Publication: The 2019 Update of the Health Equity and Financial Protection Indicators Database: An Overview
Loading...
Files in English
1,545 downloads
Published
2019-06
ISSN
Date
2019-06-13
Author(s)
Editor(s)
Abstract
This paper outlines changes that have been made in the 2019 version of the Health Equity and Financial Protection Indicators database. On the financial protection side, the changes include an increase in the number of indicators from five to 14; revisions to several previous data points, reflecting the analysis of new surveys (or adaptations thereof); and refinements to the estimation of out-of-pocket expenditures. On the health equity side, the 2019 database includes 198 more data points than the 9,733 in the 2018 database, reflecting the addition of 535 new datapoints, and the dropping of 337 previously included data points now considered to be substandard.
Link to Data Set
Citation
“Eozenou, Patrick; Wagstaff, Adam; Smitz, Marc; Neelsen, Sven. 2019. The 2019 Update of the Health Equity and Financial Protection Indicators Database: An Overview. Policy Research Working Paper;No. 8879. © World Bank. http://hdl.handle.net/10986/31869 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Publication Climate and Social Sustainability in Fragility, Conflict, and Violence Contexts(Washington, DC: World Bank, 2026-01-07)Climate change is widely recognized as a driver of violent conflict, but its broader social effects remain less understood. Ignoring these dimensions risks a vicious cycle where climate policies might undermine socially just adaptation. Evidence is still limited on how climate shocks influence political participation, trust, or migration. This paper helps fill that gap by examining links between climate change, conflict, and social sustainability, with a focus on inclusion, resilience, cohesion, and legitimacy. Using secondary data from 2019–24, the study applies simple correlation-based methods to test three hypotheses on the nature, severity, and composition of these associations. The analysis combines multiple climate impact measures, new conflict classifications, recent social sustainability frameworks, and controls for population and geography. The results reveal strong correlations—not causation—between climate events and contexts of fragility, conflict, and violence. Climate impacts are most pronounced in both national and subnational conflict settings. The study also finds robust links between fragility, conflict, and violence and low levels of social sustainability, reflecting its role as both a driver and consequence of conflict. Some dimensions—such as violent events and insecurity—appear weaker in areas most affected by climate shocks. Two of the hypotheses are supported, and one remains inconclusive.Publication The Macroeconomic Implications of Climate Change Impacts and Adaptation Options(Washington, DC: World Bank, 2025-05-29)Estimating the macroeconomic implications of climate change impacts and adaptation options is a topic of intense research. This paper presents a framework in the World Bank's macrostructural model to assess climate-related damages. This approach has been used in many Country Climate and Development Reports, a World Bank diagnostic that identifies priorities to ensure continued development in spite of climate change and climate policy objectives. The methodology captures a set of impact channels through which climate change affects the economy by (1) connecting a set of biophysical models to the macroeconomic model and (2) exploring a set of development and climate scenarios. The paper summarizes the results for five countries, highlighting the sources and magnitudes of their vulnerability --- with estimated gross domestic product losses in 2050 exceeding 10 percent of gross domestic product in some countries and scenarios, although only a small set of impact channels is included. The paper also presents estimates of the macroeconomic gains from sector-level adaptation interventions, considering their upfront costs and avoided climate impacts and finding significant net gross domestic product gains from adaptation opportunities identified in the Country Climate and Development Reports. Finally, the paper discusses the limits of current modeling approaches, and their complementarity with empirical approaches based on historical data series. The integrated modeling approach proposed in this paper can inform policymakers as they make proactive decisions on climate change adaptation and resilience.Publication Institutional Capacity for Policy Implementation: An Analytical Framework(Washington, DC: World Bank, 2026-01-07)State capacity is an important prerequisite for policy implementation, yet at the country level it is difficult to measure, assess, and reform. This paper proposes a focus on institutional capacity: the ability of public institutions to implement the specific policy mandates for which they are responsible. Based on a review of existing literature, the paper defines the different dimensions that compose institutional capacity and groups them into two cross-cutting