Analytical and evaluation study of Health expenditure in Algeria during the period 2000-2017

Dr. Hadji Fatima

Analytical and evaluation study of Health expenditure in Algeria

during the period 2000-2017
Dr. Hadji Fatima1
Bordj Bou Arreridj University - Algeria
Email: [email protected]

Received: 08/04/2019 Published: 03/03/2020

:‫ﻣﻠﺨﺺ‬
‫ و ﺪف ﻣﻦ ﺧﻼﻟﻪ اﻟﺪول إﱃ ﲢﻘﻴﻖ زﻳﺎدة و ﻛﻔﺎءة ﰲ‬،‫ﻳﻌﺪ اﻹﻧﻔﺎق ﻋﻠﻰ اﻟﻘﻄﺎع اﻟﺼﺤﻲ ﻣﻦ أﻫﻢ أوﺟﻪ اﻻﺳﺘﺜﻤﺎر ﰲ رأس اﳌﺎل اﻟﺒﺸﺮي‬
،‫ وﻟﻘﺪ اﻧﺘﻬﺠﺖ اﳊﻜﻮﻣﺔ اﳉﺰاﺋﺮﻳﺔ ﻣﻨﺬ اﺳﺘﻘﻼﳍﺎ وإﱃ ﻏﺎﻳﺔ اﻟﻴﻮم ﺿﻤﻦ ﺧﻄﻄﻬﺎ اﻟﺘﻨﻤﻮﻳﺔ‬،‫ ﳑﺎ ﻳﻨﻌﻜﺲ إﳚﺎﺑﺎ ﻋﻠﻰ اﻻﻗﺘﺼﺎد‬،‫إﻧﺘﺎج اﻷﻓﺮاد‬
‫ وﲢﺴﲔ ﻧﻈﺎم ﺗﻘﺪﱘ‬،‫ﺳﻴﺎﺳﺎت ﺗﻌﻤﻞ ﻋﻠﻰ ﲢﺴﲔ ﺻﺤﺔ اﳌﻮاﻃﻦ اﳉﺰاﺋﺮي وﲡﺴﺪ ذﻟﻚ ﻣﻦ ﺧﻼل زﻳﺎدة اﻹﻧﻔﺎق ﻋﻠﻰ اﻟﻘﻄﺎع اﻟﺼﺤﻲ‬
‫ ﻏﲑ أن اﻟﻘﻄﺎع اﻟﺼﺤﻲ‬.2017-2000 ‫ وﻟﻘﺪ ﺣﻘﻘﺖ ﻫﺬﻩ اﻟﺴﻴﺎﺳﺎت ﻧﺘﺎﺋﺞ ﻣﻘﺒﻮﻟﺔ ﰲ ﳎﺎل اﻟﺼﺤﺔ ﺧﻼل اﻟﻔﱰة‬،‫اﳋﺪﻣﺎت اﻟﺼﺤﻴﺔ‬
.‫ﻣﺎزال ﻳﻮاﺟﻪ ﲢﺪﻳﺎت وﻣﻌﻮﻗﺎت ﲢﺪ ﻣﻦ ﻣﺴﺎﳘﺘﻪ اﻟﻔﻌﺎﻟﺔ ﰲ ﲢﺴﲔ ﺻﺤﺔ اﳌﻮاﻃﻦ‬
.‫ اﻷﻣﺮاض‬،‫ ﻣﻌﺪل وﻓﻴﺎت اﻷﻃﻔﺎل‬،‫ اﻟﻌﻤﺮ اﳌﺘﻮﻗﻊ‬،‫ اﻟﺼﺤﺔ‬،‫ اﻹﻧﻔﺎق‬:‫اﻟﻜﻠﻤﺎت اﻟﻤﻔﺘﺎﺣﻴﺔ‬

