Development of Malaria Subanalysis: Rwanda Field Work & Guidelines

1. National Health AccountsDevelopment 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 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

5. 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

6. Background (3) 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)

7. Rwanda Malaria Subanalysis 2003

8. Rwanda malaria subanalysis (1) 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

9. Rwanda malaria subanalysis (2) 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?

10. Rwanda malaria subanalysis (4) 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

11. Rwanda malaria subanalysis (5) 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

12. Rwanda malaria subanalysis (6) Coordination and collaboration with malaria socioeconomic impact study 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

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

14. Guidelines

15. 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

16. 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”

17. Guidelines (3) 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

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. 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 Collaborators:

20. Thank You Susna_De@abtassoc.com Yann_Derriennic@abtassoc.com