Guide to Producing National Health Accounts, with Special Applications for Low‐income and Middle‐income Countries

The challenges pertaining to the health accountant are said to be a permanent commitment to transparency, an ability to employ judgement in a non‐partisan and professional way, a recurrent and open interaction with all stakeholders, a commitment to continuous improvement, and patience and resolution to overcome all hurdles (pp. 248‐50). National health accounts are the means of planning and recording health expenditure in which demand invariably outstrips supply, and in which resource management is crucial. This publication reflects the ten year old initiative of the Organisation for Economic Co‐operation and Development (OECD) system of health accounts (SHA), which the European Union and many non OECD states have adopted as the goal to aim for. Some slight amendment has been made to cater for the needs of the lower‐ and middle‐income countries. One thinks of an increasingly dysfunctional country such as South Africa with the world's highest murder rate (over 50,000 attempted murders and over 20,000 actual murders), endemic gratuitous violence, corruption, high road traffic fatality, and the AIDS pandemic, plus the mass migration of its health workers abroad, to understand the vital need for an accurate and transparent accounting system to permit the most valid decision‐making. Examples of good practice are drawn upon throughout, and the necessary detail is provided to cater for the requirements of the diversity and complexity that one inevitably finds in any country‐wide health system, with the combination of private, public and voluntary sector provision. Although this is work in progress, what is presented in the text is substantial, and sufficient to plot a suitable way forward.