1 Less than 15%
2 15%-29.9%
3 30%-39.9%
4 40%-49.9%
5 50% and over
6 No data
1 less than 2%
2 2% to 4.9%
3 5% to 9.9%
4 10% to 14.9%
5 15% to 24.9%
6 25% to 34.9%
7 35% or over
8 No Data

Out of Pocket Health Expenditure

What does it mean ?

This indicator is calculated by adding together all direct payments from every household to health care providers or pharmacists, as a proportion of the total health-related spending in a country. Out of pocket health expenditure is only part of private health spending, because it does not include private health insurance. Together, government, external and private health spending make up the total health care spending in a country.

Why does it matter ?

Out of pocket health expenditure is a core indicator measuring the equity of health systems and the extent to which access to health care depends on one's ability to pay. Certain households may not be able to fund health care expenses out of pocket, resulting in untreated health problems and lack of care. For others, unplanned health spending will impoverish their whole household as they may be forced borrow money, to sell their assets or pull their children out of school to afford the costs.

How is it collected ?

The preferred source of data for this indicator is a National Health Account, which is an internationally agreed method for collecting information about all financial flows related to health in a country. Where a recent National Health Account is not available, the WHO's health financing team collects similar information using technical contacts in-country and publicly available documents.

WHO World Health Statistics 2014. Estimates for 2012 http://apps.who.int/nha/database

Births by Caesarean Section

What does it mean ?

This indicator shows the number of births by caesarean section relative to all births. Birth by caesarean section requires specialist health worker skills, an operating theatre and availability of specific drugs and medical products.

Why does it matter ?

All pregnancies are associated with risk and when medically justified, a caesarean section can prevent maternal and perinatal mortality and morbidity. However, because any surgery carries risk of complications, caesarean sections should not be performed unless it is medically required. According to the World Health Organisation, about 10-15 % of all births require delivery by caesarean section. As such, caesarean section rates lower than 10% indicates under-use and caesarean section rates over 15 % indicate over-use. Because birth by caesarean section requires specialist medical skills and health services, this indicators is sometimes used as a proxy indicator to measure the availability of quality of maternal health services in countries where data from health information systems and health facility surveys are limited.

How is it collected ?

Data on the percent of birth by caesarean section is usually derived from large scale, nationally representative surveys such as Demographic and Health (DHS) and Multiple Indicator Cluster Surveys (MICS), other national surveys. DHS/ MICS are household surveys where women are asked if they have given birth (usually in the last three or five years) and the circumstances surrounding the birth including if they had a caesarean section.

"The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014" Betrán, A., et al. PLoS One. 2016; 11(2): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743929/