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Analytical summary - Health financing system

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The country spends approximately 3.8 per cent of GDP on health care (including private health expenditures). Approximately 65 per cent of healthcare funds come from Government, accounting for approximately 2 per cent of GDP, while additional funding comes from development partners, the private sector and individuals.

Some mission operated health facilities and NGOs receive a large portion of their resources from Government following the declining of the global donor base. Household expenditures as percentage of total private health expenditures were estimated to have increased from 34.9 per cent to 41.7 per cent between 1998 and 2002.

The share of Government expenditure on health has increased almost six fold in the past decade from 19 million USD$ in 1998 to 113 million USD in 2009. As a share of the total budget it translates to 7 per cent of the total Government budget in 1998 increasing to 9 per cent in 2009. Despite the significant increase in absolute figures the share of the budget allocated to health did not increase significantly as a percentage of the total budget.

The advent of the HIV/AIDS pandemic assisted the sector in drawing additional attention from policy makers in the last five years. Despite significant increases in domestic resources being channelled towards vertical programmes such as HIV and AIDS the health system was not privileged to similar benefits. Equally of note the country, experienced a significant donor fatigue especially resources supporting the health systems, while there was an upsurge for external resources supporting disease specific programmes such HIV and AIDS, TB and Malaria.

The country was not able to benefit from a number of global initiatives such as GAVI and other initiatives due to economic classification while national health indicators are poor. There is limited health insurance cover mainly for the employed minority, which enables them to access private health facilities. The SDHS 2006-07 revealed that only 8 per cent of the population is covered by any form of insurance. This shows that pooled funding including pre-payment schemes are minimal.

The government pays for health care services for patients referred outside the country for specialized services such as chemotherapy and radiotherapy. Referral expenditures have risen significantly over the years as they are estimated to well over 250 million Emalangeni for all schemes.

Healthcare financing from development partners has increased almost two folds from 2005/06 to 2009/10. These resources were specifically channelled to specific diseases such as HIV/AIDS, TB and Malaria.

Resources aimed at financing these increased from approximately US$40 million in 2005/06 to US$80 million in 2009/10. External financing of healthcare system beside disease specific programmes has not significantly increased in the sector.