categories: organizational dimensions (personnel, financial resources, information systems, and management practices) and governance dimensions (transparency, independence, and accountability). The paper proposes measures for organizational and governance dimensions using existing data, shows intra-institutional variation of these measures within countries, and discusses how new data could be collected for better measurement of these concepts. Finally, the paper illustrates how the framework can be used to diagnose the sources of common problems related to weak policy implementation.Publication South Africa’s Fragmented Cities: The Unequal Burden of Labor Market Frictions(Washington, DC: World Bank, 2026-01-08)Using high-resolution administrative, census, and satellite data, this paper shows that South African cities are characterized by spatial mismatches between where people live and where jobs are located, relative to 20 global peers. Areas within 5 kilometers of commercial centers have 9,300 fewer residents per square kilometer than expected, which is 60 percent below the global median. Poor, dense neighborhoods are most affected. In Johannesburg, a 10-percentile increase in distance from the nearest business hub corresponds to a 3.7-percentile drop in asset wealth (a proxy of household wellbeing) and 4.9-percentile drop in employment. In Cape Town, the declines are 4.0 and 3.7 percentiles, respectively. Employment is 87 percent lower in the poorest decile than the richest in Johannesburg and 61 percent lower in Cape Town. These findings suggest that South Africa’s spatial organization of people and economic activity constrains agglomeration and reinforces inequality. This methodology provides a scalable and standardized data-driven framework to analyze spatial accessibility and agglomeration frictions in complex, data-constrained urban systems.Publication Investment in Emerging and Developing Economies(Washington, DC: World Bank, 2026-01-07)The world faces a pressing challenge to meet key development objectives amid slowing growth and rising macroeconomic and geopolitical risks. With the number of job seekers rising rapidly, infrastructure shortfalls continuing to be large, and climate costs mounting, the case for a significant investment push has never been stronger. Yet the capacity to respond in many emerging markets and developing economies has eroded. Since the global financial crisis, investment growth has slowed to about half its pace in the 2000s, with both public and private investment weakening. Foreign direct investment inflows—a critical source of capital, technology, and managerial know-how—have also fallen sharply and become increasingly concentrated, leaving low-income countries with only a marginal share. The risks of further retrenchment are significant, as trade tensions, policy uncertainty, and elevated debt levels continue to weigh on investment. Reigniting momentum will require ambitious domestic reforms to strengthen institutions, rebuild macro-fiscal stability, and deepen trade and investment integration—the foundations of a supportive business climate. At the same time, international cooperation is indispensable. A renewed commitment to a predictable system of cross-border trade and investment flows, combined with scaled-up financial support and sustained technical assistance, is essential to help emerging markets and developing economies—especially low-income countries and economies in fragile and conflict situations—bridge financing gaps and implement the domestic reforms needed to restore investment as an engine of growth, jobs, and development.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication The 2018 Health Equity and Financial Protection Indicators Database(World Bank, Washington, DC, 2018-10)The 2018 database on Health Equity and Financial Protection indicators provides data on equity in the delivery of health service interventions and health outcomes, and on financial protection in health. This paper provides a brief history of the database, gives an overview of the contents of the 2018 version of the database, and then gets into the details of the construction of its two sides -- the health equity side and the financial protection side. The paper also provides illustrative uses of the database, including the extent of and trends in inequity in maternal and child health intervention coverage, the extent of inequities in women's cancer screening and inpatient care utilization, and trends and inequalities in the incidence of catastrophic health expenditures.Publication Introducing the World Bank’s 2018 Health Equity and Financial Protection Indicators Database(Elsevier, 2018-10-22)Among the many shifts of emphasis that have been evident in global health over the past twenty-five years or so, two stand out: a concern over the poor lagging behind the better off in progress towards global goals; and a concern to look beyond whether people get the services they need to the affordability of the out-of-pocket expenditures associated with these services. The World Bank's 2018 Health equity