Understanding the critical role of health in socioeconomic development and poverty reduction, most of the OIC Member Countries aim to allocate more funds on health. From 1995 to 2006, the OIC average of the health expenditure as a percentage of GDP rose from 3.4% to 4.1%, and the percentage was exceeded by 31 member countries in 2006. Maldives, Jordan and Lebanon even more than doubled the OIC average with spending 10.1%, 9.9% and 8.9 % of their 2006 GDPs on health, respectively [SMC - 1].

At the country level, the below observations are also important:

• The health expenditure share of Maldives increased by 84% from 1995 to 2006 while Egypt, Gabon, Iran, Turkey and Turkmenistan , were the other countries where the health expenditure pie in GDP grew by more than 60% for the period examined [SMC - 2].
• Niger (4%) and Algeria (3.6%) were the only two countries exhibiting no change in their health expenditure share compared to 1995 [SMC - 3].
• Maldives, Guinea-Bissau, Cote d’Ivoire, Lebanon, Azerbaijan, Libya and Gabon experienced higher variations around the mean of their health expenditure shares over the period considered [SMC - 4].
  • Maldives was worth mentioning again as it had highest variance with its share rising from 5.5% in 1995 to 7.2% in 2003 and even 12.4% in 2005 before reaching 10.1% in 2006 [SMC - 5].
  • Guinea-Bissau was the country with sharp changes in each year. In 2006, Guinea-Bissau spent 6.2% of its GDP on health and ranked 11h among member countries in terms of health expenditure as a percentage of GDP while it held the 3rd position after Lebanon and Jordan in 1998 with allocating 8.5% [SMC - 6].
  • Half of the above mentioned countries, Azerbaijan, Cote d’Ivoire, Lebanon, and Libya ended up in 2006 with lower health expenditure shares than 1995 [SMC - 7]. Azerbaijan case was especially interesting: Except from two upward spikes in 1996 and in 2002, the GDP pie allocated to health expenditure was nearly cut into half, from 6.4% to 3.4% [SMC - 8].

Overall, the total health expenditure of OIC Member Countries reached 126.8 billion USD in 2006. Although this means a 176% jump over 1995 value, 41% of the total OIC health expenditure was spent by only three countries, Turkey, Iran and Saudi Arabia, with shares of 17.8%, 13.7% and 9.5%, respectively and raising more funds for health from predictable sources is still a serious concern for most of the OIC Member Countries.

Depending on the source of funding, the total health expenditure can be divided into two:

• Public expenditure on health consists of recurrent and capital spending from central and local government budgets, external borrowings and grants (including donations from international agencies and nongovernmental organizations), and social (or compulsory) health insurance funds.
• Private¹ expenditure on health is the sum of outlays for health by private entities, such as commercial or mutual health insurance providers, non-profit institutions serving households, resident corporations and quasi-corporations not controlled by government with a health services delivery or financing, and direct household out-of-pocket payments.

For ease of expression, a country is described as public (private) spender from now on, if the share of public (private) health expenditure is higher than the private (public) in total health expenditure. When the public and private spenders were analyzed in detail from 1995 to 2006, the following points could be noted:

• In 1995, there were 22 public and 34 private spenders while the number of OIC Member Countries were nearly equal (27 public vs. 28 private) in terms of funding sources in year 2006. Hence, for some countries the private expenditure share decreased so that the country became public spender in terms of health care [SMC - 9].
  • The public share in total health expenditure increased in 38 OIC Member Countries during the period examined. This can easily be observed from [SMC - 9] as most of the countries are moving upwards along Y-axis during the period examined. From the table below, it can also be deducted that there is a positive relationship between public expenditure share and income level: OIC Member Countries belonging to high and upper middle income groups are generally public spenders while low and lower income groups are mostly private spenders.

