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Tropical Medicine and International Health. 2008 Oct; 13(10):1245-56.OBJECTIVE: To estimate recurrent costs per patient and costs for a national HIV/AIDS treatment programme model in Rwanda. METHODS: A national HIV/AIDS treatment programme model was developed. Unit costs were estimated so as to reflect necessary service consumption of people living with HIV/AIDS (PLWHA). Two scenarios were calculated: (1) for patients/clients in the year 2006 and (2) for potential increases of patients/clients. A sensitivity analysis was conducted to test the robustness of results. RESULTS: Average yearly treatment costs were estimated to amount to 504 US$ per patient on antiretroviral therapy (ART) and to 91 US$ for non-ART patients. Costs for the Rwandan HIV/AIDS treatment programme were estimated to lie between 20.9 and 27.1 million US$ depending on the scenario. ART required 9.6 to 11.1 million US$ or 41-46% of national programme costs. Treatment for opportunistic infections and other pathologies consumed 7.1 to 9.3 million US$ or 34% of total costs. CONCLUSION: Health Care in general and ART more specifically is unaffordable for the vast majority of Rwandan PLWHA. Adequate resources need to be provided not only for ART but also to assure treatment of opportunistic infections and other pathologies. While risk-pooling may play a limited role in the national response to HIV/AIDS, considering the general level of poverty of the Rwandan population, no appreciable alternative to continued donor funding exists for the foreseeable future.
In: The health of adults in the developing world, edited by Richard G.A. Feachem, Tord Kjellstrom, Christopher J.L. Murray, Mead Over, Margaret A. Phillips. New York, New York, Oxford University Press, 1992. 161-207.The consequences of adult ill-health are greater than previously believed. These consequences go beyond suffering and grief and consist of indirect adverse effects on society which increase the cost of adult ill-health in developing countries. At the household level, family and friends try to reduce the effects of an illness or injury afflicting an adult household member. Work colleagues increase their workload to pick up the slack of the ill or injured colleague. An unhealthy labor force results in slow work schedules and less specialization of employee job descriptions. These coping processes reduce the effects of illness, but are costly. Yet traditional empirical studies do not examine them. Anticipatory coping mechanisms to mitigate adverse consequences of adult ill-health include formal and nonformal insurance mechanisms, both of which bear high costs. Informal insurance mechanisms include high fertility and extended families and social networks. Formal mechanisms are investment and savings and formal health insurance. Further, adult ill-health harms children more than child ill-health harms adults. thus, the total ill-health burden of children is greater than originally surmised. Household costs of adult ill-health are effect on production and earnings, on investment and consumption, and on household health and consumption and psychic costs. At least 70% of hospital resources in developing countries goes to adult and elderly patients. A considerable proportion of primary care costs is also dedicated to adults. Even though researchers agree that disease affects income, this effect is preceded and overshadowed by the effect of disease on health status, of health status on functional capacity, and of functional capacity on productivity. In conclusion, adult ill-health restricts development in societies burdened by adult ill-health.
[Unpublished] 1987. Presented at the All Africa Health Services Consultation, Kinshasa, Zaire, June 9th-14th 1987. 15,  p.The consumption of alcohol in Africa is a possible problem and could be a serous one. Drinking as well as prostitution is illegal for those under 18 years of age. There are many people who are dependent on alcohol and will drink until they use all their money or are completely drunk. Much of the alcohol is made in the home and was originally used on ceremonial occasions. This brew had to be consumed before it spoiled, causing heavy drinking bouts. Women in a village will produce a barrel of beer even though the cost is relatively high in terms of water, firewood, and ingredients that could be used for food. The commercialization of the liquor business has changed the drinking patterns and the money economy has also contributed. With the addition of commercially produced alcohol, the numbers of drinking places increased and the variety of more potent types of beer appeared. In the central and southern parts of Africa independence has caused drinking patterns to follow those of western countries where wine and other alcoholic beverages are common. In Swaziland the pattern is affected by the large demand from the tourist trade. Although it is hard to estimate the total consumption rate of alcohol, the production rate of factory produced products was 3.39 liters of alcohol per person in 1979. Some reports of injuries suggest that in 20 years alcohol related injuries will be the largest problem. This indicates a need for treatment, rehabilitation, and educational programs. Other needs include changing attitudes by influence of the churches and other community organizations.