Health accounts: Following the money to improve healthcare worldwide
Health accounts: Tracking $9 trillion spending—making systems transparent
Finance Minister Priya Sharma stared at the spreadsheet, frustrated. Her country’s health budget had doubled in five years, yet maternal mortality remained stubbornly high. Where was all the money going?
“We know we’re spending more,” she told her advisors. “But we don’t know what we’re spending it on—hospitals? Medicines? Salaries? And we can’t compare ourselves to similar countries because everyone measures things differently.”
Her chief economist nodded grimly. “Without standardized health accounts, we’re flying blind. We can’t identify waste, can’t allocate resources effectively, can’t hold anyone accountable. We need a system.”
This scenario plays out in government offices worldwide. According to WHO’s work on health accounts, the system of health accounts is an international accounting framework for systematically tracking health spending. Time trends of overall health spending and its components guide future policies and investments to make health systems more responsive to people’s needs.
Health accounts are essential for improving the performance of health systems while enhancing transparency and accountability. Health expenditure data also provide insights for assessing the adequacy of health resources, evaluating the efficiency, effectiveness, and equity of resource allocations, benchmarking against peers, and monitoring the progress towards the key goals of universal health coverage and health security.
For more on health system financing, see our articles on healthcare economics and universal health coverage at ObserverVoice.com.
The Universal Language of Health Spending
“A System of Health Accounts 2011” (SHA 2011) establishes an integrated and comprehensive methodology for tracking health expenditure through a set of uniform accounts comparable across countries. The framework, which focuses on final consumption, tracks resource flows through the health system: from its sources (funding sources, financial arrangements), patterns of provision (providers and factors of provision), and through to its use (health care functions, diseases/programs).
Think of SHA 2011 as the accounting equivalent of a universal language—just as scientists worldwide use standardized measurements like meters and kilograms, health economists now use standardized categories to track where health money comes from, who provides services, and what treatments patients receive.
In December 2025, WHO published Tracking pharmaceutical expenditure under the System of Health Accounts 2011, providing technical guidance on tracking medicine costs. WHO also released Tracking governance and administration expenditure under SHA 2011 in June 2025, analyzing how countries measure spending on health system management.
WHO’s Health Systems Governance and Financing department and Health Expenditure Tracking team coordinate this technical work.
For more on health system performance, see our articles on healthcare quality at ObserverVoice.com.
The Global Health Expenditure Database: A Public Good
Data collection on countries’ health expenditure, based on SHA 2011, is the foundation of the Global Health Expenditure Database (GHED). GHED is a global public good: being an open-access platform that hosts internationally comparable data on annual health spending for more than 190 countries from 2000 onwards, as well as data visualization for easy comparisons across countries and over time.
The Global health expenditure database contains comprehensive information allowing policymakers to answer critical questions: Is our country spending enough on health? Are we spending it efficiently? How do we compare to similar countries? Is spending reaching the poorest populations?
GHED also contains key methodology and guidance documents for health expenditure tracking. WHO works with the countries to update the GHED annually. In August 2025, WHO published Methodology for the update of the Global Health Expenditure Database, providing an overview of this key global resource.
WHO also maintains specialized databases in the Global Health Observatory: Health Expenditure, Current Health Expenditure, and Health Financing.
Dr. Thomas Mueller, who helped develop SHA 2011, explained the transformation: “Before standardized health accounts, comparing countries was like comparing apples to oranges to pineapples. Now we have a common framework. A government can see that neighboring Country A spends 6% of GDP on health with better outcomes, while they spend 8% with worse results. That prompts important questions.”
Annual Reports Revealing Global Trends
To accompany the annual data release, WHO publishes an annual global health expenditure report that provides an overview of the trends in global health expenditure, the thematic profile of spending, as well as special topics.
In December 2024, WHO published Global spending on health: Emerging from the pandemic, delving into the intricate landscape of global economies and health systems, focusing on health spending patterns as countries recovered from COVID-19.
WHO hosted events to discuss findings: Global Spending on Health: Coping with the Pandemic in December 2023, Global spending on health: rising to the pandemic’s challenges in December 2022, and Global expenditure on health: Public spending on the rise? in December 2021.
