A core principle of Universal Health Coverage is that accessing care should not lead to financial hardship. High private spending, particularly high OOP payments, signals a failure in the health system's financial risk-pooling mechanisms.
Risk of Catastrophic Spending: The WHO defines catastrophic health spending as household health payments exceeding a certain threshold of their total consumption or income (e.g., 10% or 25%). A high national OOP % CHE is strongly correlated with a higher proportion of households facing such payments, which can force families to choose between health care and other basic necessities, like food or education.
Impeding Access: When patients have to pay a significant share of the costs, they are often deterred from seeking care, delaying treatment until an illness is advanced and more expensive. This leads to poorer health outcomes and greater overall social cost.
Inequity: Private payments, especially OOP, disproportionately affect the poor, who spend a larger share of their limited income on health. This exacerbates income inequality and undermines efforts to build an equitable society.
To progress towards UHC, the WHO advocates for a system where Domestic General Government Health Expenditure (GGHE-D) increases as a share of total spending, thereby reducing the reliance on PVT-D, especially OOP payments.
.jpg "The WHO External Funding Indicator")
The WHO External Funding Indicator
The External Health Expenditure (EXT) indicator, tracked by the World Health Organization (WHO) in its Global Health Expenditure Database (GHED), is a key metric for understanding the sustainability and reliance of a country's health system on foreign aid. It highlights the financial contribution of international partners to national health goals, particularly in low- and middle-income countries.
What is External Health Expenditure?
External Health Expenditure (EXT) is the portion of a country's health spending that comes from outside its borders. This funding is critical for supplementing domestic resources, especially for programs targeting specific diseases (like HIV, TB, or malaria) and for public health initiatives.
External sources include:
International Organizations: Such as the WHO itself, UNICEF, and development banks.
Bilateral Aid: Funds or services in kind provided directly by foreign governments.
Global Health Initiatives: Entities like the Global Fund to Fight AIDS, Tuberculosis and Malaria, and Gavi, the Vaccine Alliance.
Foreign Non-Governmental Organizations (NGOs) and Private Donors.
This funding can be channeled directly to health care providers or NGOs within the country, or it can be transferred to the recipient government to be distributed through its health budget.
Core WHO External Funding Indicators
The primary WHO indicator measures the magnitude of external financing relative to the country's total health spending, providing a clear picture of donor reliance.
| Core Indicator | Short Name | Definition and Significance |
| External Health Expenditure as a % of Current Health Expenditure | EXT % CHE | Measures the share of total health spending financed by external sources (donors, foreign NGOs, etc.). A high percentage indicates high dependence on foreign aid, which raises concerns about long-term sustainability. |
| External Health Expenditure per capita (Current US$) | EXT per capita | Measures the average amount of external health aid received per person in a year. Useful for tracking aid intensity and trends over time. |
| External Health Expenditure as a % of Total Government Expenditure on Health | EXT % GGHE-D | Measures the extent to which government health spending relies on external sources. This highlights the impact of aid on public financial planning for health. |
Significance of the EXT % CHE Indicator
While external funding is vital for addressing urgent health needs and funding large-scale public health campaigns, a high EXT % CHE signals potential risks to the health system's long-term sustainability and independence:
Sustainability Risk: If a country relies heavily on external aid, any sudden withdrawal or reduction in donor funding (a common occurrence due to changing geopolitical priorities or donor economic conditions) can lead to a drastic shortfall in the health budget, disrupting essential services and jeopardizing progress. The WHO encourages countries to develop clear "exit strategies" to transition from donor dependence to domestic financing.
Volatile Funding: External aid is often earmarked for specific diseases or programs (e.g., vertical programs) rather than for general system strengthening. This can lead to imbalances in the health budget, favoring donor priorities over national health needs, and creating separate, potentially unsustainable, service delivery structures.
Accountability and Alignment: High reliance on external sources can complicate the transparency and accountability of financial flows. The WHO advocates for external aid to be better aligned with national health strategies and channeled through government systems where possible to strengthen national financial management and planning.
