1. 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

2. Impact of the HIV/AIDS Epidemic KenyaRwandaZambia Adult prevalence6.7%5.1%15.6% HIV infected adults982,685199,2791.2M Declining life expectancy 1990 625054 2002 474440 GDP per capitaUSD 371USD 196USD 354

3. Providing HIV/AIDS Prevention, Treatment and Care: A Heavy Toll on the Health Sector HIV/AIDS is the single largest contributor to the burden of disease in Africa 19% of the total years of life lost due to disability or premature mortality 14% 24% 45% In percentages HIV/AIDS as a share of total health expenditures PPP$ 306 PPP$ 433 PPP$ 141

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

5. Treatment and Care Absorb the Majority of Health Funds 75% KENYA

6. 19% 75% Is HIV/AIDS a Priority in Resource Allocation? 5%21%33%57% RwandaKenyaZambia

7. Dependence on external resources Global Fund and PEPFAR funds relative to health expenditures Source: PHRplus analysis of Global Fund data

8. 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

9. 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

10. The Burden on HIV+ Households Is Considerable HIV/AIDS Out-of pocket 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

11. Meeting basic needs in Rwanda 58% of HIV+ households received assistance, borrowed or sold assets 34% received assistance 29% borrowed 21% sold assets

12. Inequities in Zambia USD

13. 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