Introduction:
It is recognized that the goal of any development, the means of achieving it is human. It is therefore
necessary to pay attention to human health and nutrition so that he can do his best. Therefore, we
find that all countries of the world are working to increase spending on the health sector, where the
latter is one of the most important aspects of investment in human capital, and these countries aim to
achieve an increase and efficiency in the production of individuals, which reflects positively on their
economies. Health is a prominent place in Algeria's economic and social development plans. The
state is keen to provide both preventive and therapeutic health care by increasing public spending in
Algeria on the health sector from year to year, in addition to spreading health and nutrition
awareness and preserving the health of the environment.
The problem of the study: Public expenditure in Algeria on the health sector increases from one
year to another, as it was estimated at 3.49% in 2000 and reached 7.1% in 2015. The problem of the
study can be formulated to the following question: What is the value of health expenditure in
Algeria? What has Algeria achieved in terms of health care and human health care?
Objective of the study: The study aims at clarifying the concept of health, highlighting the
development of government expenditure on the health sector, and analyzing the indicators and
results of this development, which may contribute to the service of policymakers and decision
makers in the future.

1- Corresponding author: Hadji Fatima, [email protected]

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Analytical and evaluation study of Health expenditure in Algeria during the period 2000-2017
Dr. Hadji Fatima

1. The Conceptual Framework of Health, Health Expenditure:

1.1. Definition of Health:
WHO definition of health: "A state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity 1".
1.2. Health determinants:
These parameters can be classified into internal (within the individual) and external determinants,
and the following figure illustrates this.
Figure 1 : Social Determinants of Health
Economic Neighborhood Community
Health Care
stability and physical Education Food and Social
System
environment Context
Employment Housing Literacy Hunger Social Health coverage
income Transportation Language Access to integration Provider
Expenses Safety Early healthy support availability
Debt Parks childhood options systems Provider
Medical bills Playgrounds education Community linguistic and
support walkability Vocational engagement cultural
training discrimination competency
Higher Quality of care
education

Health outcomes
Mortality, morbidity, Life Expectancy, health Care Expenditures, Health Status, functional Limitations
Source: Harry J. Heiman and Samantha Artiga, Beyond Health Care: The Role of Social Determinants in
Promoting Health and Health Equity, Kaiser Family Foundation, 04 Nov 2015,
1.3. The concept of spending on Health:
Before addressing the expenditure on health, public expenditure is defined as those amounts paid by
the public authority or a monetary amount spent by a public person for the purpose of public
benefit2, and divided expenses in terms of the purposes that are intended as follows 3:
A. General expenses:
These include allocations for the presidency (presidency of the republic), expenditure on
parliamentary bodies, the presidency of the Council of Ministers, and then the expenditure of the
ministry, which is based on financial management, which collects revenues and distributes
expenditures, namely the Ministry of Finance or Treasury, from which benefit all other public
departments.
B. Public Defense Expenditures:
These include expenditures for defense against external aggression (Ministry of Defense),
expenditures of political and consular representation bodies (Ministry of Foreign Affairs) and
expenditure on internal security by police forces (Ministry of Interior and Local Communities) and
judiciary (Ministry of Justice).

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Analytical and evaluation study of Health expenditure in Algeria during the period 2000-2017
Dr. Hadji Fatima
C. The expenses of improving the state of the people and increasing its welfare:
include expenditures to improve public health and expenses to improve the economic situation such
as: the Ministry of Commerce, the Ministry of Industry, the Ministry of Tourism, etc., and the
expenses of improving the scientific situation and spreading national awareness such as the Ministry
of Education, Ministry of Culture, and social improvement expenses such as: Ministry of National
Solidarity, Family and National Community Abroad, Ministry of Labor, Employment and Social
Security.
D. Definition of Health expenditure :
-Health spending consists of health and health-related expenditures. Expenditures are defined
on the basis of their primary or predominant purpose of improving health, regardless of the
primary function or activity of the entity providing or paying for the associated health services.
-Health expenditure consists of all expenditures or outlays for medical care, prevention, promotion,
rehabilitation, community health activities, health administration and regulation and capital
formation with the predominant objective of improving health.
-Health-related expenditures include expenditures on health-related functions such as medical
education and training, and research and development 4.
2. The reality of public spending on the Health sector in Algeria
2.1. The volume of Health expenditure in Algeria
It should be noted that in the 1990s, public expenditure on health decreased, reaching 6% of GDP in
1990, 4.6% in 1993, and 1.81% in 1999 5. Again with the beginning of the millennium, where in
2015 it reached 7.3%, and the following table shows that.
Table 1: The volume of public expenditure on the health sector in Algeria for the period 2000-
2017 Unit: billion dinars
The Provision for health sector Provision allocated to the social Provision for health
years from the management budget sector from the budget of processing sector of GDP %
2000 33.900 17.188 3.49
2001 45.747 40.257 3.84
2002 491.171 71.71 3.73
2003 55.430 98.644 3.60
2004 63.770 42.533 3.54
2005 62.460 95.024 3.24
2006 70.315 149.724 3.36
2007 93.552 179.592 3.82
2008 129.201 215.686 4.20
2009 178.322 375.21 5.18
2010 195.0118 425.7392 4.82
2011 227.859 726.9938 5.14
2012 404.945 185.941 6.01
2013 306.9256 235.901 6.80
2014 365.946 219.301 7.2
2015 381.972 151.366 7.1
2016 379.407 32.703 -
2017 389.073 30.695
Source: Official Gazette, Financial Laws for the years 2000 to 2017

