Reproductive health accounts

Why, What and How?


The health system in a country comprises a myriad of financial transactions between numerous actors, including the people who finally benefit from health services and goods. Insight into these financial flows and the distribution of funds is key to evaluate and improve the performance of the health system in a particular country or region. The RF project initiated the development of a Reproductive Health Account (RHA) to better capture the financial flows for reproductive health (including HIV/AIDS). A RHA will help answer questions like:

  • How are funds mobilized; how do public and private sources compare?
  • Who provides reproductive health services; what resources do they use?
  • Are funds adequate to achieve reproductive health goals set in the health sector?
  • Who pays and how much is paid for reproductive health care?
  • Who benefits from reproductive health care expenditures?


A RHA is basically a set of origin-destination tables that present financial flows related to reproductive health services and goods (or activities) between categories of stakeholders in a particular country: financing sources, financing agents, health care providers and beneficiaries (see figure 1). These actors include public, private (including households) and donor entities. To identify and classify the different categories of actors and activities, the RHA draws on classifications of the International Classification for Health Accounts (ICHA) by OECD. The organization of information about who pays, how much and for what in a RHA is consistent with the widely endorsed methodology of National Health Accounts (NHAs). RHAs can therefore be seen as satellite accounts of NHAs, similar to other disease-specific sub-accounts.


The RF project initiated a RHA at sub-national level in India in December 2004. The case study was implemented in Karnataka State, by the Centre for Multi-Disciplinary Development Research (CMDR) in collaboration with NIDI. Initial activities included the inventory of the reproductive health system and the development of context-specific and policy-relevant classification schemes. In March 2005, data collection on reproductive health expenditures began among the different actors, including a survey on household out-of-pocket expenditures. Collected information and estimates of missing data will be combined to produce the set of tables that trace reproductive health funds from financing sources to activities and final beneficiaries. Subsequent analysis will provide insight into the performance of the Karnataka health system and address equity and distribution issues. This will support decision processes of policy makers and stakeholders for effective and efficient programmes and policies.