HIV/AIDS Expenditures in Sub-Saharan Africa:Observations from Kenya, Rwanda and Zambia

S. Muchiri, Wellington Godo, K Chebet,Ministry of Health, Nairobi, Kenya

C. Kabago, P. Kayabotsi, D. Ndushabandi, Government of Rwanda, Kigali, Rwanda

F. Phiri, Ministry of Health, Lusaka, Zambia

T. Dmytraczenko, S. De, C. Chanfreau, M. Tien and G. Kombe, Abt Associates Inc., Bethesda MD USA

Impact of the HIV/AIDS Epidemic

Kenya Rwanda Zambia

Adult prevalence 6.7% 5.1% 15.6%

HIV infected adults 982,685 199,279 1.2M

Declining life expectancy1990 62 50 542002 47 44 40

GDP per capita USD 371 USD 196 USD 354

Providing HIV/AIDS Prevention, Treatment and Care: A Heavy Toll on the Health Sector

05

101520253035404550

Rwanda Kenya Zambia

HIV/AIDS is the single largest contributor to the burden of disease in Africa19% of the total years of life lost due to disability or premature mortality

14%

24%

45%

In p

erc

enta

ge s

HIV/AIDS as a share of total health expenditures

PPP$ 306

PPP$ 433

PPP$ 141

Household and Donors Finance a Large Share of HIV/AIDS Expenditures

Donors34%

Public24%

Other private1%

Households41%

Kenya

Households13%

Public8%

Donors78%

Other private1%

Public17%

Other private7%

Donors46%

Households30%

Rwanda Zambia

Treatment and Care Absorb the Majority of Health Funds

05

1015202530354045

Inpatientcare

Outpatientcare

Otherprevention

Condomdistribution

VCT IEC Medicalgoods

Public entitities Non profit inst. OOP

75%KENYA

0%

20%

40%

60%

80%

100%

Public Donor Public Donor Public Donor

HIV/AIDS General health

19% 75%

Is HIV/AIDS a Priority in Resource Allocation?

5% 21%33% 57%

Rwanda Kenya Zambia

Dependence on external resources

0

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000

Public HE

Private HE

GF + PEPFAR

Global Fund and PEPFAR funds relative to health expenditures

Source: PHRplus analysis of Global Fund data

The Burden on HIV+ Households Is Considerable

Preliminary results

A person living with HIV/AIDS spends

approximately 9 times more out-of-pocket than the average Zambian on health care

General Out-of-pocket spending

=$3.70 per capita

HIV/AIDS Out-of-pocket spending

= $31.62 per HIV+ individual

The Burden on HIV+ Households Is Considerable

HIV/AIDS Out-of-pocket spending

= $60.84 per HIV+ individual

General Out-of-pocket

Spending

=$8.90 per capita

Preliminary results

A person living with HIV/AIDS spends

approximately 7 times more out-of-pocket than the average Kenyan on health care

The Burden on HIV+ Households Is Considerable

HIV/AIDS Out-ofpocket spending

= $4.97 per HIV+individual

General Out-of-pocket

Spending

=$2.13 per capita

Preliminary results

A person living with HIV/AIDS spends

approximately 2 times more out-of-pocket than the average Rwandan on health care

Meeting basic needs in Rwanda

58% of HIV+ households received assistance, borrowed or sold assets 34% received assistance 29% borrowed 21% sold assets

Inequities in Zambia

0

20

40

60

80

100

120

Poorest 2nd Qtr 3rd Qtr 4th Qtr Wealthiest

US

D

Policy Issues

Sustainability of donor funding in view of long-term challenges posed by HIV/AIDS

Equity issues related to substantial household out-of-pocket HIV/AIDS spending