Ultimately, the goal for countries progressing toward Universal Health Coverage (UHC) is to ensure that the bulk of their current health expenditure is funded by predictable, domestic sources, with external financing serving as a supplementary resource, not a core requirement.
.jpg "The WHO Financial Protection Indicators")
The WHO Financial Protection Indicators
Financial protection is a fundamental pillar of Universal Health Coverage (UHC). It is achieved when direct payments for healthcare do not expose people to financial hardship or threaten their living standards. The World Health Organization (WHO), in partnership with the World Bank, tracks financial protection globally using key indicators derived from household expenditure surveys. These indicators measure the incidence and intensity of financial hardship caused by Out-of-Pocket (OOP) health spending.
Key Financial Protection Indicators
The WHO focuses on two primary measures of financial hardship, both of which are critical for monitoring progress toward Sustainable Development Goal (SDG) Target 3.8.2 (financial risk protection). These indicators show the proportion of the population facing severe financial burdens due to health costs.
| Indicator | Short Description | WHO/SDG Definition | Significance |
| Catastrophic Health Expenditure (CHE) | Financial hardship relative to a household's budget. | The proportion of the population in households where Out-of-Pocket (OOP) payments for health exceed a specified threshold of the household's total consumption or income. | Measures the severity of the financial shock. The two main thresholds used for global monitoring are $\mathbf{10\%}$ (SDG 3.8.2) and $\mathbf{25\%}$ of total household spending. |
| Impoverishing Health Expenditure (IHE) | Financial hardship relative to a poverty line. | The proportion of the population in households that are pushed below a specified poverty line (or are pushed further into poverty) due to OOP payments for health. | Measures the impact on poverty. The common poverty lines used are the international extreme poverty line (e.g., $2.15 per day) and national poverty lines. |
Understanding the Financial Hardship Thresholds
1. Catastrophic Health Expenditure (CHE)
Catastrophic spending occurs when a household must dramatically cut back on spending for other basic necessities, such as food, housing, or education, to cover health costs. It forces trade-offs that can severely undermine a household's quality of life.
10% Threshold: If health spending exceeds 10% of the total household consumption or income, it is generally considered catastrophic. This is the official SDG indicator (3.8.2) and captures a broader incidence of financial distress.
25% Threshold: A higher threshold that captures instances of more extreme financial catastrophe. Some studies also use a capacity-to-pay measure, where the health spending is measured against the household's income remaining after basic needs (like food) are met.
2. Impoverishing Health Expenditure (IHE)
Impoverishing expenditure highlights how healthcare payments can deepen poverty, particularly for the most vulnerable.
Pushed into Poverty: This refers to households whose consumption or income was just above the poverty line before paying for healthcare, but fall below it after deducting OOP health costs.
Pushed Further into Poverty: This refers to households that were already living below the poverty line, and their health payments drive them even deeper into destitution.
IHE is a direct measure of the failure of a health system to provide financial protection and its contribution to the global poverty agenda (related to SDG 1: No Poverty).
The Role of Out-of-Pocket Payments
The key driver of financial hardship in health is reliance on Out-of-Pocket (OOP) payments—direct payments made by individuals at the time of receiving care. These include user fees, co-payments, and costs for medicines not covered by insurance.
A robust health financing system minimizes OOP payments through effective prepayment and pooling mechanisms (such as mandatory social insurance or general government taxation). Monitoring the WHO Financial Protection Indicators provides policymakers with the evidence needed to design reforms that reduce reliance on OOP payments, thus ensuring that access to necessary health services does not result in a life-altering financial shock.
.jpg "Leading Countries in WHO Health Expenditure Indicators")
Leading Countries in WHO Health Expenditure Indicators
The World Health Organization (WHO) and the World Bank closely monitor Health Expenditure and Financing Indicators to track progress toward Universal Health Coverage (UHC) and financial protection. These indicators reveal which countries commit the greatest resources to health, both in absolute terms and as a proportion of their economies, and how those resources are financed.
