! ! !!!!!!!!!!!!!!!!!!!!!!!!!! 79348 ! ! ! ! ! MACRO-FISCAL CONTEXT AND HEALTH FINANCING FACT SHEETS MIDDLE!EAST!AND!NORTH!AFRICA! ! How!Much!Can!a!Country!Spend!on!Health?!! ! ! Health! Financing! Revenue! Composition! Fiscal!Context! Macroeconomic!! Environment! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ACKNOWLEDGEMENTS. ! These!factsheets!are!produced!by!a!task!team!consisting!of!Rafael!Cortez!(Task! Team! Leader,! Sr.! Economist,! HDNHE),! Aakanksha! Pande! (Young! Professional,! Health! Specialist,! MNSHH),! Patrick! Eozenou! (Young! Professional,! Economist,! HDNHE),! Adam! Leive! (Consultant),! Marc! Smitz! (Consultant),! and! Ece! Ozcelik! (Consultant),! under! the! overall! supervision! of! Armin! Fidler! (Acting! Sector! Manager,!HDNHE)!and!Nicole!Klingen!(Acting!Director,!HDNHE).!! ! The! task! team! is! grateful! for! inputs! from! Jack! Langenbrunner,! Ajay! Tandon,! Robert!Gilingham,!George!Schieber,!Edit!Velenyi,!and!Cheryl!Cashin.! ! The!financial!contribution!of!the!Rockefeller!Foundation!Trust!Fund!is!gratefully! acknowledged.!!! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! . . . . ABOUT.THE.MACRO3FISCAL.CONTEXT.AND.HEALTH.FINANCING.FACT.SHEETS. . Health.Financing.Indicators Health! Total!Health!Expenditure!(THE!as!%!GDP)! Financing! Government!Health!Spending!(GHE!as!%THE)! Government!Health!Spending!(GHE!as!%GGS)! Out!of!Pocket!Spending!(OOP!as!%!THE)! Sources!of! Revenue! Sources.of.Revenue Taxes!on!Income,!Profits!and!Capital!Gains!(%!GDP) Other!Taxes!(as!%!of!GDP) Fiscal!Context! Non[Tax!revenue!(as!%!of!GDP)! Fiscal.Context Macroeconomic! Gross!Debt!(as!%!of!GDP) Context!! Deficit!(as!%!of!GDP) Spending!(as!%!of!GDP) Revenues!(as!%!of!GDP)! Macroeconomic.Indicators Growth!(GDP!Constant!Prices)! Inflation!(end!of!period!consumer!prices)! !!!! Unemployment!(Rate)!!! ! . What.are.the.factsheets?. How! much! can! a! country! spend! on! health?! To! answer! this! question! it! is! important! to! understand! the! macro! fiscal! constraints! under! which! a! country! operates.! The! Macro! Fiscal! Context!and!Health!Financing!Factsheets!were!created!to!provide!quickly!digestible!information! about! a! given! country’s! fiscal! health! trends! over! time! and! benchmark! the! country! against! its! income!group!or!regional!peers.!! ! What.is.in.the.factsheets?.. The! factsheets! use! graphical! representations! of! 14! key! indicators! linked! to! the! larger! macro! fiscal!environment!in!which!a!health!system!operates.!The!definition!of!each!indicator!as!well!as! a! guide! for! interpreting! them! in! the! context! of! fiscal! space! for! health! is! provided! in! all! factsheets.!! . What.is.the.availability.of.the.factsheets?.. The!factsheets!are!available!for!188!countries!covering!a!period!from!1995[2010.!! . Where.is.the.data.from?.. The!data!used!in!the!factsheets!is!from!the!World!Development!Indicators!(World!Bank);!Word! Economic!Outlook!(IMF);!and!World!Health!Statistics!(WHO)!of!November!2012.!Gross!National! Income!(GNI)!is!based!on!the!Atlas!method!(current!US!$).!! ! .How.do.I.cite.the.factsheets?.. Pande,! A,! Leive! A,! Smitz! M,! Eozenou! P! and! E! Ozcelik.!Macro!fiscal!context!and!health!financing! factsheet.!World!Bank:!Washington!DC,!2013! ! For! inquiries,! please! contact:! Aakanksha! Pande:! apande@worldbank.org,! Ece! Ozcelik:! eozcelik@worldbank.org!and!Emiliana!Gunawan:!egunawan@worldbank.org!! ! ! . . . List.of.Countries.. ALGERIA......................................................................................................................................................1. BAHRAIN.....................................................................................................................................................2. DJIBOUTI.....................................................................................................................................................3. ..........................................................................................................................................................4. EGYPT. IRAN,.ISLAMIC.REP..................................................................................................................................5. IRAQ..............