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Analytical and evaluation study of Health expenditure in Algeria during the period 2000-2017
Dr. Hadji Fatima
Table 1 shows that the expenditure on the health sector in Algeria during the period 2000-2016
is increasing from year to year. However, the financing of the health sector remains weak despite the
high level of national health expenditure. To give a clearer view of the expenditure, we will address
the per capita expenditure index, which was estimated in 2015 at $ 400, a small amount compared to
some Arab countries, estimated in Saudi Arabia at $ 522, and in Kuwait at $ 1178, and the following
figure illustrates this.
Figure 2: Per capita expenditure on health care in Algeria for 2004-2015
Unit: $
1600
1400 1455
1375
1200 1264 1319 1251 1249
1169
1149
1074 1061 1091
1000 963 977 992
844 860 Koweït
800
742 685 671 Arabie saoudite
600 574 575
544
470 algeria
400 399 358
286 334 330 292
200 206 207 228
100 116 150
74
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

source: World Atlas of Data.2018. World Atlas of Data. https://knoema.fr/atlas

2.2. Sources of funding for the health sector in Algeria
We distinguish between three major sources of funding for the health sector in Algeria 6:
A. Contribution of the State:
The role of the State is essential in financing the health sector. The State undertakes to look after
needy people uninsured by social security, protection, and scientific research expenses. With the
beginning of the new millennium has been contributing to the average by 50%.
B. The contribution of social security:
It remained paid in a contractual manner until the current year, despite the recommendations and
decisions made regarding payment for contractual reasons. This contribution has begun to decline,
due to the deficit experienced in the early 1990s, because of the dismissal of workers and the closure
of some institutions. The number of wage earners has declined, the latter being the main financier of
social security, and with the beginning of the new millennium the contribution of social security has
increased by an average of 30%.
C. Contribution of families:
Under the Joint Ministerial Circular No. 1 of 8 April 1995, which defines the nature and value of
resources derived from the activities of public health institutions, citizens contribute to the financing
of the health services they benefit from in public hospitals, with the exception of certain categories
covered by the State, but this contribution remains symbolic because it represents about 2% of the
total budget of health institutions, which led the Ministry of Health and Population in early 2002 to
amend the previous publication of the Joint Ministerial Decision of 26 February 2002, which
remains not applicable nowadays 7. The following table shows the sources of health financing in
Algeria.

