1. The PHRplus Project is funded by U.S. Agency for International Development and implemented by: Abt Associates Inc. and partners, Development Associates, Inc.; Emory University Rollins School of Public Health; Philoxenia International Travel, Inc. Program for Appropriate Technology in Health; SAG Corp.; Social Sectors Development Strategies, Inc.; Training Resources Group; Tulane University School of Public Health and Tropical Medicine; University Research Co., LLC. URL: http://www.phrplus.orghttp://www.phrplus.org National Health Accounts Development of a Malaria Subanalysis: Rwanda Field Work and Guidelines Development Susna De and Yann Derriennic Abt Associates Inc. June 1, 2005

2. Overview  Background  Rwanda malaria subanalysis  Guidelines development  Next steps

3. Background

4. The initiative  Pilot malaria subanalysis in Rwanda and incorporate lessons learned  Develop internationally viable set of guidelines for measuring national-level malaria health care expenditures  To be prepared by RBM partnership secretariat with support from WHO (EIP and RBM) and the USAID/PHRplus project Background (1)

5. Need for malaria expenditure data  Competing needs for limited health care resources means limited resources for malaria control  Given limited resources  Imperative that policy decisions for malaria control be based on good information to get best outcome  Expenditure data can help guide allocation of limited resources among alternative uses e.g. intervention mix Background (2)

6. Two distinct outputs  Pilot estimates of malaria related expenditures for Rwanda  Internationally viable guidelines on tracking malaria health expenditures within the NHA framework  As such, will consider issues inherent in context of Asia, Africa, and Latin America (areas with high prevalence) Background (3)

7. Rwanda Malaria Subanalysis 2003

8. Rwanda malaria subanalysis  As with general NHA, the malaria subanalysis will  Address key policy issues for malaria stakeholders  Track national expenditures between  Financing Sources, Financing Agents, Providers, and Functions – specific to malaria health care  Comprehensive in scope (track public, private, and donor expenditures)  Will estimate 2003 malaria expenditures  Note, overall health expenditures will be tracked for general NHA Rwanda malaria subanalysis (1)

9. Addresses key policy questions  What is resource envelope for malaria control and treatment?  Who finances malaria health care and how much do they spend?  With household survey, can determine financing burden by income quintile, urban/rural, and gender  Who manages malaria health funds?  Where do these funds go? To what providers and services/functions?  How much is spent on prevention, treatment, sensitization, and research?  What has been the impact of large donor funds? E.g. Global Fund - have funds reached their intended target? Rwanda malaria subanalysis (2)

10. Definition of malaria expenditure  Those incurred on activities  Primarily intended to have a positive impact on health status of people, confirmed or not, with malaria within a given period of time, and  Intended to prevent spread of malaria, which may target population at large (e.g. recipients of ITNs)  To track only direct expenditures of malaria  Excludes “indirect” expenses such as loss of income and days of work due to illness Rwanda malaria subanalysis (4)

11. Data collection approach  Same as that done for NHA  Attempt triangulation of data by obtaining estimate for a given cell from more than one information source  Review secondary data  Government records, situation analysis of malaria, SIS etc  Primary data collection  Donors  Non-governmental organizations  Insurance companies  Employers  Add rider questions to ongoing surveys  Household survey implemented for study on socioeconomic impact of malaria  National accounts Rwanda malaria subanalysis (5)

12. Coordination and collaboration with malaria socioeconomic impact study Malaria subanalysis Includes Household survey (on malaria expenditure) Includes Donor survey NGO survey (on overall health and malaria expenditures) Socioeconomic impact study Adding rider questions on each others’ surveys Collaboration: Minimizes financial costMinimizes financial cost Avoids duplication of effortsAvoids duplication of efforts Reduces respondent fatigueReduces respondent fatigue Rwanda malaria subanalysis (6)

13. Rwanda field work  Delays in implementation  Socioeconomic impact of malaria household survey  Data collection in process Rwanda malaria subanalysis (7)

14. Guidelines

15. Why prepare standard guidelines?  To produce country comparable estimates  Allows for sharing and exchange of lessons learned among country policymakers  Allows for better tracking of expenditures globally Guidelines (1)

16. Approach of guidelines  To be consistent with the general NHA framework, which examines overall health spending  Draw upon experiences with adapting NHA to measure HIV/AIDS health spending - called “NHA HIV/AIDS subanalysis”  To describe implementation of a “NHA malaria subanalysis” Guidelines (2)

17. Key issues of guideline development  To adapt NHA methodology at program level and target group in a standardized manner  Boundaries: what to include: vector control, sequelae of severe malaria  Unbundle resources and interventions, eg, IMCI  To promote standard use of classification, data sources, and indicators of resources flows Guidelines (3)

18. Next steps  Complete the Rwandan field work (data cleaning, populating the tables, analysis and report writing)  Based on Rwanda and Philippines experiences, draft the data analysis chapters of the guidelines  Guidelines produced by end of the year  Another country?

19. Collaborators:  Rwanda:  Dr. Ben Karenzi  Emmamuel Kabanda  Lazare Ndazaro  Claude Rwagacondo  Charles Waza  Francois Nijitegeka  Nicholas Theopold  Emmanuel Higiro  Vincent Nyauma  RBM: (WHO/EIP/RBM)  Rachel Racelis  Patricia Hernandez  Patience Kuruneri  Tessa Tan-Torres  Jan Vanerps

20. The PHRplus Project is funded by U.S. Agency for International Development and implemented by: Abt Associates Inc. and partners, Development Associates, Inc.; Emory University Rollins School of Public Health; Philoxenia International Travel, Inc. Program for Appropriate Technology in Health; SAG Corp.; Social Sectors Development Strategies, Inc.; Training Resources Group; Tulane University School of Public Health and Tropical Medicine; University Research Co., LLC. URL: http://www.phrplus.orghttp://www.phrplus.org Thank You Susna_De@abtassoc.comYann_Derriennic@abtassoc.com