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3.2.1 INTERNATIONAL STANDARDS IN TRACKING PHC
SPENDING

The System of Health Accounts (SHA) is the result of a joint international effort to
propose a framework for the systematic description of financial flows related to healthcare, first
published in 2000 by the Organisation for Economic Co-operation and Development (OECD).
The latest edition was released in 2017 (named SHA 2011) as a collaborative effort between
the OECD, the European Union (EU), and the WHO. The SHA emphasised a tri-axial
relationship between the following (Figure 3.5) (OECD et al., 2017):

• The classifications by the functions of healthcare (Functions ICHA-HC, types of healthcare
goods and services to be consumed);

• The classifications by healthcare provision (Providers ICHA-HP, types of healthcare
providers who deliver these goods and services); and

• The classifications by financing schemes (Financing schemes, ICHA-HF, how are these
goods and services paid for).

Figure 3.5
The core and extended accounting framework of SHA 2011

Characteristics of bene ciaries
(Diseases, age, gender, income, etc.)
Consumer health
interface

Functions
ICHA-HC

SHA
Core
accounting
Revenues of nancing framework Gross capital
schemes ICHA-FS formation
Financing Financing Providers Provision
interface schemes ICHA-HF ICHA-HP interface
Financing Factors of provision
agents ICHA-FA ICHA-FP External trade

Note: Adopted from A System of Health Accounts 2011: Revised Edition
Source: OECD, 2017

Subsequently, the WHO’s 2019 Global Report, “Global Spending on Health: A World in
Transition” presented the definition of PHC spending based on the SHA 2011. The
categorisation, presented in Box 3.5, was developed in 2018 and for the first time, offered a
framework on tracking comparable PHC spending across jurisdictions.

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