Swaziland: health sector financing and expenditure

Abstract

A Health Sector Financing and Expenditure (HSFE) survey was conducted in Swaziland against a background of growing concern about resource constraints on policy implementation. It sought to provide basic financial information which could be used when discussing policy options for addressing these constraints. Under a wide definition of the health sector, expenditure in 1984/85 was found to be equivalent to 9.8% of GDP and E73 ($US35) per capita. Recurrent expenditure dominated sectoral expenditure, at 86.7% of the total; 57% of recurrent expenditure was for primary health care (PHC) activities, but only 17.9% for the core preventive programmes which the policy emphasizes. Moreover, the Ministry of Health's own expenditure was biased in favour of curative care. Out-of-pocket payments largely supported general PHC activities and the core programmes were predominantly funded by foreign aid. Policy calls for increased PHC funding, therefore, are justified on the grounds of existing inappropriate allocations. If this is to be achieved there must be improved efficiency of resource use within services and improved coordination with other sources of finance in the sector. It is especially important to address efficiency issues within the Ministry. Particular attention should be paid to strengthening the role and effectiveness of decentralized management structures in resource allocation. The Ministry should also address concerns about the quality of care provided by its services, especially the poor availability of drugs. Increased PHC funding may, further, be made possible through the recruitment of additional finance. More discussion of alternative financing arrangements is necessary, but their efficacy may be dependent on improving the quality of care provided within public facilities.