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

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Utilization and Expenditures on Outpatient Health
Care by HIV Positive Individuals in RwandaPHR
Rwanda - Abt Associates Inc.IAEN and AIDS
Conference DurbanJuly 2000

• Abt Associates Inc.
• In collaboration with
• Development Associates, Inc.
• Harvard School of Public Health
• Howard University International Affairs Center
• University Research Co., LLC

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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?

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Why National Health Accounts?

• Effective method for compiling descriptive
  statistics of a nations 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.

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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

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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

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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

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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

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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

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Rwanda NHA 1998 Results
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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

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Socio-demographics of surveyed individuals
mainly women, widowed, without education, living
in urban areas
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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

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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

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NHA Finding Sero-positive individuals have
higher per capita spending
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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

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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

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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
  lower-income groups
• donor financed prepayment for poor households
  with access to health centers and district
  hospital
• international efforts lower the costs of AIDS
  treatments

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Recommendations

• Further Research
• effectiveness of alternative approaches to
  improve access and equity for the poor with
  HIV/AIDS

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