................................................................................................................................................6. .........................................................................................................................................................7. ISRAEL. JORDAN........................................................................................................................................................8. KUWAIT.......................................................................................................................................................9. LEBANON.................................................................................................................................................10. LIBYA.........................................................................................................................................................11. MOROCCO................................................................................................................................................12. OMAN........................................................................................................................................................13. ......................................................................................................................................................14. QATAR. SYRIAN.ARAB.REPUBLIC.....................................................................................................................15. TUNISIA....................................................................................................................................................16. UNITED.ARAB.EMIRATES...................................................................................................................17. YEMEN.......................................................................................................................................................18. ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! Algeria Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2010 GNI per capita: 4.5e+03 80 10 Population: 3.6e+07 2A. Health Financing Indicators, 2010 80 8 60 60 % % 6 % 40 40 4 20 20 2 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Algeria [left] [right] Average in UMICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 30 10 8 20 6 % % 4 10 2 0 Growth Unemployment Inflation 0 Algeria 1995 2000 2005 2010 2015 Year Average in UMICs Growth Unemployment Inflation Average in MENA Algeria Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 150 60 50 40 40 100 20 30 % GDP % GDP % GDP 20 50 10 0 0 Debt De�cit Spending Revenue -20 0 1995 2000 2005 2010 Algeria Year Average in UMICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 2006-2009 2D. Sources of Revenue, 2010 30 15 10 20 % GDP % GDP 5 10 0 Income tax Other taxes Grants & other revenue 0 Algeria 1995 2000 2005 2010 Year Average in UMICs Income Other Taxes Grants & Other Revenue Average in MENA Bahrain Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2010 GNI per capita: 1.6e+04 12 80 Population: 1.3e+06 2A. Health Financing Indicators, 2010 80 10 60 60 8 40 % % % 40 6 20 20 4 0 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Bahrain [left] [right] Average in HICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 10 8 8 6 6 % 4 % 4 2 2 0 0 Growth Unemployment Inflation -2 Bahrain 1995 2000 2005 2010 2015 Year Average in HICs Growth Unemployment Inflation Average in MENA Bahrain Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 40 60 35 30 30 40 % GDP 20 % GDP % GDP 25 20 10 20 0 0 Debt De�cit Spending Revenue 15 -10 1995 2000 2005 2010 Bahrain Year Average in HICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 1995-2007 2D. Sources of Revenue, 2010 15 30 10 % GDP 20 % GDP 5 10 0 Income tax Other taxes Grants & other revenue 0 Bahrain 1995 2000 2005 2010 Year Average in HICs Income Other Taxes Grants & Other Revenue Average in MENA Djibouti Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2010 GNI per capita: 1.3e+03 14 Population: 9.1e+05 70 2A. Health Financing Indicators, 2010 12 80 60 10 60 50 % % 8 % 40 40 6 20 30 4 