WHO produced videos explaining health spending: Universal Health Coverage – Everything You Need to Know about Global Health Expenditure in June 2018, and Global Spending on Health: A World in Transition in May 2020, available in both full and short versions.
For more on global health trends, see our articles on pandemic economics at ObserverVoice.com.
Supporting Countries to Build Capacity
WHO works closely with partners to establish and institutionalize harmonized, integrated mechanisms for the routine and timely collection and publication of health expenditure data, as well as using health accounts information in policymaking. At a technical level, WHO has developed methodologies, practical guidance, and IT tools, and provides direct technical support. At an institutional level, it involves efforts to help countries build their capacity to undertake such functions.
WHO’s activities include Addressing the political economy of health financing reform, Assessing country progress in health financing for UHC, Fostering fiscal dialogue between finance and health, and Pooling revenues and reducing fragmentation.
Accordingly, the demand for timely, accurate, and comprehensive data on health expenditures has been increasing at both the country and global levels.
Global Commitments to Health Financing Transparency
The United Nations adopted Political declaration of the high-level meeting on universal health coverage in 2019. The World Health Assembly passed WHA72.4 on Preparation for the high-level meeting on universal health coverage, emphasizing the importance of health financing tracking.
Related WHO work includes health budget, health financing, universal health coverage, common goods for health, and health taxes.
Finance Minister Sharma eventually implemented SHA 2011 in her country. Within two years, the data revealed shocking truths: 40% of health spending went to hospitals in the capital city serving just 15% of the population. Rural clinics were chronically underfunded. Pharmaceutical spending was triple the regional average due to corruption in procurement.
“The health accounts didn’t solve our problems,” she said, “but they finally showed us exactly what the problems were. Now we can fix them.”
With WHO’s comprehensive approach to health accounts, countries worldwide can track their health spending systematically—ensuring every dollar reaches those who need it most and making universal health coverage a reality, not just a promise.
For more information, visit WHO’s health accounts topic page or explore related content at ObserverVoice.com.
Frequently Asked Questions (FAQs)
Health accounts are an international accounting framework for systematically tracking health spending. They guide future policies and investments to make health systems more responsive to people’s needs, while enhancing transparency and accountability. “A System of Health Accounts 2011” (SHA 2011) establishes a comprehensive methodology for tracking health expenditure through uniform accounts comparable across countries, tracking resource flows from their sources through providers to their use.
The Global Health Expenditure Database (GHED) is an open-access platform hosting internationally comparable data on annual health spending for more than 190 countries from 2000 onwards. It includes data visualization for easy comparisons across countries and over time, plus key methodology and guidance documents. WHO updates GHED annually and publishes annual global health expenditure reports.
WHO published Tracking pharmaceutical expenditure under SHA 2011 in December 2025, Tracking governance and administration expenditure under SHA 2011 in June 2025, and Methodology for the update of GHED in August 2025. These technical notes explain how countries can track different components of health spending systematically.
WHO provides methodologies, practical guidance, IT tools, and direct technical support through its Health Systems Governance and Financing department. Activities include assessing country progress in health financing for UHC, fostering fiscal dialogue between finance and health, and building capacity for routine data collection and publication.
The UN adopted the Political declaration on universal health coverage in 2019, and WHO passed WHA72.4 on preparation for the high-level meeting on UHC. These emphasize the importance of tracking health spending to assess resource adequacy, evaluate efficiency and equity, benchmark against peers, and monitor progress towards universal health coverage and health security.
- WHO Health Accounts Topic Page
- Global Health Expenditure Database (GHED)
- Global Spending on Health: Emerging from the Pandemic (Dec 2024)
- WHO Health Systems Governance and Financing Department
- UN Political Declaration on Universal Health Coverage (2019)
Disclaimer: This article is an adaptation of publicly available information from WHO’s Health accounts
health topic page (WHO, Geneva. Licence: CC BYNC-SA 3.0 IGO). WHO is not responsible for the
content or accuracy of this adaptation. This content is for informational and educational purposes
only and does not constitute medical advice. ObserverVoice.com is a news and information platform
— not a healthcare provider.
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