The National Health Accounts (NHA) 2017 was launched by the Health Minister, Dr Honourable Anwar Husnoo, on 24 September 2018 during a workshop in the presence of Dr Laurent Musango, WHO Representative in Mauritius, Dr Myriam Timol, Acting Director General Health Services, Permanent secretary, Mrs M.Mudaliar and Dr (Mrs) L. D. Luckheenarain from the Ministry of Health and Quality of Life,  and representatives of the private sector academia and civil society. The NHA 2017 has improved over the past rounds as it includes expenditures on classification of diseases developed for the first time in Mauritius. It tracks the levels and structure of healthcare spending vis-a-vis the general health status of the population occurred over a period of one year.  The Health Minister, Dr Hon. A. Husnoo, during his keynote address, said that ‘government acknowledges that health is a basic human right and that healthcare services should be provided according to need and not ability to pay.’ He added that ‘for the Government, health is not a commodity that can be traded at a price to alleviate the sufferings of people who are sick.’ 

Dr Husnoo highlighted that, ‘Universal Health Coverage remains high in the agenda of Government and the state continues to sustain the provision of free healthcare services to the population.’ He added that ‘financial resources are key determinants of health system performance in terms of equity, efficiency and health outcomes. They are critical for our health system to effectively respond to peoples’ legitimate demand for quality health care services and to ensure universal health coverage.’ According to him, it is essential that the health system in Mauritius supports, by adequate funding, robust health plans and evidence-based policies for the cost-effective provision of services.

The NHA Report 2017 shows Mauritius in a leading position, with an expenditure of US$ 548 per person on health, among SADC Member States. A high per capita expenditure on health has resulted in remarkable health gains. Life expectancy at birth is, at present, 74.7 years. Infant mortality rate per thousand live births has improved to 12.2 and maternal mortality rate stands at 0.74 per thousand live births. As regards to disease estimates, the report indicates that the country spent an estimated amount of Rs 16.5 billion on non-communicable diseases, representing 66.52% of the total health expenditure. The lion’s share of this amount, that is, some around Rs 3.6 billion, was spent on the treatment of cardiovascular diseases. In addition, Mauritius spent Rs 1.2 billion and Rs 955 million on diabetes and cancer, respectively in 2016.  NHA 2017 confirms the high correlation between per capita spending on health and the general health status of the population. In developed nations like the United Kingdom and Singapore, where per capita expenditure on health is more than US$ 2,200, life expectancy is over 80 years and child health indicators are figured at one digit. On the other hand, in countries like Mauritius and Seychelles where per capita spending on health is between US$ 500 to US$ 600, life expectancy is in the range of 66 to 75 years and infant mortality rate ranges between 11.0 and 14.0 per thousand live births. 

Dr Laurent Musango, WHO Representative in Mauritius, during his address, pointed out that Mauritius was identified as one of the countries that has good access to health services in a recent WHO report on the State of Health in the WHO African region which analyzed the status of health, health services and health systems in the context of SDGs. However, he added that ‘Mauritius was kept below the levels of Algeria and Seychelles as these countries not only have good access but also good financial protection and low out of pocket expenditure as a key component for moving towards Universal Health Coverage.’ It is to be noted that fund spent on prevention activities is very low, that is 1% of Total Health spending and is not commensurate to the magnitude of the Non-Communicable diseases epidemic. Dr Musango emphasized on the fact that ‘the prevention of risks factors of NCDs is the key in tacking NCDs.’ He urged the participants to the workshop which comprised high level technical and administrative officers of the Ministry of Health and Quality of Life, members of the National Health accounts committee, representatives of other key ministries, the private sector, NGOs and Civil society, to make good use of the NHA report. The WHO Representative in Mauritius reiterated the commitment and support of the three levels of the organization, namely WHO Headquarters in Geneva, WHO Regional Office for Africa and the WHO Country Office in the institutionalization of NHA in Mauritius as well as the implementation of recommendations from the reports. 

 ‘The NHA report is an important tool  which can be used to refocus the efforts to Primary Health Care (PHC) and Prevention as well as for identifying the ways of reducing the out of pocket expenditure in order to meet the global commitment of Universal Health Coverage’, pointed out Dr Laurent Musango.  He further added that the NHA report can also be used for advocating for change and for adjustment of the distribution of available funds and for identification of new reforms in the planning to mitigate challenges identified in the report.  ‘This document will also serve as reference material for UN agencies involved in the health sector, bilateral and multilateral organizations and NGOs for planning of their financial and technical support according to the needs and for priority setting’, said Dr Musango. 

Public health institutions remain the main providers of health care services to the population in Mauritius. The NHA 2017 report reveals that the healthcare spending per person in Mauritius was Rs 20,023 in 2016 while the Total Health Expenditure, as a percentage of the Gross Domestic Product was 5.83 percent.  Mauritius spent an estimated amount of Rs 25.3 billion on health in 2016, out of which Government spent around Rs 11.3 billion while the private stakeholders, including households, spent approximately Rs 13.98 billion.  As far as the private sector is concerned, households managed Rs 11.95 billion for the purchase of healthcare services in 2016. Private health insurance companies spent an estimated amount of Rs 1.50 billion. Other financing agents in the private sector included non-governmental organizations and foreign donors, which managed Rs 144.5 million and Rs 6.45 million of funds, respectively. The National Health Accounts Report 2017 confirms that household’s out-of-pocket expenditure on health continue to be on the rise in Mauritius, despite the provision of free health care services in the public sector.  It is good to note that the Household Out-of-Pocket Expenditure Survey 2015 indicates that 3.6% of households in Mauritius are experiencing catastrophic expenditure on health.

The development of the National Health Accounts is in line with the recommendations of the World Health Organization which requires Member States to generate country-level evidence and contribute to “better-informed” policy choices. The NHA tracks and describes the flows of health expenditures through the application of standard accounting frameworks called SHA 2011. They are extensively used to monitor progress in achieving universal health coverage and health expenditure related targets of the Sustainable Development Goal 3.

The NHA Report 2017 confirms that spending on health in Mauritius has been growing over the years, from Rs 6.1 billion in 2001 to Rs 25.3 billion in 2016. The key determinant behind this increasing trend is economic growth. This can be explained by a growth in the Mauritian economy and greater investment by the Government in the social sector and an increase in household expenditure on goods and services, including private healthcare services. Other drivers of healthcare spending include the ageing population, costly treatment of chronic conditions associated with non-communicable diseases, health-sector price inflation, medical advances and introduction of new products and techniques. The NHA Report 2017 is available at below link: http://health.govmu.org/English/Documents/2018/NHA%20Report%202017%2024%20September%202018.PDF

The Health Minister announced further development of the public health sector and enhancement of the quality of services in terms of new health infrastructure. The World Health Organization would be requested to provide technical guidance in view of planning the family doctor service in the public sector and for the formulation of a five year Health Sector Strategy which will lay down the roadmap for progressing further towards universal health coverage.