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Djibouti [left] [right] Average in LMICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 10 10 8 5 6 % % 4 0 2 0 Growth Unemployment Inflation -5 Djibouti 1995 2000 2005 2010 2015 Year Average in LMICs Growth Unemployment Inflation Average in MENA Djibouti Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 70 40 50 20 30 40 30 65 % GDP % GDP % GDP 20 60 10 10 0 Debt De�cit Spending Revenue 0 55 1995 2000 2005 2010 Djibouti Year Average in LMICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 1995-2010 2D. Sources of Revenue, 2010 15 10 % GDP % GDP 5 0 Income tax Other taxes Grants & other revenue Djibouti 1995 2000 2005 2010 Year Average in LMICs Income Other Taxes Grants & Other Revenue Average in MENA Egypt, Arab Rep. Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2010 GNI per capita: 2.6e+03 Population: 8.3e+07 8 60 2A. Health Financing Indicators, 2010 55 60 7 50 % % 6 40 45 % 5 40 20 4 35 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Egypt, Arab Rep. [left] [right] Average in LMICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 20 15 15 10 % 10 % 5 5 0 Growth Unemployment Inflation 0 Egypt, Arab Rep. 1995 2000 2005 2010 2015 Year Average in LMICs Growth Unemployment Inflation Average in MENA Egypt, Arab Rep. Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 2002-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 110 40 8060 100 30 % GDP % GDP % GDP 40 20 90 20 10 80 0 Debt De�cit Spending Revenue 70 0 1995 2000 2005 2010 Egypt, Arab Rep. Year Average in LMICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 2002-2010 2D. Sources of Revenue, 2010 15 1210 10 % GDP % GDP 8 5 6 0 Income tax Other taxes Grants & other revenue 4 Egypt, Arab Rep. 1995 2000 2005 2010 Year Average in LMICs Income Other Taxes Grants & Other Revenue Average in MENA Iran, Islamic Rep. Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2009 GNI per capita: 4.5e+03 12 60 Population: 7.5e+07 2A. Health Financing Indicators, 2010 10 55 60 50 8 % % 40 % 6 45 20 4 40 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Iran, Islamic Rep. [left] [right] Average in LMICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 40 20 15 30 % 10 20 % 5 10 0 Growth Unemployment Inflation 0 Iran, Islamic Rep. 1995 2000 2005 2010 2015 Year Average in LMICs Growth Unemployment Inflation Average in MENA Iran, Islamic Rep. Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 30 35 40 30 20 30 % GDP % GDP % GDP 25 20 10 10 20 0 0 15 Debt De�cit Spending Revenue -10 1995 2000 2005 2010 Iran, Islamic Rep. Year Average in LMICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 1995-2009 2D. Sources of Revenue, 2010 20 15 15 10 % GDP % GDP 10 5 5 0 Income tax Other taxes Grants & other revenue 0 Iran, Islamic Rep. 1995 2000 2005 2010 Year Average in LMICs Income Other Taxes Grants & Other Revenue Average in MENA Iraq Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1996-2009 GNI per capita: 2.6e+03 100 Population: 3.3e+07 8 2A. Health Financing Indicators, 2010 80 60 6 60 % % 4 40 40 % 2 20 20 0 0 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Iraq [left] [right] Average in LMICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 2005-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 60 10 8 40 6 % % 4 20 2 0 Growth Unemployment Inflation 0 Iraq 1995 2000 2005 2010 2015 Year Average in LMICs Growth Unemployment Inflation Average in MENA Iraq Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 2004-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 150 500 8060 100 400 % GDP 40 % GDP % GDP 300 50 20 200 0 0 Debt De�cit Spending Revenue 100 -50 1995 2000 2005 2010 Iraq Year Average in LMICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 1996-2009 2D. Sources of Revenue, 2010 15 10 % GDP % GDP 5 0 Income tax Other taxes Grants & other revenue Iraq 1995 2000 2005 2010 Year Average in LMICs Income Other Taxes Grants & Other Revenue Average in MENA Israel Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2009 GNI per capita: 2.9e+04 11 70 Population: 7.8e+06 2A. Health Financing Indicators, 2010 60 80 10 50 60 % % 9 40 % 40 8 30 20 20 7 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Israel [left] [right] Average in HICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 15 10 8 10 6 % % 5 4 2 0 0 Growth Unemployment Inflation -5 Israel 1995 2000 2005 2010 2015 Year Average in HICs Growth Unemployment Inflation Average in MENA Israel Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 2000-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 100 60 80 95 60 40 % GDP 90 % GDP % GDP 40 85 20 20 80 0 Debt De�cit Spending Revenue 75 0 1995 2000 2005 2010 Israel Year Average in HICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 2000-2010 2D. Sources of Revenue, 2010 16 15 14 10 % GDP 12 % GDP 10 5 8 0 Income tax Other taxes Grants & other revenue 6 Israel 1995 2000 2005 2010 Year Average in HICs Income Other Taxes Grants & Other Revenue Average in MENA Jordan Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2010 GNI per capita: 4.4e+03 70 Population: 6.2e+06 18 2A. Health Financing Indicators, 2010 60 80 16 50 14 60 % % 40 12 % 40 30 10 20 20 8 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Jordan [left] [right] Average in LMICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 15 15 10 10 % % 5 5 0 0 Growth Unemployment Inflation Jordan 1995 2000 2005 2010 2015 Year Average in LMICs Growth Unemployment Inflation Average in MENA Jordan Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 120 40 8060 30 100 % GDP % GDP % GDP 40 20 20 80 10 0 Debt De�cit Spending Revenue 60 0 1995 2000 2005 2010 Jordan Year Average in LMICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 1995-2010 2D. Sources of Revenue, 2010 15 20 15 10 % GDP % GDP 10 5 5 0 Income tax Other taxes Grants & other revenue 0 Jordan 1995 2000 2005 2010 Year Average in LMICs Income Other Taxes Grants & Other Revenue Average in MENA Kuwait Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2009 GNI per capita: 4.9e+04 100 10 Population: 2.8e+06 2A. Health Financing Indicators, 2010 80 80 8 60 60 % % 6 % 40 40 4 20 20 2 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Kuwait [left] [right] Average in HICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 20 10 8 10 6 % % 4 0 2 0 Growth Unemployment Inflation -10 Kuwait 1995 2000 2005 2010 2015 Year Average in HICs Growth Unemployment Inflation Average in MENA Kuwait Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 100 100 60 80 40 50 % GDP 60 % GDP % GDP 20 40 0 0 20 -20 Debt De�cit Spending Revenue -50 0 1995 2000 2005 2010 Kuwait Year Average in HICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 1995-2010 2D. Sources of Revenue, 2010 80 60 60 % GDP 40 % GDP 40 20 20 0 Income tax Other taxes Grants & other revenue 0 Kuwait 1995 2000 2005 2010 Year Average in HICs Income Other Taxes Grants & Other Revenue Average in MENA Lebanon Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2009 GNI per capita: 9.1e+03 12 60 Population: 4.3e+06 2A. Health Financing Indicators, 2010 11 60 50 10 % % 40 40 9 % 8 20 30 7 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Lebanon [left] [right] Average in UMICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 10 10 8 6 5 % % 4 0 2 0 Growth Unemployment Inflation -5 Lebanon 1995 2000 2005 2010 2015 Year Average in UMICs Growth Unemployment Inflation Average in MENA Lebanon Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 2000-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 180 150 40 170 100 30 % GDP % GDP % GDP 160 50 20 150 0 10 Debt De�cit Spending Revenue 140 1995 2000 2005 2010 Lebanon Year Average in UMICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 2000-2009 2D. Sources of Revenue, 2010 15 15 10 10 % GDP % GDP 5 5 0 Income tax Other taxes Grants & other revenue 0 Lebanon 1995 2000 2005 2010 Year Average in UMICs Income Other Taxes Grants & Other Revenue Average in MENA Libya Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2009 GNI per capita: 1.2e+04 70 Population: 6.4e+06 8 2A. Health Financing Indicators, 2010 60 60 6 50 % % 40 % 4 40 20 30 2 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Libya [left] [right] Average in UMICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Fiscal Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 150 30 30 100 20 20 % GDP % GDP % 50 10 10 0 0 0 -50 Growth Unemployment Inflation -10 1995 2000 2005 2010 2015 Libya Year Average in UMICs