and financial protection indicators (HEFPI) database is a new global resource for tracking progress on both fronts. It is, in effect, the fourth in the series of such databases. The 2018 database includes eighteen indicators of service use (twelve preventative, six curative) and twenty-eight health outcome indicators. The data are calculated from household surveys, identified mostly through searches of data catalogues and websites of multicountry survey initiatives. The 2018 HEFPI dataset is freely downloadable, and a data visualisation tool is also available. To ensure the data are reproducible, and in line with the guidelines for accurate and transparent health estimates reporting, the authors document their methods thoroughly in a working paper and highlight the differences between their definitions and others; They also provide the essential computer code used to produce the estimates.Publication The 2022 Update of the Health Equity and Financial Protection Indicators Database(Washington, DC: World Bank, 2022-12)This paper outlines changes that have been made for the third version of the World Bank’s Health Equity and Financial Protection Indicators (HEFPI) database launched in 2022. Across all indicators, subpopulation breakdowns by urban and rural place of residence and subnational region were added. On the financial protection side, the number of indicators further expanded to 31, reflecting a broadening of the definition of medical impoverishment from being limited to those pushed below the poverty line by medical spending to also include those already under the poverty line who incur any medical spending, that is, those ‘further impoverished’ by medical spending. The additional financial protection indicators also include indicators that show the intersection of catastrophic and impoverishing health spending, that is, identify the populations exposed to both types of financial hardship simultaneously. The health equity side of the database now includes 19,820 country-level data points from 1,318 surveys across 35 service coverage and 38 health outcome indicators. An upgraded data visualization portal was launched alongside the new dataset.Publication Progress on Impoverishing Health Spending in 122 Countries(Elsevier, 2017-12-13)The goal of universal health coverage (UHC) requires that families who get needed health care do not suffer financial hardship as a result. This can be measured by instances of impoverishment, when a household's consumption including out-of-pocket spending on health is more than the poverty line but its consumption, excluding out-of-pocket spending, is less than the poverty line. This links UHC directly to the policy goal of reducing poverty. We find impoverishment due to out-of-pocket spending even in countries where the entire population is officially covered by a health insurance scheme or by national or subnational health services. Incidence is negatively correlated with the share of total health spending channelled through social security funds and other government agencies. Out-of-pocket spending on health can add to the poverty head count and the depth of poverty by diverting household spending from non-health budget items. The scale of such impoverishment varies between countries and depends on the poverty line but might in some low-income countries account for as much as four percentage points of the poverty head count. Increasing the share of total health expenditure that is prepaid, especially through taxes and mandatory contributions, can help reduce impoverishment.Publication Out-of-Pocket Expenditures on Health(Published by Oxford University Press on behalf of the World Bank, 2020-07)This paper provides an overview of research on out-of-pocket health expenditures by reviewing the various summary measures and the results of multi-country studies using these measures. The paper presents estimates for 146 countries from all World Bank income groups for all summary measures, along with correlations between the summary measures and macroeconomic and health system indicators. Large differences emerge across countries in per capita out-of-pocket expenditures in 2011 international dollars, driven in large part by differences in per capita income and the share of GDP spent on health. The two measures of dispersion or risk—the coefficient of variation and Q90/Q50—are only weakly correlated across countries and not explained by our macroeconomic and health system indicators. Considerable variation emerges in the out-of-pocket health expenditure budget share, which is highly correlated with the incidence of “catastrophic expenditures”. Out-of-pocket expenditures tend to be regressive and catastrophic expenditures tend to be concentrated among the poor when expenditures are assessed relative to income, while expenditures tend to be progressive and catastrophic expenditures tend to be concentrated among the rich when expenditures are assessed relative to consumption. At the extreme poverty line of $1.90-a-day, most impoverishment due to out-of-pocket expenditures occurs among low-income countries.
