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Zambia National Health Accounts 2002: Main Findings September 2004 Prepared by: Felix Phiri Ministry of Health, Zambia Marie Tien, MHS Abt Associates Inc. Zambia Ministry of Health Partners for Health Reformplus Abt Associates Inc. „ 4800 Montgomery Lane, Suite 600 Bethesda, Maryland 20814 „ Tel: 301/913-0500 „ Fax: 301/652-3916 In collaboration with: Development Associates, Inc. „ Emory University Rollins School of Public Health „ Philoxenia International Travel, Inc. „ Program for Appropriate Technology in Health „ Social Sectors Development Strategies, Inc. „ Training Resource Group „ Tulane University School of Public Health and Tropical Medicine „ University Research Co., LLC. Funded by: U.S. Agency for International Development Order No. WP 007 Mission Partners for Health Reformplus is USAID’s flagship project for health policy and health system strengthening in developing and transitional countries. The five-year project (2000-2005) builds on the predecessor Partnerships for Health Reform Project, continuing PHR’s focus on health policy, financing, and organization, with new emphasis on community participation, infectious disease surveillance, and information systems that support the management and delivery of appropriate health services. PHRplus will focus on the following results: Implementation of appropriate health system reform. Generation of new financing for health care, as well as more effective use of existing funds. Design and implementation of health information systems for disease surveillance. Delivery of quality services by health workers. Availability and appropriate use of health commodities. This document was produced by PHRplus with funding from the US Agency for International Development (USAID) under Project No. 936-5974.13, Contract No. HRN-C-00-00-00019-00 and is in the public domain. The ideas and opinions in this document are the authors’ and do not necessarily reflect those of USAID or its employees. Interested parties may use the report in part or whole, providing they maintain the integrity of the report and do not misrepresent its findings or present the work as their own. This and other HFS, PHR, and PHRplus documents can be viewed and downloaded on the project website, www.PHRplus.org. September 2004 Recommended Citation Phiri, Felix, Marie Tien. September 2004. Zambia National Health Accounts 2002: Main Findings. Bethesda, MD: The Partners for Health Reformplus Project, Abt Associates Inc. For additional copies of this report, contact the PHRplus Resource Center at PHR-InfoCenter@abtassoc.com or visit our website at www.PHRplus.org. Contract/Project No.: Submitted to: and: HRN-C-00-00-00019-00 USAID/Lusaka Karen Cavanaugh, CTO Health Systems Division Office of Health, Infectious Disease and Nutrition Center for Population, Health and Nutrition Bureau for Global Programs, Field Support and Research United States Agency for International Development Abstract The National Health Accounts (NHA) methodology is a tool that allows countries to track the flow of health spending from financial sources to end users. NHA includes estimates of household expenditures, spending that governments have not historically considered when looking at national health expenditures. This paper summarizes how NHA was used to capture general health and HIV/AIDS-specific expenditures in Zambia in 2002. It was that country’s first attempt to assess spending on a disease-specific expenditure. HIV/AIDS-related expenditure estimates show that households and donors are the major financiers of HIV/AIDS care. People living with HIV/AIDS spend 12 times more on health care than non-HIV-infected individuals. The paper also reviews health care utilization and borrowing patterns for people living with HIV/AIDS. Table of Contents Acronyms ..............................................................................................................................................ix Acknowledgments .................................................................................................................................xi 1. Background..................................................................................................................................... 1 1.1 1.2 2. Socio-Economic Background................................................................................................1 National Health Accounts: The Process ................................................................................1 Methodology................................................................................................................................... 3 2.1 Selection of Survey Respondents ..........................................................................................3 2.1.1 People Living with HIV/AIDS ......................................................................................3 2.1.2 Other Survey Respondents ............................................................................................4 2.2 3. Limitations and Challenges ...................................................................................................4 NHA Findings: Health Sector......................................................................................................... 7 3.1 3.2 Main Findings........................................................................................................................7 Household Expenditures........................................................................................................8 4. NHA Findings: HIV/AIDS ........................................................................................................... 11 5. 4.1 HIV/AIDS in Zambia ..........................................................................................................11 4.2 Utilization ............................................................................................................................13 4.3 Expenditures on Outpatient Visits.......................................................................................14 4.4 Household Financing of HIV/AIDS Care, and Implications for Equity .............................14 4.5 Care Provision by Traditional Healers, and Implications for Quality .................................14 Conclusion .................................................................................................................................... 15 Reference List....................................................................................................................................... 27 List of Tables Table 1: Summary Statistics from Zambia NHA 2002................................................................................. 7 Table 2: Health Care Revenue from Households.......................................................................................... 9 Table 3: Summary Statistics from 2002 NHA HIV/AIDS Subanalysis...................................................... 11 Table 4: Annual Per Capita Outpatient Visits............................................................................................. 13 Table 5: Average Expenditure on Outpatient Visit..................................................................................... 14 List of Figures Figure 1: Sources of Funds from Zambia NHA 2002................................................................................... 8 Figure 2: Household Spending by Provider Type....................................................................................... 12 Figure 3: Health Spending PLWHA in Zambia.......................................................................................... 13 Table of Contents vii Acronyms AIDS Acquired Immune Deficiency Syndrome HBC Home-based Care DHS Demographic and Health Survey GDP Gross Domestic Product HIV Human Immunodeficiency Virus LCMS Living Conditions Monitoring Survey NGO Nongovernmental Organization NHA National Health Accounts PLWHA People Living with HIV/AIDS THE Total Health Expenditures UNAIDS Joint United Nations Programme on HIV/AIDS USAID United States Agency for International Development VCT Voluntary Counseling and Testing Acronyms ix