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Analytical and
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H expenditure in Alggeria during the period 2000-2017
Dr. Hadji
H Fatimaa
Table 2 : Sources of
o health fin
nancing in Algeria% of total exp
penditure
The years
T Country Social Securrity Familiees
2000 47.27 26.02 26.7
2001 51.62 25.77 22.6
2002 48.42 26.88 24.7
2003 50.38 27.01 22.6
2004 48.43 24.01 27.5
2005 51.16 26.63 25.2
2006 53.8 27.4 18.8
2007 50.7 30.9 18.4
2008 55.1 31 13.9
2009 55.2 31 13.8
2010 49.9 30.0 20.1
2012 50.8 29.1 20.1
Source: Kaid
K Tlilanee N.: The problem of care financcing in Algeeria, Internaational Soccial Securityy
Review n ° 4vol.57, European
E sciientific pubblications, O
October 20044, p.116
-OMS, Woorld Health Report 2002,2004. andd 2006 and 2010 and 2015.In 2 www
w.who.int.
- Brahim Brahamia, Health Traansition in Algeria annd Health Insurance Financing Challengess,
Internationnal Symposiium on Heaalth Policiess, Constantinne Universiity 2, 18-19 January 20
014, P.35.
In Tabble 2, it is clear that thee state conttinues to contribute moore in the health sectorr in Algeriaa,
followed byb social security contrribution. Fiinally, the contribution
c n of the fam mily sector to
t financingg
this sector is weak, deespite the neew amendm ments and law ws issued foor this purpose.
In genneral, the qu
question of financing the
t treatment system in Algeria is complicated by thee
problems ofo organizaation and management
m of the Alggerian healtth system. P Public authorities havee
improved methods
m of financing the
t health syystem by reeplacing thee old fundinng system by y a new onee
called conttract system
m, which linnks the hosppital to the funded insttitution andd on which the servicess
are financeed.
2.3. Imporrts of "conssumption" of the Algeerian health sector:
Algeria's immports of mmedicines remain
r a larrge proportiion of Algeeria's total iimports, despite all thee
policies foollowed byy the state by establishing drugg-producing complexes similar to t SAIDAL L
COMPLEX X. The folloowing figure illustratess this.
figure 3:
3 Algeria'ss imports of mediciness during th he period 20005-2017
Unit: milllion dollarss

25
500
2061
1
1929 1879
20
000 30
173 1
1695
1546 1511 1498 1575
1342 1335
15
500 1119 1002
10
000 Série1
5
500
0
0

source: ANDI
A .2018, : http://ww
ww.andi.dz/inndex.php/ar/sstatistique/biilan-du-comm
merce-exteriieur

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Dr. Hadji Fatima
figure 3 shows the increase in Algeria's total imports of pharmaceutical products from year to
year during the period 2005-2017. This increase is due to the expansion of health coverage, the
increase in the value of medicines for human use, as well as veterinary medicines. The most
important types of drugs, such as those against expensive cancer, account for 42% of Algeria's total
pharmaceutical imports. Algeria has not yet been able to produce medicines that reduce its
consumption bill.
3 .Assessment of the Health situation in Algeria during the period 2000-2017:
The judgment on the availability of health services in a community depends on a number of
indicators, the most important are: the share of the population of pharmacists, doctors, dentists and
hospitals, the mortality rate of children less than one year, the mortality rate of children under five
years of age and life expectancy at birth.
The main results achieved in the Health sector in Algeria during the period 2000-2017
3.1. Basic structures and health facilities:
Since independence, the Algerian state has adopted the establishment of health structures and at the
end of the 1980s, the Constitution of 23 February 1989 set the State's intervention in the field of
prevention and control of communicable diseases In addition, the 1976 Constitution also upholds
this right in Article 67, which explicitly states that all citizens have the right to protect their health
and that this right is guaranteed by public and free public health services and by the extension of
preventive medicine 8. In 2007, the health sectors were reorganized to become public hospitals and
public health institutions, ie, the separation of treatment and examination, a type of decentralization
which aimed at facilitating access to treatment and bringing the hospital or health institution closer
to the citizen. The following illustrates this.
Table 3 : Health infrastructure in Algeria during the period 2008-2016
2008 2010 2011 2012 2013 2014 2015 2016
Public Hospitals 190 192 192 193 194 196 200 200
Hospital establishments 4 4 4 5 5 5 9 9
University Hospital Centers 13 13 14 14 14 14 15 15
University Hospitals 1 1 1 1 1 1 1 1
Specialized Hospital institutions 57 64 63 66 68 71 75 75
Private obstetric clinics 85 97 101 105 107 97 114 123
Source : http://www.ons.dz/-Sante-2017-.html
Table 3 shows the basic health infrastructure developed during the period 2008-2016, with the
number of completed hospitals increasing from 190 in 2008 to 200 in 2016. The number of
specialized hospital institutions, health centers, obstetrics clinics and treatment rooms has also
increased. However, this number is very small considering the increasing population of Algeria,
which reached 40.83 million in 2016. There is also some discrimination in the provision of
possibilities between a health center and another in the same jurisdiction, in addition to the
imbalance in the distribution of health centers, and this is because of the weakness of scientific
planning, so that the lack of information on the distribution of population in the planning bodies, led
to the existence of this problem. The capital alone accounts 55% of these structures, while the South
accounts only 3% of these structures. Some health facilities also suffer from a decline in health care,
whether physical or human, especially specialized doctors, in addition to the problem of the lack of
qualified health personnel, leading to poor health services.

