Washington DC, 10 January 2020 (PAHO)—The Department of Health Systems and Services of the Pan American Health Organization (HSS/PAHO) organized two workshops, in March and October 2019, on Financial Protection in Health to identify and produce key financial protection indicators in the advancement of health systems towards universal health goals.

Representatives from 19 Spanish-speaking countries and from 16 countries and territories of the English-speaking Caribbean countries in the Americas attended the workshops, that aimed to address the technical and calculation details of the financial protection monitoring indicators so that participants can produce and use them as part of health policy formulation.

Financial protection in health means that everyone can obtain the health care services they need without experiencing financial hardship. It is a key health system objective and an important dimension of universal health, a target (3.8) of Sustainable Development Goal (SDG) 3.

At the workshops, attendees reflected on the link between financial protection, universal health, and the SDGs in terms of health policies, and on the importance of measuring these indicators and informing them. They performed the basic calculations considering key aspects that are linked to the achievement of universal health and not just financing. In addition, participants calculated the financial protection indicators, which include catastrophic expenditure and impoverishing expenditure.

After these activities, PAHO was able to inform some indicators that were outlined in the 2019 Global Monitoring Report: “Primary Health Care on the Road to Universal Health Coverage.” These include an increase in average regional public expenditure in health, from 3.8 to 4.2% of GDP over the last five years. The report mentions that the Americas was the only Region where the number of people and percentage of the population with catastrophic health spending at both thresholds fell between 2010 and 2015.
In addition, PAHO reported some of the indicators that were included in the “Global Monitoring Report on Financial Protection in Health 2019” of the World Health Organization and the World Bank. This report offers indicators of catastrophic health spending (SDG indicator 3.8.2, defined as out-of-pocket health spending exceeding 10% or 25% of total household consumption or income) and indicators of impoverishing health spending (capturing the impact of out-of-pocket health spending on poverty using various global poverty lines).

Some of the results from the Region of the Americas mentioned in the report were related to a study on gender inequalities that suggests that women tend to have higher out-of-pocket health spending than men, individually and by gender of the household head. But this does not always lead to a higher incidence of catastrophic health spending as tracked by SDG indicator 3.8.2 for households headed by women, even when controlling for the poverty status and geographic location of the household. 

The organization of the workshops is part of PAHO’s efforts to build capacities in the countries of the Region for the future calculation and reporting of health indicators for policy development for the transformation and strengthening of health systems in the Americas. 


Primary Health Care on the Road to Universal Health Coverage. World Health Organization 2019. 

Global Monitoring Report on Financial Protection in Health 2019. World Health Organization and the International Bank for Reconstruction and Development /The World Bank 2019.