Financing of Improved Health Information
The annual per capita cost, estimated earlier, of US$0.53 to US$2.99 for a comprehensive HIS, represents a substantial portion of the current per capita health expenditure for many developing countries. These figures include capital and recurrent costs, although they do not include the costs of any external technical assistance. Because most countries have already made a substantial investment in a HIS, the actual incremental costs to improve the existing HIS likely are much less. Salaries, which account for more than 90 percent of HIS costs, are expenditures that are already being made in most settings, so the marginal cost of HIS improvements would be primarily the initial development costs of planning, training, technical assistance, and information technology upgrades. Furthermore, the costs of HIS improvements may be fully offset or even exceeded by the savings from the resulting improvements in efficiencies in the health care system.
Existing funding is adequate to strengthen systems substantially in all low-income and lower-middle-income countries primarily through the major international initiatives (Global Fund to Fight AIDS, Tuberculosis, and Malaria; President's Emergency Plan for AIDS Relief; and Multi-country AIDS Program of the World Bank). All these funders recommend that 3 to 7 percent of grants and loans be allocated to monitoring and evaluation. Several bilateral development agencies and the multilateral development banks will provide financing for HIS reform, including the U.S. Agency for International Development (USAID) through the MEASURE (Monitoring and Evaluation to Assess and Use Results) Project, which is designed to improve and institutionalize the collection and use of data for health policy development and program monitoring. The HMN offers some financial assistance to countries that are preparing for and planning HIS reform and will assist countries in negotiating financing packages that blend loan funding with grants from bilateral donors to implement those reforms.
Several international agencies support strengthening systems for national statistics that extend beyond the health sector. STATCAP (Statistical Capacity Building), which is a new lending program offered by the Partnership in Statistics for Development in the 21st Century (PARIS21 2004) through the World Bank, supports the development of national statistical systems. The separate Trust Fund for Statistical Capacity Building offers smaller amounts of grant funding to prepare the statistical master plan that is required for obtaining a STATCAP loan. Although short-term project funding can often be secured for system development, the resulting system and its recurrent costs must be within the country's capacity to sustain it, both technically and financially.