Growth Unemployment Inflation [left] [left] [right] Average in MENA Libya Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 80 80 60 60 60 40 % GDP 40 % GDP % GDP 20 40 20 0 20 0 -20 Debt De�cit Spending Revenue -40 0 1995 2000 2005 2010 Libya Year Average in UMICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 1995-2009 2D. Sources of Revenue, 2010 15 10 % GDP % GDP 5 0 Income tax Other taxes Grants & other revenue Libya 1995 2000 2005 2010 Year Average in UMICs Income Other Taxes Grants & Other Revenue Average in MENA Morocco Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2010 GNI per capita: 3.0e+03 60 Population: 3.2e+07 8 2A. Health Financing Indicators, 2010 7 60 50 6 % % 40 40 % 5 20 30 4 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Morocco [left] [right] Average in LMICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 10 15 8 10 6 % 5 % 4 2 0 0 Growth Unemployment Inflation -5 Morocco 1995 2000 2005 2010 2015 Year Average in LMICs Growth Unemployment Inflation Average in MENA Morocco Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 40 60 90 30 80 40 % GDP % GDP % GDP 20 70 20 10 60 0 0 50 Debt De�cit Spending Revenue 1995 2000 2005 2010 Morocco Year Average in LMICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 2002-2010 2D. Sources of Revenue, 2010 20 2015 15 % GDP % GDP 10 10 5 0 Income tax Other taxes Grants & other revenue 5 Morocco 1995 2000 2005 2010 Year Average in LMICs Income Other Taxes Grants & Other Revenue Average in MENA Oman Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2009 GNI per capita: 1.9e+04 Population: 2.8e+06 8 80 2A. Health Financing Indicators, 2010 80 60 6 60 % % 40 % 40 4 20 20 2 0 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Oman [left] [right] Average in HICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 15 10 8 10 6 % % 4 5 2 0 Growth Unemployment Inflation 0 Oman 1995 2000 2005 2010 2015 Year Average in HICs Growth Unemployment Inflation Average in MENA Oman Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 60 40 60 40 30 40 % GDP % GDP % GDP 20 20 20 10 0 0 Debt De�cit Spending Revenue -20 0 1995 2000 2005 2010 Oman Year Average in HICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 1995-2001 2D. Sources of Revenue, 2010 40 15 30 10 % GDP % GDP 20 5 10 0 Income tax Other taxes Grants & other revenue 0 Oman 1995 2000 2005 2010 Year Average in HICs Income Other Taxes Grants & Other Revenue Average in MENA Qatar Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2010 GNI per capita: 8.0e+04 12 Population: 1.9e+06 80 2A. Health Financing Indicators, 2010 10 80 60 8 60 % % 6 40 % 40 4 20 20 2 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Qatar [left] [right] Average in HICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 30 10 8 20 6 % 10 % 4 2 0 0 Growth Unemployment Inflation -10 Qatar 1995 2000 2005 2010 2015 Year Average in HICs Growth Unemployment Inflation Average in MENA Qatar Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 60 80 60 40 60 40 % GDP % GDP % GDP 20 40 20 20 0 0 Debt De�cit Spending Revenue -20 0 1995 2000 2005 2010 Qatar Year Average in HICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 2004-2010 2D. Sources of Revenue, 2010 30 2015 20 % GDP % GDP 10 10 5 0 Income tax Other taxes Grants & other revenue 0 Qatar 1995 2000 2005 2010 Year Average in HICs Income Other Taxes Grants & Other Revenue Average in MENA Syrian Arab Republic Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2009 GNI per capita: 2.8e+03 70 Population: 2.1e+07 8 2A. Health Financing Indicators, 2010 7 60 60 6 50 % % 40 5 % 40 4 20 30 3 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Syrian Arab Republic [left] [right] Average in LMICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2010 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 10 15 8 10 6 % % 4 5 2 0 0 Growth Unemployment Inflation -5 Syrian Arab Republic 1995 2000 2005 2010 2015 Year Average in LMICs Growth Unemployment Inflation Average in MENA Syrian Arab Republic Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 150 40 40 30 30 100 % GDP % GDP % GDP 20 2010 50 10 0 0 Debt De�cit Spending Revenue 0 1995 2000 2005 2010 Syrian Arab Republic Year Average in LMICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 