Abstract
National Health Accounts (NHA) are designed to give a comprehensive description of resource
flows in a health system, showing where resources come from and how they are used. The Rwandan
Ministry of Health (MOH) has recognized the importance of documenting the overall flow of health
funds—and in particular funds related to HIV/AIDS—and has initiated the NHA activity with a view
to generate data that can assist formulation of health policies that improve access to care and
efficiency of resource allocation. With this first NHA report, the MOH aims to document the
magnitude of sources, flow and uses of funds within the public and private health care sector in
Rwanda during 1998. NHA findings reveal total per capita health expenditures in the amount of US$
12 per year, of which 50 percent is funded by the international community, 40 percent by households,
and 10 percent by the government. This report also includes information on HIV/AIDS expenditures
in Rwanda and establishes a baseline to determine the sources, flow, and use of HIV/AIDS monies. In
terms of overall health spending, the MOH aims to document the level of health expenditures related
to HIV/AIDS, the flow of AIDS monies from sources to users, and how HIV/AIDS expenditures
relate to overall health sources and funds. With a growing number of sero-positive patients
demanding access to care, the demand for resources is growing and this in turn is causing increasing
challenges to the Rwandan health system. The comparison of HIV/AIDS-related costs (prevention,
treatment, and mitigation) within overall health expenditures reveals that AIDS prevention is to a
large extent financed by donor funds, whereas treatment costs place the heaviest financial burden on
households. This is because there is an absence of a financial support system that facilitates patients’
access to care. Thus, access to treatment of HIV/AIDS-related diseases is defined by the patient’s
socioeconomic background and ability to pay user fees. Based on this analysis, the NHA report
suggests health policies for the overall Rwandan health sector and for the HIV/AIDS sector, to
improve the financial information process, the sustainability and affordability of health care, as well
as the equity of access to health care.