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.org Findings from National Health Findings from National Health Accounts: Investing in Reproductive Accounts: Investing in Reproductive Health Health Tania Dmytraczenko Tania Dmytraczenko Senior Health Economist, PHR Senior Health Economist, PHR plus plus Global Health Council Conference Global Health Council Conference 1 June 2005 1 June 2005
Transcript
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.org
Findings from National Health Accounts: Findings from National Health Accounts: Investing in Reproductive HealthInvesting in Reproductive Health
Tania DmytraczenkoTania DmytraczenkoSenior Health Economist, PHRSenior Health Economist, PHRplusplus
Global Health Council ConferenceGlobal Health Council Conference
RwandaRwanda Susna De Emmanuel Kabanda Vianney Nizeyimana
OutlineOutline
BackgroundBackground
MethodMethod
ResultsResults
Next stepsNext steps
BackgroundBackground
Achieving the Millennium Achieving the Millennium Development GoalsDevelopment Goals
Addressing the principles causes of the Addressing the principles causes of the burden of diseaseburden of disease Maternal health indicators Reproductive health (RH) more broadly
Managing for resultsManaging for results
Background
““We manage what we measure”We manage what we measure”
Support sound policy decisions by tracking:Support sound policy decisions by tracking: Who finances RH services and programs? How much do they spend? Where do RH funds go, i.e., what is the distribution
among providers and ultimately among services provided?
Hospitals vs. ambulatory care facilities Curative care vs. prevention programs
Who benefits from spending for RH? Socio-economic groups Gender Geographic distribution
Background
MethodMethod
Definition of reproductive health Definition of reproductive health expendituresexpenditures
Family planning servicesFamily planning services Outpatient counseling and issuance of contraceptive
commodities Female and male surgical sterilization Retail sale of family planning commodities
Maternal health servicesMaternal health services Antenatal care Deliveries Emergency obstetric care Postnatal care
Definition of reproductive health Definition of reproductive health expenditures (continued)expenditures (continued)
Other reproductive health servicesOther reproductive health services STI RTI Gynecological services Oncology Infertility
IEC, public awareness, health education IEC, public awareness, health education campaignscampaigns
TrainingTraining ResearchResearch
Reproductive Health Accounts: Reproductive Health Accounts: Countries coveredCountries covered
Ongoing in Mexico, Karnataka (India) Ongoing in Mexico, Karnataka (India) Bangladesh, Nepal, Sri Lanka, India (2 states)Bangladesh, Nepal, Sri Lanka, India (2 states)
ResultsResults
Reproductive health indicatorsReproductive health indicators
Egypt Jordan Rwanda
Maternal mortality (per 100,000 live births) 170 41 1071
Total fertility rate 3.5 3.7 5.8
% of women in union using a modern birth control method
53.9% 41.2% 4%
Use of antenatal care (% of births) 52.9% 98.6% 92%
% of births delivered in a health care facility
48.2% 96.9% 27%
% of births with a trained birth attendant 60.9% 99.5% 30%
Use of postnatal care (% of births) 52.5% 96.9/28%* 1.1%
Source: DHS 2000, 2002Source: DHS 2000, 2002
Reproductive health results
*subsequent to discharge
RH expenditures15.3%
Reproductive health within context of Reproductive health within context of general health caregeneral health care
RH expenditures15.7%
Total Health Expenditures
RH spending as a percentage of total health expendituresRH spending as a percentage of total health expenditures
Reproductive health results
Total Health Expenditures
JordanJordanRwandaRwanda= USD $10.9M
or $5.31 / WRAor $5.31 / WRA
= USD $127.6M
or $98.14 / WRAor $98.14 / WRA
Public8%
Households10%
Donors80%
Other private2%
Other private11%
Donors5%
Public38%
Households46%
Where do reproductive health dollarsWhere do reproductive health dollarscome from?come from?
Donors3%
Public50%
Other private2%
Households45%
JordanJordanEgyptEgyptRwandaRwanda
RH is being financed mostly by either: donors (Rwanda)RH is being financed mostly by either: donors (Rwanda)or government and households (Egypt, Jordan)or government and households (Egypt, Jordan)
Reproductive health results
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Public Donor Public Donor Public DonorRH General health
Public versus donor priorities in Public versus donor priorities in resource allocationresource allocation
4% 37%RwandaRwanda
16% 17%JordanJordan
6% 12%EgyptEgypt
Donor funding is concentrated on RH and HIV/AIDS in RwandaDonor funding is concentrated on RH and HIV/AIDS in Rwanda
Reproductive health results
Other private11.1%
NGOS3.6%
Public entities45.7%
Household OOP39.6%
Who is managing reproductive Who is managing reproductive health funds?health funds?