1995-1997 2D. Sources of Revenue, 2010 15 1210 10 % GDP % GDP 8 5 6 0 Income tax Other taxes Grants & other revenue 4 Syrian Arab Republic 1995 2000 2005 2010 Year Average in LMICs Income Other Taxes Grants & Other Revenue Average in MENA Tunisia Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2009 GNI per capita: 4.1e+03 55 11 Population: 1.1e+07 2A. Health Financing Indicators, 2010 10 50 60 9 45 % % 40 8 % 40 7 20 6 35 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Tunisia [left] [right] Average in LMICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 20 15 15 10 % 10 % 5 5 0 Growth Unemployment Inflation 0 Tunisia 1995 2000 2005 2010 2015 Year Average in LMICs Growth Unemployment Inflation Average in MENA Tunisia Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 70 50 30 40 60 20 30 % GDP 20 % GDP % GDP 50 10 10 0 Debt De�cit Spending Revenue 40 0 1995 2000 2005 2010 Tunisia Year Average in LMICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 1995-2010 2D. Sources of Revenue, 2010 15 15 10 % GDP 10 % GDP 5 5 0 Income tax Other taxes Grants & other revenue 0 Tunisia 1995 2000 2005 2010 Year Average in LMICs Income Other Taxes Grants & Other Revenue Average in MENA United Arab Emirates Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2009 GNI per capita: 4.1e+04 10 80 Population: 7.9e+06 2A. Health Financing Indicators, 2010 80 60 8 60 40 % % 6 % 40 20 4 20 2 0 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) United Arab Emirates [left] [right] Average in HICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 10 15 8 10 6 % % 4 5 2 0 0 Growth Unemployment Inflation -5 United Arab Emirates 1995 2000 2005 2010 2015 Year Average in HICs Growth Unemployment Inflation Average in MENA United Arab Emirates Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 40 25 60 20 40 20 % GDP 15 % GDP % GDP 20 10 0 0 5 -20 -20 Debt De�cit Spending Revenue 0 1995 2000 2005 2010 United Arab Emirates Year Average in HICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 1997-1999 2D. Sources of Revenue, 2010 24 15 10 23 % GDP % GDP 5 22 0 Income tax Other taxes Grants & other revenue 21 United Arab Emirates 1995 2000 2005 2010 Year Average in HICs Income Other Taxes Grants & Other Revenue Average in MENA Yemen, Rep. Macro-Fiscal Context and Health Financing Factsheet 1A. Health Financing Indicators, 1995-2009 GNI per capita: 1.1e+03 Population: 2.5e+07 9 70 2A. Health Financing Indicators, 2010 8 60 60 7 50 % % 40 6 % 40 5 20 30 4 1995 2000 2005 2010 0 Year Tot. Health Exp. (% GDP) Govt. (% THE) Govt. (% GGS) OOP (% THE) Tot. Health Exp. (% GDP) Govt. (% THE) Yemen, Rep. [left] [right] Average in LICs Govt. (% GGS) OOP (% THE) [left] [right] Average in MENA 1B. Macroeconomic Indicators, 1995-2017 2B. Macroeconomic Indicators, Average 2012-2017 (proj.) 60 10 8 40 6 % 20 % 4 2 0 0 Growth Unemployment Inflation -20 Yemen, Rep. 1995 2000 2005 2010 2015 Year Average in LICs Growth Unemployment Inflation Average in MENA Yemen, Rep. Macro-Fiscal Context and Health Financing Factsheet 1C. Fiscal Indicators, 1995-2010 2C. Fiscal Indicators, Average 2012-2017 (proj.) 100 40 50 40 30 80 20 30 % GDP 20 % GDP % GDP 10 60 10 0 0 40 Debt De�cit Spending Revenue -10 1995 2000 2005 2010 Yemen, Rep. Year Average in LICs Debt De�cit Spending Revenue [left] [right] [right] [right] Average in MENA 1D. Sources of Revenue, 1995-1999 2D. Sources of Revenue, 2010 25 15 20 10 % GDP % GDP 15 5 10 0 5 Income tax Other taxes Grants & other revenue Yemen, Rep. 1995 2000 2005 2010 Year Average in LICs Income Other Taxes Grants & Other Revenue Average in MENA Definition of Macro Fiscal Health Indicators The$14$indicators$describe$a$country’s$macro5fiscal$environment$to$identify$constraints$or$opportunities$for$health$systems$financing.$For$each$ indicator$two$aspects$are$important:$level$and$trend.$A$country$with$a$10$percent$unemployment$rate$that$has$fallen$from$15$percent$may$be$ in$ better$ shape$ than$ one$ with$ an$ 8$ percent$ unemployment$ rate$ that$ has$ risen$ from$ 4$ percent.$ It$ is$ also$ important$ to$ benchmark$ to$ group$ averages$of$countries$in$the$same$Word$Bank$(WB)$region$(EAS,$ECS,$LCN,$MEA,$NAC,$SAS,$or$SSF)$and$income$group$(HIC,$Upper$MIC,$Lower$ MIC,$or$LIC).