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Analytical and evaluation study of Health expenditure in Algeria during the period 2000-2017
Dr. Hadji Fatima
3.2. Population share in pharmacists, doctors, dentists and hospitals
The World Health Organization (WHO) estimated that the average required coverage of doctors and
nurses was estimated at 12 per 10,000 inhabitants, 19.5 nurses per 10,000 inhabitants 9, and Algeria
in 2015 with 1 doctor for 1118 inhabitants, one specialist per 1,413 inhabitants, one dentist per
2,972, one pharmacist per 3,347 inhabitants and one midwife per 1,203 inhabitants 10. These figures
show that the coverage of doctors and nurses in Algeria remains weak.
3.3. Child and maternal mortality rate:
Algeria has recorded an improvement in the health and well-being of children. The under-five
mortality rate has declined in the period 2000-2016, confirming that there has been a steady
improvement in the health status of children, from 43.00 deaths per 1,000 in 2000 to 25.4 in 2016.
There is a decrease in the number of dead births from 24.7 deaths per 1,000 live births in 2000 to
13.2 deaths per 1,000 born in 2016, and the following table illustrates this.
Table 4 : Development of the under-five mortality rate and Average number of births dead for
the period 2000-2016
Average number of births dead ‰ Under-five mortality rate ‰

The years Females Males Total Females Males Total

2000 22.8 26.4 24.7 41.30 44.80 43.00

2001 23.3 26 24.7 41.90 44.40 43.30
2003 23.8 27 25.5 35.37 40.14 37.81
2004 22.1 26.5 25 33.41 37.44 35.51
2005 22.1 25 23.6 32.95 37.50 35.29
2006 20 22.7 21.4 29.81 32.92 31.41
2008 18.4 21.3 19.9 27.81 31.44 29.68
2010 16.7 19.61 18.2 26.00 28.98 27.52
2012 14.9 16.8 15.9 24.7 27.3 26.1
2013 14.2 16.4 15.4 24.9 27.3 26.1
2014 13.5 15.8 14.6 23.9 27.1 25.6
2015 12.9 14.8 13.9 24.2 27.1 25.7
2016 12.2 14.1 13.2 23.7 26.9 25.4
Source : http://www.ons.dz/-Sante-2017-.html

In Table 4, the number of under-five-year children has declined over the period 2000-2016, and
the number of stillbirths has also declined from 24.7% in 2000 to 13.2% in 2016. This decline is due
to the attention given to women's health in matter of pregnancy control and improvement of
delivery, where the process of maternal care and follow-up health of the prenatal period increased
significantly, reaching more than 90% in 2016, which enabled the reduction of maternal mortality
rates from 170 to 100,000 live births in 2000 to 140 to 100,000 live births in 2015, but neonatal
deaths between the ages of 1 to 28 days, remain the largest rate of child mortality, and represents the
first cause of the high mortality rate in Algeria.

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Analytical and evaluation study of Health expenditure in Algeria during the period 2000-2017
Dr. Hadji Fatima

3.4. Life Expectancy at Birth in Algeria:

Life expectancy at birth has improved significantly, reaching 76.07 in 2017, thus Algeria has
achieved a very high value compared to the Arab countries, and the following figure illustrates this.
Figure 4: Age indicator at birth in Algeria for the period 2000-2016

Life expectancy at
birth, total (years
80
72,76 74,67 74,94 75,18 75,41 75,64 75,86 76,07
70 70,29
60
50
40
30
20
10
0 0
years 2000 2005 2010 2011 2012 2013 2014 2015 2016

Source : - world bank, https://data.worldbank.org/country/algeria2017.

