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Utilization and Expenditures on Outpatient Health Care by HIV Positive Individuals in Rwanda PHR Rwanda - Abt Associates Inc. IAEN and AIDS Conference Durban July 2000 Partnerships for Health Reform Abt Associates Inc. In collaboration with: Development Associates, Inc. Harvard School of Public Health Howard University International Affairs Center University Research Co., LLC Background: NHA and HIV in Rwanda PHR, Rwandan National Health Accounts Team, UNAIDS, PNLS, and MOH collaborating to examine the sources of uses of funding for HIV services in Rwanda using the NHA framework National Health Accounts will clearly illustrate: Who (Private, Public, Donors) pays for what? How much do they pay? Why National Health Accounts? Effective method for compiling descriptive statistics of a nation’s health economy. Represents the flow of funds throughout the system. Can assist policy-makers in setting health care policy priorities. Can assist governments in assessing the performance of their health sectors. Can assist governments in identifying areas of inequity in the distribution of care. NHA Data Collection Data on sources and uses of HIV funds is collected through surveys from all levels of the health system including: Donors Hospitals Pharmaceutical Companies Ministry of Health NGOs Households* Household Survey: Snapshot of Out-of -Pocket Expenditures PHR with NHA team, UNAIDS, and MOH developed a survey to investigate the use of and expenditures on outpatient and inpatient health by HIV positive individuals in Rwanda Findings on expenditures will contribute to understanding of out-of -pocket expenditures on health, and contribute to existing limited body of literature looking at the impact of HIV on households Outpatient Survey: Methodology 350 HIV positive individuals were identified in four facilities 1 Hospital 1 Health Center 1 AIDS Association 1 meeting and testing facility Interviews were conducted by social assistants who had a relationship with the patient Data Limitations for the Study Sample size 350 total 293 were women Many facilities do not test, nor inform patients of their HIV status in Rwanda, which limits the sample size Issue of self-selection: all patients knew their status Findings are not representative of the universe of HIV positive individuals in Rwanda as most were identified from non-routine testing Rwanda: Background 7.8 million people in 1998 Per Capita GDP in 1997: $242 Service Sector: economically most productive with 7% of the population produces 43% of GDP 70% of population lives below the poverty line Rwanda NHA 1998 Results Health Spending Public Per capita Exp. on Health $1.30 Health Distribution Exp. as % of Sources of GDP 0.5% 12% Private $2.70 1.1% 25% Donors $6.80 2.7% 63% HIV/AIDS in Rwanda Estimated that 11% of the adult population is sero-positive Highest prevalence in service sector population (19%) Testing takes place in few facilities and often status is not revealed to those tested Government of Rwanda has a clearly articulated multi-sectoral approach to combating the HIV epidemic Socio-demographics of surveyed individuals: mainly women, widowed, without education, living in urban areas 100% 80% 92% 85% 69% 60% 50% 43% 40% 41% 5+ Y HIV <=PRIM EDU AGE 26-35 URB WIDO 0% FEM 20% HH 2+HIV 26% NHA Finding: Households affected by HIV/AIDS suffer economically The following percentage of people indicated that they were “with difficulty” and “unable to meet” the following basic needs: food (73%) housing (57%) education (86%) clothing (82%) Average Number of Work days lost in the past two weeks: : 4.8 NHA Finding: Sero-positive patients seek care more often Annual per capita utilization rates 0.29 visits per general population 10.9 visits per sero-positive individual Highest service use rates among sero-positive patients who are: urban, married, in highest expenditure quintiles NHA Finding: Sero-positive individuals have higher per capita spending $200 $180 $160 $140 $120 $100 $80 $60 $40 $20 $0 $182 $63 $2.7 TOT POP HIV+ SAMPLE HIV+ MARRIED SAMPLE Per Capita Health Spending How are health expenditures financed? 66% receive assistance from church and family 18% borrow from family/friends Sero-positive low-income individuals did not perceive to have received donor and government assistance Conclusions for Sample Group Sero-positive individuals who are poor need care almost 10x more often than the general population have higher health care costs than the general population need assistance to pay out-of-pocket fees receive help from family, friends and church Recommendations Prevention: Strengthen efforts to prevent HIV/AIDS Provide extensive public information - IEC Broader, more extensive and routine testing for HIV Improve access and equity for the poor with HIV increase government financing targeted to lowerincome groups donor financed prepayment for poor households with access to health centers and district hospital international efforts lower the costs of AIDS treatments Recommendations Further Research effectiveness of alternative approaches to improve access and equity for the poor with HIV/AIDS Partnerships for Health Reform is implemented by Abt Associates Inc. under contract No. HRN-C-95-00024 with the U.S. Agency for International Development (USAID) Partnerships for Health Reform