Currency equivalents

Avant-projet de loi relative à la santé, has been prepared more recently.

142 According to Algerian data sources (MOHPR), life expectancy is at 74.8 in 2004.

143 According to Algerian data sources (MOHPR), it is at 30.4 per thousand in 2004.

144 For the child mortality MDG, the target is to reduce the under-five mortality rate by two-thirds between 1990 and 2015. The under-five rate for Algeria was 69/1,000 live births in 1990. So, the target is 23/1,000 by 2015.

145 For the maternal mortality MDG, the target is to reduce the maternal mortality ratio by three-quarters between 1990 and 2015. The ratio in Algeria was 160/100,000 live births in 1990. So, the target is 40/1,000 by 2015.

146 The MMR is very difficult to measure, and often underestimated, even in high income countries. WHO, UNICEF and UNFPA have developed a new estimation method, which provides the numbers described here. Algerian data (MOHPR), however, are better (230/100,000 in 1989, 117.4 in 1999, and 96.8 in 2004).

147 Bacille Calmette Guerin (BCG) is the most widely used vaccination in the world. BCG was developed in the 1930s and remains the only vaccination available against tuberculosis today.

148 Except where otherwise indicated, all data in this section are for the year 2004 and are taken from the health map prepared by the Ministry of Health.

149 Comparisons are not always straightforward. World Development Indicators for 2005 refer to the beds ratio for 1998. It is possible, however, to derive orders of magnitude, for example, a ratio of 3.38 for lower-middle-income countries in 1998.

150 These contributions cover retirement, unemployment, occupational accident, and CNAS benefits for sickness, maternity, disability, and death benefits. The latter distribution dates from a decree of 2000 that assigned 14 percent of the 34.5 percent to CNAS (12.5 percent paid by the employer and 1.5 percent by the employee). In the case of insured “non-wage earners”, the state contributes on their behalf at a reduced rate—6 percent of the national guaranteed minimum wage (SNMG) for indigents, 2 percent of the SNMG for students, and so forth.

151 See Annex T for a description of functions by institution in the health system.

152¹⁵¹ The first draft was revised without major modifications. However, the future of this bill appears uncertain.

¹⁵² The rapid finalization of the strategy might be an indirect fortunate outcome of the preliminary discussions between the Review and the ministry’s authorities during the seminar of July 2006. At that stage, the authorities had already announced its preparations that led to its urgent finalization.

153 The figures used in this section are taken from the WDI (2005). Algeria compiled National Health Accounts (NHA) for the first time in 2003. That report however covers only the years 2000 and 2001 and does not allow for longer-term comparisons of total health spending or of the public-private split. Use of the WDI data also facilitates international comparisons. In the remainder of this report, the more detailed Algerian data are generally used for more in-depth analysis of the distribution, efficiency, and equity of public health spending.

154 This estimate assumes that per capita health expenditure by age and by sex remains constant. Since data on health expenditure by age and by sex are generally unavailable for low- and middle-income countries, the weighting used is for the United States. As a result, the impact of age could be overestimated, recognizing the very high level of technology and resources in the United States that are devoted preponderantly to older population cohorts.

155 Beyond 2001, the data available to us for interpretation are much more detailed for the “major funding sources” (Ministry of Health, and Social Security) than for the other sources (other ministries than Health, and households).

156 Private expenditure relates primarily to expenses from private care providers. It is especially difficult to find reliable figures, however, because the government does not collect any systematic data on this activity. Generally speaking, the private sector is not well understood by the authorities and is subject to little regulation. The private expenditure share may therefore be understated in official statistics. One remedy would be to conduct regular surveys of household health outlays. The National Health Account (NHA) report, published in May 2003, also recommended that the National Statistics Office surveys this issue.

157 This issue is addressed only in the NHA, and the authors of that report lacked all the necessary information. They had to estimate health spending by the Ministry of Defense since the ministry did not provide precise financial data. This situation poses management and programming difficulties, and could even create problems coordinating operations among the various ministries. It would be desirable in the future to prepare an annual synthesis summarizing all state financing of the health sector.

158 For an analysis of this issue, see World Bank (2002a).

159 For brievity, the Ministry of Health, Population, and Hospital Reform is referred to in the remainder of this report as simply the “Ministry of Health” or the “Health Ministry.”

160 Article 54 merely declares, “All citizens are entitled to protection of their health. The state is responsible for prevention and for combating epidemic and endemic diseases.”

161 Assistance provided by the World Health Organization, the United Nations Fund for Population Activities, and UNICEF.

162 See Statistiques sanitaires – Année 2003, Ministry of Health.

163 Expenditure increases were not concentrated at any particular level of care. The distribution of spending remained relatively stable for secteurs sanitaires delivering primary and secondary care on the one hand, and CHU and EHS delivering secondary and tertiary care on the other hand (see Table A.7.10).

164 Data for the Social Security system are less comprehensive than those for the State. No data were available on health expenditures by the insurance funds prior to 2000, or on the trend in the numbers of social insurees, or on the revenues and profit/deficit of the funds.

165 See the Statement by the Minister of Labor and Social Security to the Finance and Budget Committee of the People’s National Assembly (APN) on October 27, 2005.

166 The poorest wilayas are those that include most towns classified as "poor" in the four dimensions of the health map study: wealth, education, health, and housing.

167 Capitation means that a fixed amount is paid to provide a defined set of services to an individual patient for a given period of time. Experience shows that fee-for-service can be inflationary by providing incentives for more procedures than necessary. Still, any payment mechanism, taken in isolation, can have perverse effects, whether on the number of procedures, on cost control, or on service quality. Capitation generally allows for sound cost control and promotes service quality, but it may induce health professionals to limit contact with their patients. For this reason, the most effective payment systems for health services are often those that combine different mechanisms.