National Health Accounts Development of a Malaria Subanalysis: Rwanda Field Work and Guidelines Development

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National Health AccountsDevelopment of a
Malaria SubanalysisRwanda Field Work and
Guidelines Development

• Susna De and Yann Derriennic
• Abt Associates Inc.
• June 1, 2005

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Overview

• Background
• Rwanda malaria subanalysis
• Guidelines development
• Next steps

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Background
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The initiative
Background (1)

• 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

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Need for malaria expenditure data
Background (2)

• 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

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Two distinct outputs
Background (3)

• 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)

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Rwanda Malaria Subanalysis 2003
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Rwanda malaria subanalysis
Rwanda malaria subanalysis (1)

• 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

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Addresses key policy questions
Rwanda malaria subanalysis (2)

• 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?

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Definition of malaria expenditure
Rwanda malaria subanalysis (4)

• 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

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Data collection approach
Rwanda malaria subanalysis (5)

• 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

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Coordination and collaboration with malaria
socioeconomic impact study
Rwanda malaria subanalysis (6)
Adding rider questions on each others surveys
Malaria subanalysis
Socioeconomic impact study

• Includes
• Donor survey
• NGO survey
• (on overall health and malaria expenditures)

• Includes
• Household survey
• (on malaria expenditure)

• Collaboration
• Minimizes financial cost
• Avoids duplication of efforts
• Reduces respondent fatigue

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Rwanda field work
Rwanda malaria subanalysis (7)

• Delays in implementation
• Socioeconomic impact of malaria household survey
• Data collection in process

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Guidelines
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Why prepare standard guidelines?
Guidelines (1)

• To produce country comparable estimates
• Allows for sharing and exchange of lessons
  learned among country policymakers
• Allows for better tracking of expenditures
  globally

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Approach of guidelines
Guidelines (2)

• 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

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Key issues of guideline development
Guidelines (3)

• 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

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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?

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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

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Thank You

• Susna_De_at_abtassoc.com
• Yann_Derriennic_at_abtassoc.com