Table: Number of Public vs. Private Spending OIC MCs from 1995 to 2006

Source: SESRIC (BASEIND)

• Guyana and Maldives constituted exceptional cases of the above mentioned relationship. Despite being lower middle income countries, not only their total health expenditures were dominated by public spending, but also they were the top two leading countries with shares of 84.5% and 84.1% in 2006, respectively. Their GNI per capita never exceeded the level 2900 USD but still the public share of the total health expenditures were always higher than the rate 75% in the period examined [SMC - 10].
• Although all of the high income countries, GCC Countries and Brunei, are public spenders, the public health expenditure share of Saudi Arabia (59.9%), Qatar (66.1%) and Bahrain (66.9%) were lower than the rest in 1995. However, the public share of Saudi Arabia and Qatar increased by 28.9% and 18.2%, respectively, leading Bahrain to become the only high income country with a public expenditure share below 70% in 2006 [SMC - 11].
• As shown in [SMC - 12], the public health expenditure has begun to exceed the private part of the total for 6 low income countries, namely Gambia, Burkina Faso, Benin, Niger, Mali and Uzbekistan in a year between 2000 and 2005, while Mozambique, Mauritania and Comoros has been public spenders during the period examined [SMC - 13]. Mozambique and Mauritania drew attention especially as they were the only two low income countries having public expenditure share closer to 70% and in this respect were placed 15th and 16th among OIC Member Countries after Turkey (71.5%) and Libya (70.2%) Moreover, their GNI per capita never exceeded the level 1000 USD during the period examined.
• When the remaining four² pre-private - currently public OIC Countries , Gabon, Indonesia, Iran and Libya, investigated, it could be observed that the time after the switching and the magnitude of the public expenditure share were positively related for middle income countries. In other words, the earlier the switch was, the higher would the weight of public expenditure in total health spending be. For example, Gabon was a private spender before 1997 when the public expenditure share reached 58.6%. After 1997, the public expenditure share increased constantly and even became the 6th public spender country with a share of 78.7% in 2006. Whereas Iran and Indonesia , being a late switcher in 2005 and 2006 respectively, the private and public spending had nearly equal weights in total health expenditure [SMC - 14].
• In 2006, there were 28 private spender OIC Member Countries. The private expenditure was more than the public part in 24 of them in 1995, as well From SMC-15, it can also be observed that health care system depended on private expenditure more in low or lower middle income countries [SMC - 15].
  • The countries with the highest private funding are Guinea, Pakistan, Tajikistan, Cote d’Ivoire and Guinea-Bissau with shares always over 75% during the period under consideration [SMC - 16].
  • Among the private spenders, the weight of private spending had increased the most in Tajikistan as the private expenditure went up from 59.1% in 1995 to 77.4 % in 2006 [SMC - 17].
  • On the other extreme, the private spending share deteriorated the most in Lebanon (71.7% to 53.2%) Sudan (86.4% to 62.9%) and Sierra Leone (64.1% to 51%) compared to 1995 values as the sharp downward trend indicated in the [SMC - 18].
  • Lebanon and Malaysia were the only two upper middle income countries where the private expenditure was higher than the public part in 2006. Lebanon was among the top ten OIC Member Countries in terms of private expenditure share in 1995 and the private funding continued to be highly dominant in Lebanon with shares around 70% till 2000. But then the weight of public funding began to increase and the gap got closer especially in last two years. For Malaysia, it is hard to say the dominance of either source during the whole period examined as the total health expenditure seemed to be equally divided [SMC - 19].
  • Although Suriname, Jordan and Kyrgyzstan became private spenders after 2000, the weight distribution (around 58% -42% in 2006) of health expenditure revealed that public funding was still an important source for health care. Among the four countries switching from public to private, Albania was the only country where the private expenditure share is above 60% in 2006 [SMC - 20].
    

1 Private expenditure is usually estimated through surveys, which may yield grossly diverging results.
2 Gabon and Libya belong to upper middle income; the remaining two countries are lower middle income.