Other private2.4%
NGOs35.8%
Public entities51.8%
Household OOP10.0%
Public entities are the largest payer / purchaser of RHPublic entities are the largest payer / purchaser of RH
Who is financing reproductive health Who is financing reproductive health expenditures by public entities?expenditures by public entities?
Donors finance a large share of RH expenditures by Donors finance a large share of RH expenditures by public entities and 100% of spending by NGOspublic entities and 100% of spending by NGOs
25%25%
85%85%
Origin of funds managed by public entities in Rwanda
Reproductive health results
What types of RH services are being What types of RH services are being funded and by whom in Rwanda?funded and by whom in Rwanda?
2%
8%
2%
1%6% 6%
60%
6%
1%
6%
0%
10%
20%
30%
40%
50%
60%
70%
Curative Care(18%)
Prevention andpublic health
(66%)
Pharmaceuticalsand other
nondurables (3%)
Healthadministration
(7%)
Other (6%)
Public SourcesDonors (incl. NGOs)HouseholdsPrivate Companies
% o
f T
HE
fo
r H
IV/A
DS
Reproductive health results
20022002
Households finance half of all curative care while donor funds go Households finance half of all curative care while donor funds go principally towards prevention programsprincipally towards prevention programs
Breakdown by RH categories in Breakdown by RH categories in RwandaRwanda
Other (NSK)6%
FP commodities and consultation
6%
Administration7%
Maternal health15%
Prevention and public health programs on
MCH and FP66%
Reproductive health results
20022002
DeliveriesDeliveries
Expenditure/ delivery in a facilityExpenditure/ delivery in a facility $7.59$7.59
Number of deliveries in a facilityNumber of deliveries in a facility 99,20199,201
Number of deliveries at homeNumber of deliveries at home 268,210268,210
If all deliveries were to take place at facilities, current If all deliveries were to take place at facilities, current expenditures (60% of which are financed by households) on expenditures (60% of which are financed by households) on deliveries would need to increase by deliveries would need to increase by 3 fold3 fold
Reproductive health results : maternal health
Breakdown of expenditures by Breakdown of expenditures by method mixmethod mix
13% 12%
3%
3%18%
16% 22%
12%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Injectables Oralcontraceptives
Condoms
Households
Donors via NGO
Donors via MoH
% o
f F
P c
om
mo
dit
y ex
pen
dit
ure
20022002
Reproductive health results : family planning
Utilization vs OOP expenditure on Utilization vs OOP expenditure on commoditiescommodities
90
15
82
717
10
72
17
8778
94
126 5 6
1
0
10
20
30
40
50
60
70
80
90
100
Use
OOP Expe
nditure Use
OOP exp
enditu
re Use
OOP exp
enditu
re
Other Providers
Private Providers
Public Providers% of use/OOP expenditure for each FP commodity
InjectablesOral Contraceptives
Condoms
Reproductive health results : family planning
Utilization of commodities by Utilization of commodities by quintilequintile
1.7 1.76.6 10
17.4
10
5.6
63.6
73.3
83.1
2.8
8.5
510.7
0
10
20
30
40
50
60
70
80
90
100
Injectables Oral contraceptives Condoms
Highest Quintile
Fourth Quintile
Third Quintile
Second Quintile
Lowest Quintile
DHS 2000
Reproductive health results : family planning
Conclusion of RH subanalysisConclusion of RH subanalysis
Dependence on donors to finance RHDependence on donors to finance RH
Low government contribution to RHLow government contribution to RH In fact, households finance more than the
government
Households contribute close to half of all Households contribute close to half of all curative RH expenditurescurative RH expenditures Donor expenditures are primarily targeted for
prevention and public health programs
Reproductive health results
Conclusion (cont’d)Conclusion (cont’d)
Optimal mix of spending on curative versus prevention?Optimal mix of spending on curative versus prevention? Curative = 18% of total RH expenditures Prevention and public health programs = 66% of total RH exp
Little is being spent on maternal health care servicesLittle is being spent on maternal health care services
Financial burden on householdsFinancial burden on households Households pay to obtain donated contraceptives given to the
government Consultation fees Anecdotal evidence that fees may be charged by some facilities for the commodity
itself* In some service delivery points, households payments exceed price of
donated commodities Oral contraceptives (households pay twice as much) Injections (households pay the same amount)
Reproductive health results
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.org
Thank You
Reports related to this presentation Reports related to this presentation are available at www.phrplus.orgare available at www.phrplus.org
