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Using the NHA Malaria Subaccounts Methodology

Policy implications of findings from the new NHA malaria subaccount work as well as training in the subaccounts methodology itself were the main topics of a workshop for the East and Southern Africa regional NHA network held in Kigali, Rwanda, May 2-5, 2006. In addition to Rwanda, delegations from Ethiopia, Kenya, Malawi, and Zambia took part in the training.

Dr. Jean Damascene Ntawukuliryayo, Rwandan Minister of Health.The workshop also served as a venue to disseminate Rwanda NHA 2003 findings, which included the first-ever country estimate of malaria subaccounts. The Rwandan Minister of Health, Dr. Jean Damascene Ntawukuliryayo, chaired the conference and led a dynamic discussion of the findings – including that in 2003 only 16 percent of all donor funds went toward malaria care and prevention. This is a concern to a country where malaria is the major cause of morbidity and mortality. He stressed the need for coordination among partners, and for finding the optimal mix of spending for prevention vs. curative care and on malaria vs. other priority diseases. In closing, the Minister stated that he ultimately wanted "subaccounts done for all the sectors of the Ministry."

The event received front-page coverage in the national newspaper and headlined evening news broadcasts (in three languages).

Participants from the workshopIn addition to the aforementioned delegates from the ESA NHA network, more than 60 national health care stakeholders from major donor, NGO, and government institutions attended. Donors present included French Cooperation, German Cooperation, WHO, USAID, CDC, Belgian Technical Cooperation, Swiss Cooperation, UNAIDS, and DFID.

The workshop, hosted by the Government of Rwanda and sponsored by USAID/REDSO/E through the PHRplus project, was held in Kigali because Rwanda was the first country to conduct the malaria subaccounts; and because the Rwandans have had extensive experience with NHA in general. This enabled the Rwanda NHA team to serve as workshop trainers.

In addition to Rwanda NHA team members, workshop trainers included PHRplus staff and an international expert from WHO/Geneva. Country teams comprised experienced NHA and national malaria program experts. This mix of participants proved quite effective; all were highly engaged in the training program and contributed greatly to class discussion. Participants rated the workshop as "very well-done" and agreed they need "to borrow a leaf from Rwanda."

The subaccounts course manual will be revised based on workshop comments and then posted at and, and PHRplus and WHO/Geneva will provide email updates to participants regarding methodological developments. The workshop served to establish a regional network for malaria subaccounts and in the future, WHO/Geneva will facilitate network teleconferences to discuss methodological issues and challenges.

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