Figure 3 shows that the life expectancy at birth in Algeria improved from 70.29 in 2000 to 76.07 in
2016 and that it didn’t exceed 45 years after independence, which is due to the improvement in
living conditions of the Algerian individual.
3.5. Development of Infectious Diseases:
Despite all the policies and efforts made in Algeria to improve the health situation in this country
and the elimination of infectious diseases, there are still some diseases in Algeria such as meningitis,
tuberculosis, typhoid and others, while these diseases have disappeared in most countries of the
world, and the following table illustrates this.
Table 5: Development of infectious diseases for the period 2016-2005

The years 2005 2010 2011 2012 2013 2014 2015 2016

Meningitis 3580 3369 5284 3455 3313 6536 3367 5015

Typhoid 918 223 217 232 177 123 97 137
Hepatitis A 903 1853 1262 1466 1556 2746 1357 1719
Hepatitis B 1083 1783 2003 1797 2342 2576 2886 2861
Hepatitis C 639 1526 672 603 785 821 935 798
Measles - 1486 1899 1891 3544 154 197 342
tuberculosis - 21228 21878 21413 21973 22449 23562 22226
People with AIDS - 142 102 93 95 101 90 119
Source : http://www.ons.dz/-Sante-2017-.html

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Analytical and
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H expenditure in Alggeria during the period 2000-2017
Dr. Hadji
H Fatimaa
3.6. Millen
nnium Objeectives:
Algeria haas achieved the 2015 millennium
m m objectivess by achiev
ving a two-tthirds reducction in thee
proportion of childrenn dying less than five years.
A. Objectiive 5: Redu
uce to two-tthirds the proportion
p of children
n dying lesss than five years.
The mortallity rate of children un
nder five years of age, and childreen under onee year of ag
ge, has been
n
significantly reduced, as follows::
Figu
ure 5: Child
d mortalityy rate less th
han five years, and ch
hildren und
der one yea
ar old.

Chilld mortalityy rate

50
mortality rate

40
30
20
10
0
1990 2000 2002 2004
2 201
15
Leess than five years
y 46,8 36,9 34,7 3
30,4 15,6
Leess than one year
y 48,6 0 36,7 3
35,5 16,2

Source: National
N Repport on the Millennium
m Developmeent Goals, Report preppared by thee
Government, Algeria, 2011, P50.
Algerian G

Figuree 3 shows thhat the objecctive of 201

15, to reducce the propoortion of chhildren dyingg before thee
age of fivee years has been achievved in 2004 4, as well ass for the un
nder-1 mortaality rate, th
he objectivee
will be ach
hieved in 20015, due to improved
i health condittions in Alggeria.
B. Objectiive related to the imprrovement of
o maternall health:
Maternal mortality
m dro opped to 1440 per 100,0
000 in 20155 compared to 170 per 100,000 in 2000, whilee
the percenttage of birtths in the su
ubsidized co
ommunity increased
i frrom 0.76 peer cent in 1992 to 2.97
7
per cent in 2014, with
h improved maternal
m an
nd child heaalth coverage.
C. Objectiive 6 relateed to HIV / AIDS, mallaria, tuberrculosis and
d other diseases contrrol:
Algeria is one
o of the countries
c wiith a very sm
mall diseasee prevalencee rate with 1% for the AIDS
A viruss.
Since the diagnosis
d of the first case
c in 19855, the numb ber of confiirmed casess in 2017 was
w 119, and d
the coveragge of antireetroviral treaatment of people
p livin
ng with HIVV (80%), wh hile the num
mber of HIV V
carriers waas 4179, and d 61 free annd confidenntial diagnosstic centers were openeed at the naational levell,
while the institutional
i l apparatus was
w strengtthened to en nsure the establishmentt of the Nattional Blood d
Agency an nd the establlishment off eight HIV / AIDS refeerence centeers . The raate of malariia (per 1000 0
populationn at risk) waas 0.0019% in 2015. For TB, the rate of tubeerculosis (per 100,000 people) hass
moved from m 80 cases in 2004 to 70 7 cases in 2016 11.

