Monitoring and tracking of health system expenditure is an essential component of universal health coverage. The National Health Accounts (NHA) is an internationally recognized method for monitoring and tracking health system expenditure over a specific period, usually a year. It serves as a diagnostic tool to assess health expenditure levels, with the data generated being used for health sector policy formulation, planning, high-level policy dialogue, and advocacy. The latest NHA for fiscal year 2019/2020, covered health expenditure for the period from July 1, 2019, to June 30, 2020, and marks the seventh cycle of NHA reporting for Liberia. It's worth noting that Liberia transitioned to a January-December fiscal year starting in 2021. This NHA cycle, overseen by the Ministry of Health's Healthcare Financing Unit, estimated household out-of-pocket spending based on the 2016 Household Income and Expenditure Survey. It also compiled data from the 2019/2020 fiscal year on health spending by employers, insurance, donors, and non-governmental organizations (NGOs).

On 12 June, 2024, the Ministry of Health organized a validation workshop for the NHA FY2019/2020. The NHA FY 2019/2020 was as a result of collaboration between the Ministry of Health of Liberia, the three levels of WHO, the Ministry of Finance and Development Planning (MFDP), Liberia Institute of Statistics and Geo-Information Services (LISGIS), health sector partners, donors, and the private sector. The World Health Organization (WHO) supported the NHA planning, adaptation of data collection tools, data entry, data mapping, analysis, and report writing in the third and fourth quarters of 2023. While other partners have supported resource mapping for the MoH, the NHA captures the actual expenses occurred including the broad resources provided by other partners.

Key recommendations from the validation workshop included the development of policy and advocacy briefs by the MOH for policy dialogue and high level advocacy on sustainable financing. Secondly, the MOH will submit the validated NHA data to WHO HQ for publication in the Global Health Expenditure Database.

The validation workshop brought together 24 participants from MOH, MFDP, Central Bank and various partners. Key findings indicated a high out-of-pocket expenditure at 62%. Partners such as Last Mile Health, the World Bank, the Global Fund, GAVI, Jhpiego, CDC, USAID, UNICEF, UNFPA, and private sector insurance companies contributed data on their funding and participated in the NHA planning, implementation, and findings validation.

"We sincerely thank WHO for building the capacities of MOH to be able to conduct NHA over the years. At the beginning, we (MOH and WHO) used to hire consultants from outside Liberia but this has stopped over the years due to our local capacities developed by WHO to conduct quality NHA processes," said Mr. Ernest Gonyon the Director of Health Financing, MOH Liberia who represented the Deputy Minister for Policy, Planning and M&E, at the validation workshop opening.

The impact of the validated NHA report addressed key questions such as who financed health services in Liberia and how much they spent in FY2019/20, what types of services were available, who provided them, and who benefited from these health expenditures.

The WHO Liberia Country Office Health Systems Advisor, Dr. Charles Ocan, hailed MoH for prioritizing the National Health Accounts as a tool to monitor and track Liberia’s health system expenditures, “We thank the MOH and partners for prioritizing NHA over the years. With WHO support, Liberia has institutionalized NHA as recommended by WHO for its Member States to track and report on health expenditures. In order to ensure its full potential, the MOH and partners need to complete the entire NHA processes which should climax with actual utilization of its findings and implementation of the key recommendations. One of the key products that MOH and partners need to develop is the NHA policy brief which will facilitate and catalyze policy dialogue and high-level advocacy for sustainable financing towards UHC and other SDG 3 targets in Liberia,” said Dr. Ocan.

Moving forward, a policy brief based on the findings will be shared with multiple health stakeholders, including the MFDP, legislature, and other sectors. The final validated data will be published in the Global Health Expenditure Database (GHED). In an era of dwindling resources, the NHA can be used to refocus efforts on Primary Health Care and prevention, as well as identifying ways to reduce high out of pocket expenditure in order to meet the country and global commitments towards universal health coverage. This builds on and complements other ongoing health financing efforts such as performance based financing, Liberia Health Equity Funds, revolving drugs fund and increasing domestic funding to health sector.