Users also downloaded
Showing related downloaded files
Publication A Guide to the World Bank(Washington, DC, 2003)This book is intended for the wide range of people around the world who need basic information about the work of the Bank Group. This audience includes people working in all aspects of development, students, members of the general public, and staff members of the Bank Group itself. Because this audience is so broad, the text emphasizes the organizational and conceptual divisions of the Bank Group's activities and guides readers to potential sources of more-detailed explanations of the development work in progress. The annual reports of the Bank Group institutions provide more details on the volume and types of development assistance. The annual World Bank Group Directory lists telephone contacts for individuals and departments. The following chapters explain how the World Bank Group is organized; how it operates; and how its work focuses on countries, regions, and specific topics in development. Appendixes provide further information on Bank Group contacts, on the organization's history, on country membership and the voting shares in the institutions, on the sector and thematic categories for the Bank Group's activities, and on Bank Group resources in individual countries.Publication Infrastructure Development in Sub-Saharan Africa(World Bank, Washington, DC, 2018-05)Infrastructure is viewed as a crucial ingredient to foster growth and productivity. Amid the post -- global financial crisis slowdown, Sub-Saharan Africa is in dire need to continue the growth momentum it experienced during the period of the Africa Rising narrative. An emerging consensus in the empirical literature is that, under the right circumstances, an adequate supply of infrastructure can help foster growth in the region. This paper provides a scorecard on infrastructure development in Sub-Saharan Africa over the past decades along four sectors (telecommunications, electric power, transportation, and water and sanitation) and three dimensions (quantity, quality, and access). First, it documents the existence of a large gap in infrastructure in the region—although the magnitude of the gap depends on the sector, dimension, and country/group. Second, the potential growth benefits from closing the infrastructure gap are large. Third, the infrastructure financing needs are very large, and the public sector so far is unable to meet these needs. Other options that involve the private sector may be available for the region. Finally, there is room for improving the efficiency of public infrastructure spending (that is, the quality of public investment management systems and procurement methods), which, in turn, may increase the output multiplier of investment spending.Publication Comoros Tourism Sector Review : Discovering the Tourism Potential of Natural Wonders(Washington, DC, 2013-07)The Union of Comoros has struggled through political unrest for over thirty years. As a result, its tourism sector is still in the exploration phase of its life cycle. There have been initiatives by both the public and private sectors in the tourism industry, but to date, a lack of commitment from both sectors and external circumstances have prevented further growth. Comoros needs a tourism development plan that will provide a framework for all tourism stakeholders to the next phase of development. Strong institutional leadership from both the public and private sectors is one of the most important requirements to be addressed in order to support tourism in Comoros. The objective of this review is to conduct an analysis of the tourism sector performance and policies in the Union of Comoros. It presents policy options and recommendations at a country and sub-regional level. This review has been constructed as part of a larger Indian ocean regional tourism integration study including similar reports on the tourism sectors of Seychelles, Mauritius, and Madagascar. Combined recommendations provide a basis for practical approaches towards improved tourism competitiveness through leveraging regional integration opportunities across these economies. This report is structured as follows: section one gives introduction to the Comoros study; section two gives overview of the Union of Comoros tourism sector; section three presents key issues; section four gives recommendations; and section five gives conclusion.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.Publication Republic of Argentina Financial Sector Assessment(Washington, DC, 2011-10)This assessment finds that Argentina has made significant progress to improve its securities regulatory system within the existing legal framework. Specifically, Argentina operates a highly, even uniquely, transparent securities regulatory program. The assessment also finds that the Argentine securities regulator has dedicated professional staff, active on-site inspection programs, pro-active investigation of complaints, a road map to transition by 2012 to international accounting standards (IFRS) and plans to modernize auditing standards, the ability to assist foreign regulatory authorities to the extent of its current powers, and a commitment to use the powers it has to meet its mandate, achieve international benchmarks, and build on its practical experience to strengthen regulatory oversight. At the same time this assessment finds areas, of which the securities regulator is well aware, that need to be improved. These include that: (i) the complex structure of the market may be a source of inefficiency and an impediment to price formation and best execution; (ii) the regulator has insufficient administrative power to oversee comprehensively the regulatory performance by certain self-regulatory organizations affecting equity and private debt markets with respect to their members and to supervise, discipline and enforce its rules and the securities laws over such members directly; (iii) the ability to cooperate domestically and with foreign regulators is constrained by securities and banking secrecy law; (iv) the legal underpinning for protecting customer funds held by intermediaries needs enhancements; (iv) there are no existing market disruption contingency plans at the regulatory level; and (v) the markets offer some products that may require additional, tailored monitoring and explanation to external participants. This assessment of the International Organization of Securities Commissions (IOSCO) objective and principles of securities regulation was conducted between May 11 and May 26, 2011 in Buenos Aires, Argentina and includes references to certain post on-site improvements. The assessment included a review of the main securities laws, executive decrees, and general resolutions that relate to the mandate of the Comision Nacional de Valores (CNV) and underpin the public offer and trading of securities in Argentina.