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Analytical and evaluation study of Health expenditure in Algeria during the period 2000-2017
Dr. Hadji Fatima
D. Objective 7: Ensuring a Sustainable Environment:
Algeria has achieved great achievements thanks to the national program for the integrated
management of municipal waste. It has also made considerable progress in the field of combating
industrial pollution, environmental collection and forest areas due to the rural renewal policy and
improving the utilization of all water resources. The percentage of the population benefiting from
drinking water increased to 95% in 2011, and the connection to sewerage networks reached 95%.
4. Criticism to the Algerian Health sector:
In spite of the results achieved in the health sector, it still suffers from a number of constraints that
have negatively impacted on health development:
- Poor health sector financing: Despite the high level of national health expenditure, it is still far
from the levels achieved in some countries. For example, in France, the indicator (health
expenditure to GDP) is estimated at 15.7% in 2016. The percentage in Turkey and Tunisia was
respectively 10.5% and 11.8%, while in Algeria it was only 7.6% during the same year 12, while the
World Health Organization (WHO) recommended that expenditure on health should not be less than
12%. This is reflected in the low per capita expenditure on health. Algeria's average per capita
health expenditure is about $ 358 in 2014 13. This figure is weak compared with the global average
of $ 1059, while in Switzerland and Norway it reached respectively $ 9674 and $ 9522 in 2014.
- The population increase was not accompanied by a similar increase in health structures and the
medical staff: the population grew from 31.84 million in 2003 to more than 41 million in 2017.
However, the growth of health structures was only 2.8%. The number of physicians in the public
sector did not exceed 55158 physicians in 2016, with 7014 dentists, 1695 pharmacists and the
number of private sector doctors was 19779 in 2016, with 19779 doctors, 6733 dentists and 10139
pharmacists 14, and number is very small compared to the population.
- Absence of equitable and rational distribution of doctors, especially in remote areas deprived,
where 70% of specialist doctors and highly qualified people are located in 15 provinces across the
country, which means that there is no balance in the distribution of specialist doctors.
- The infrastructures are very old and there is a decrease in the family and in workers in the health
sector. The mismatch of the health map system and the exposed needs. These impediments raise the
responsibility of the health sector towards the poor categories. Poverty leads to an inability to afford
health services, leading to an increase in disease outbreaks.
- The training problem, which is that the education and training system does not accurately take into
account the needs expressed by the health sector. The academic training is no longer able to respond
to the qualifications required by the profession and the requirements of multiple services in the
sector. This results in a significant decrease in some medical and paramedical specialties; semi-
medical training schools.
- The absence of motivation for employees, which led to the stagnation of their activity, in the
absence of adaptation of the Basic Law, and poor working conditions and wages compared to the
private sector, the management of their professional career, is regulated by a law based on
administrative thought based on the logic of administrative organization linked to bureaucracy.
- Lack of attention to the need for an effective monitoring system within all health structures to
judge the quality of health services provided to patients and the extent to which these services are
improved 15.

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Analytical and evaluation study of Health expenditure in Algeria during the period 2000-2017
Dr. Hadji Fatima
Conclusion:
The development of expenditure on the health sector contributes in improving the quality of life.
Statistics in Algeria indicate a remarkable growth in government health expenditure during the
period 2000-2016. The Ministry of Health budget increased from about 51.08 billion DZD in 2000
to about 541 billion DZD in 2013, representing 7.1% of GDP in 2015. The average per capita health
expenditure was about US $ 400 in 2016. As a result, Algeria has made progress in the health sector
from 2000 to 2017. The number of health structures and the number of health workers has increased
and infant mortality rates of less than five years have decreased. In addition to the low maternal and
neonatal mortality rate. The life expectancy of the individual reached 77.1 years in 2016. Algeria
has achieved the objectives of the third millennium. However, the health sector in Algeria continues
to face challenges and obstacles that limit its effective contribution to improving the health of
Algerian citizens. From this we make some recommendations as follows:
- Increase spending on the health sector, with the need to attract private sector support to increase
health spending.
- Follow-up and continuous evaluation of the quality and accessibility of health services to all
citizens.
- Renovating the infrastructure of public sector hospitals and centers to meet quality standards, and
establishing accountability mechanisms in case of non-compliance with the application of quality
standards at any level of the system.
- Formulate and activate a preventive health strategy through a strong management system to
monitor and evaluate the effectiveness of projects of independent prevention.
- Encouraging investment in the field of pharmaceutical industries by increasing the establishment
of factories inside Algeria, to provide medicines at affordable prices so that the medicine is available
to all categories of society.
- The need to promote the system of contracting between hospitals and universities to obtain the best
doctors.
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Analytical and evaluation study of Health expenditure in Algeria during the period 2000-2017
Dr. Hadji Fatima
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