The tables below highlight the leading countries in three critical WHO financing metrics, using the latest available data from the Global Health Expenditure Database (GHED), primarily for 2021 or 2022.
1. Current Health Expenditure (CHE) as a Percentage of GDP
This indicator measures the total share of a country's economic output dedicated to health. A higher percentage generally signifies a greater societal commitment to healthcare. The leaders often include high-income nations with established, comprehensive health systems, but also some lower-income nations with significant reliance on external or highly fragmented financing.
| Rank | Country | CHE as % of GDP (c. 2021) | Key Context |
| 1 | Afghanistan | 21.51% | High reliance on External Health Expenditure (foreign aid/donors) to fund its health system. |
| 2 | Tuvalu | 19.55% | A small island nation where the relative cost of running a comprehensive health system is high. |
| 3 | United States | 17.51% | The highest spending large economy, driven by high service prices and complex, market-driven financing. |
| 4 | Palau | 14.63% | Similar to Tuvalu, high CHE share due to the relatively small size of the economy and high import costs. |
| 5 | Liberia | 13.84% | Significantly supported by donor funding and external aid for health. |
2. Current Health Expenditure (CHE) Per Capita (PPP)
This indicator provides a measure of absolute spending power on health per person, adjusted for Purchasing Power Parity (PPP) to allow for meaningful comparison across different economies. High-income countries dominate this metric, as their large economies enable greater overall investment in advanced and comprehensive care.
| Rank | Country | CHE Per Capita (PPP Intl $) (c. 2021) | Key Context |
| 1 | United States | $12,375 | Leads by a significant margin, reflecting the world's most expensive health system. |
| 2 | Switzerland | $8,392 | A high-income country with a universal health insurance system. |
| 3 | Germany | $8,103 | High spending supported by a strong social health insurance model. |
| 4 | Norway | $7,890 | High public spending supported by vast natural resource wealth. |
| 5 | Austria | $7,465 | Strong social insurance and a wealthy economy enable high per capita investment. |
3. Out-of-Pocket (OOP) Expenditure as a Percentage of CHE
This indicator is crucial for monitoring financial protection in health. The lower the percentage, the greater the financial protection provided to the population, as less of the total health spending comes directly from individuals' pockets at the point of service. This is a measure of system efficiency and equity.
| Rank | Country | OOP as % of CHE (Target: Low) (c. 2021) | Key Context |
| Lowest | Luxembourg | Approx. 5-7% | Highly comprehensive social security system provides extensive coverage. |
| Lowest | Czechia | Approx. 7-9% | Strong public health system with minimal co-payments. |
| Lowest | Netherlands | Approx. 8-10% | Mandatory private health insurance with a generous basic package funded by payroll taxes. |
| Lowest | France | Approx. 8-10% | Universal health care with complementary coverage ensuring low financial burden. |
| Lowest | Germany | Approx. 11% | Robust statutory health insurance system minimizes direct patient costs. |
Note on Interpretation: A high percentage in the first two tables indicates a high level of financial commitment to health. However, a high percentage in the third table (OOP as % of CHE) indicates a poor level of financial protection for the population, as it suggests individuals bear a significant cost burden themselves.
Conclusion: Financing as the Foundation of Health Equity
The data on health expenditure highlights a critical challenge: simply spending more money (as seen in high CHE per capita countries like the US) doesn't guarantee superior outcomes or financial security. True progress toward UHC is best measured by the structure of the financing—specifically, the lowering of the Out-of-Pocket (OOP) share. Countries with low OOP percentages, such as Luxembourg and France, demonstrate that effective risk pooling and prepayment models are the most reliable way to shield citizens from catastrophic health costs. Ultimately, the WHO's financing indicators serve as a powerful policy guide, affirming that financial protection—and not just total spending—is the core prerequisite for achieving universal access and true health equity.
.jpg "The Data Sources for WHO Health Expenditure Indicators")
The Data Sources for WHO Health Expenditure Indicators
The World Health Organization's (WHO) Health Expenditure and Financing Indicators are the global gold standard for tracking how much countries spend on health, where the money comes from, and who provides the services. These indicators are crucial for monitoring progress toward Universal Health Coverage (UHC) and ensuring financial protection for populations.