$ $ Indicator Source Definition How to interpret for fiscal space for health? Health Financing Indicators The sum of public and private health expenditure, which covers provision of health services (preventive 1. Total health expenditure World Health and curative), family planning activities, nutrition (THE as % GDP) Organization activities, and emergency aid designated for health (WHO) but does not include provision of water and sanitation (ratios in nominal LCUs). Consists of recurrent and capital spending from Health financing indicators reflect not only the 2. Government health WHO government (central and local) budgets, external share of resources devoted to health, but also spending (GHE as % borrowings and grants, and social health insurance the role of the government in the health sector THE) funds (ratios in nominal LCUs). in terms of financing, provision, or regulation. General government health spending as share of 3. Government health WHO general government spending (GGS) (ratios in spending (GHE as % nominal LCUs).! GGS) The direct outlay of households including gratuities 4. Out of pocket spending WHO and in-kind payments to health practitioners, (OOP as % THE) suppliers of pharmaceuticals, and other goods and services whose primary intent is to improve health status (ratios in nominal LCUs). Macroeconomic Indicators Growth is the most important macroeconomic 5. Growth (GDP, constant International Growth is the rate of change of a nation’s GDP from indicator. Additional fiscal space for health can prices) Monetary one year to another. be generated through economic growth without Fund (IMF) altering government spending priorities. Persistent high unemployment is also evidence Unemployment is the rate of unemployed workers of of structural problems in the economy. High the total labor force. Unemployed workers are rates of unemployment also may affect fiscal 6. Unemployment (rate) IMF currently not working but are willing and able to work space for health if a large share of government for pay, currently available to work, and have actively health resources come from searched for work. employer/employee contributions through payroll taxes. 7. Inflation (end of period IMF Inflation is the rate at which general level of prices for High levels of inflation can indicate structural consumer prices) goods and services are rising. problems and macroeconomic instability. Debt, Deficits, and Spending Indicators General government gross includes debt liabilities in SDRs, currency and deposits, debt securities, loans, 8. Gross Debt (as % of IMF insurance, pensions and standardized guarantee GDP) schemes, and other accounts payable. Equity and investment fund shares and financial derivatives and employee stock options are not included. General government net lending or borrowing is In the medium to long run, the level of debt is revenue minus total expenditure—it is the extent to the most important indicator of fiscal solvency, 9. Deficit (as % of GDP) IMF which general government is putting in or utilizing the and the deficit provides information on whether financial resources generated by other sectors and the debt level is under control or being brought non-residents. under control. The level of spending reflects Total expenditure is the total expense and the net choices about the role of government in the 10. Spending (as % of IMF acquisition of nonfinancial assets. It accounts for economy. These choices should be constantly GDP) disposals of nonfinancial assets. reviewed. Revenue consists of taxes, social contributions, 11. Revenues (as % of IMF grants receivable, and other revenue. Revenue GDP) increases government’s net worth, which is the difference between its assets and liabilities. Revenue Composition 12. Taxes on income, WB/IMF Tax payments on personal and corporate income and profits, and capital gains capital gains. The cost of raising revenues, in terms of the (% GDP) excess burden, generally differs by the source 13. Other taxes (% GDP) WB/IMF Other forms of tax payments, including taxes on of revenue. international trade, VAT, and other excise taxes. 14. Non-tax revenue (% WB/IMF Other forms of revenue, including grants. GDP) ! ! !