The vast majority of these internationally comparable data points are housed within and disseminated through the WHO Global Health Expenditure Database (GHED). This database represents a monumental, collaborative effort to standardize complex national financial flows using a globally recognized accounting framework.
The Foundation: National Health Accounts (NHA)
The bedrock of all WHO health financing data is the National Health Accounts (NHA). This is a systematic, comprehensive framework used by countries to track resource flows in the health sector.
The NHA methodology is based on the international standard known as the System of Health Accounts 2011 (SHA 2011), which was developed collaboratively by the Organisation for Economic Co-operation and Development (OECD), Eurostat, and the WHO.
| SHA 2011 Classification (The Three Axes) | Purpose | Key WHO Indicators Derived |
| Health Care Functions (HC) | Tracks what health services are provided (e.g., curative care, public health, pharmaceutical provision). | Current Health Expenditure (CHE) |
| Health Care Providers (HP) | Tracks who provides the services (e.g., hospitals, pharmacies, government agencies). | Spending by Provider Type |
| Health Care Financing Schemes (HF) | Tracks how the services are paid for (e.g., government, social security, out-of-pocket, external aid). | Domestic General Government Health Expenditure (GGHE-D), Out-of-Pocket (OOP) Spending |
Primary Data Sources for the WHO GHED
The WHO team works directly with Member States to collect, validate, and standardize data from a variety of in-country and international sources, which are then compiled into the GHED.
| Data Source Category | Specific Data/Reports | Role in Health Expenditure Indicators |
| Country-Reported Data | Official National Health Accounts (NHA) reports provided by Ministries of Health/Finance or National Statistics Offices. | Provides the core structure and disaggregated data on sources and uses of funds (SHA 2011). |
| Government Finance | Government Budgets and Public Expenditure Reviews (PERs) from Ministries of Finance and Central Banks. | Used to determine Domestic General Government Health Expenditure (GGHE-D) and its share of total government spending. |
| Household Data | National Household Surveys (e.g., Household Consumption Surveys, Living Standards Measurement Surveys). | Used to estimate Out-of-Pocket (OOP) Expenditure by households. |
| International/Donor | Creditor Reporting System (CRS) data from the OECD's Development Assistance Committee (DAC). | Used to track External Health Expenditure (EXT), such as foreign aid and donor funding. |
| Macroeconomic Data | World Bank, International Monetary Fund (IMF), and national sources. | Provides Gross Domestic Product (GDP) and Purchasing Power Parity (PPP) exchange rates for creating macro indicators like CHE as % of GDP and CHE per capita (PPP). |
Harmonizing Global Finance
The WHO's reliance on the Global Health Expenditure Database (GHED), which is built on the rigorous foundation of National Health Accounts (NHA) and the SHA 2011 framework, ensures that global comparisons of health financing are reliable and consistent. This painstaking process of collecting and harmonizing disparate national data sets transforms raw financial figures into powerful policy tools. By tracking these standardized indicators, the WHO empowers governments, donors, and policymakers to accurately assess health system performance, identify funding gaps, and make informed decisions to expand access and financial protection worldwide.
Conclusion: The Imperative of Strategic Health Financing
The analysis of WHO Health Expenditure and Financing Indicators clearly demonstrates that strategic financing is the bedrock of equitable health systems. While high-income countries often lead in per capita spending, the true measure of a successful system is its ability to protect citizens from financial hardship. The critical takeaway is the inverse correlation between financial protection and Out-of-Pocket (OOP) expenditure: countries with well-developed, compulsory social or government-led financing schemes consistently report the lowest OOP shares, indicating effective risk pooling and progress toward Universal Health Coverage (UHC). For all nations, the challenge is not just increasing total investment in health, but ensuring that these funds are channeled through mechanisms that maximize financial protection and equity, thereby translating economic commitment into tangible health security for every citizen.