HIV/AIDS Costing Exercises
Strengthening Round 9 Global Fund Applications in Three African Countries through HIV/AIDS Program Costing Exercises
As countries prepare for Round 9 applications to the Global Fund to Fight AIDS, TB, and Malaria (GFATM), it has become increasingly necessary for them to provide accurate cost estimates to receive program funds. Health Systems 20/20 has conducted a number of costing exercises that have contributed to more reliable and realistic cost estimates for HIV/AIDS programming in Liberia, Zambia, and Nigeria.
Liberia: At the request of the National AIDS Control Program in Liberia, Health Systems 20/20 conducted a detailed review of the National HIV/AIDS Strategic Framework’s thematic areas including: prevention, care, treatment and support, research, monitoring and evaluation, and impact mitigation. The project provided a more realistic and validated cost estimate for Liberia’s HIV/AIDS programming that will ultimately be more viable and acceptable to the government, donors, and other stakeholders.
Zambia: Throughout 2007-2008, the government of Zambia conducted a sustainability analysis of their public HIV/AIDS program to generate evidence for HIV/AIDS policy, planning, and resource mobilization. Health Systems 20/20 developed and applied a Microsoft Excel-based tool called HIV/AIDS Program Sustainability Analysis Tool (HAPSAT) for assessing the sustainability of public sector HIV/AIDS services in Zambia including HIV counseling and testing, prevention of mother-to-child transmission, antiretroviral treatment, care and support. Data regarding epidemiology, demographics, financing, human resources, service delivery protocols, and service volume was collected from government agencies, donors, and their implementing partners. These data were used to construct a model in HAPSAT representing Zambia’s HIV/AIDS situation.
By comparing scenarios in HAPSAT, policymakers gained a clearer understanding of tradeoffs associated with policy choices. The evidence base generated from sustainability analysis is being used to inform goal setting decisions, to mobilize and allocate resources, and to address bottlenecks in service delivery. The Zambian government is using the HAPSAT findings to request additional funding from Global Fund round 8 and the National AIDS Commission is using the Zambia HAPSAT model to project costs for the next three to five years.
Nigeria: In collaboration with the National Agency for the Control of AIDS (NACA) in Nigeria, Health System 20/20 is carrying out a sustainability analysis of Nigeria’s response to HIV/AIDS. Data regarding epidemiology, demographics, funding levels, human resources, service delivery protocols, and service volume were collected from a sample of health facilities, health ministries, the State Agency for the Control of AIDS (SACAs), and civil society organizations in 18 states across all six zones, as well as from donors, principal recipients, and federal line ministries. Analyses are being conducted using the Excel-based HIV/AIDS Program Sustainability Analysis Tool (HAPSAT) to estimate the financial, human, and physical resources required to deliver HIV/AIDS services in Nigeria over a five-year time period.
Preliminary results indicate that the total cost of the volume of HIV/AIDS services in 2008 is about US$522 million per year. Anti-retroviral services constitute 20 percent of the total cost. Based on the data collected for this sustainability analysis, only a small proportion of 2008 funding came from domestic sources. PEPFAR and GFATM accounted for 50 percent and 35 percent of the total budget, respectively. To scale up HIV/AIDS services to full coverage levels within five years would require a dramatic increase in resources to nearly US$1.8 billion per year by 2012. Substantial donor-funding commitments will be continually required for years 2009-2012.
The size of the gap between the resources required and the expected level of available domestic funds for HIV/AIDS suggests that substantial innovation in health system improvement and health financing will be needed to mobilize domestic resources, increase operational efficiency, and ultimately reduce Nigeria’s reliance on external funders of its HIV/AIDS response. The results of data collection also highlight weaknesses in processes for generating accurate, action-oriented strategic information regarding the financing of HIV/AIDS services.
Has the donor fund influx for HIV/AIDS affected the domestic investments? Results from the multicountry analysis
Type: Presentation
Sustainability Analysis of HIV/AIDS Services in the Republic of Cote d’Ivoire, Using HAPSAT
Type: Report
Country: Cote d'Ivoire
Sustaining HIV Services: HAPSAT estimates of resource needs under alternative policy scenarios
Type: Presentation
Country: Cote d'Ivoire, Ethiopia, Nigeria, Zambia
Sustainability Analysis of HIV/AIDS Services in Nigeria
Type: Report
Country: Nigeria
Linking NASA and NHA: Concepts and Mechanics
Type: Report
Health Systems 20/20 Work in Haiti
Feb 1 2010Health Systems 20/20 Contributes to Lancet Article Examining Interactions between Global Health Initiatives and Health Systems
Aug 18 2009Over the past two decades the emergence of several large disease-specific global initiatives (GHI) has shifted the way development assistance in public health is provided. To help assess the interaction between GHIs and country health systems, Health Systems 20/20 staff Susna De, Wenjuan Wang, Jenna Wright, and Takondwa Mwase participated in the WHO Maximizing Positive Synergies Collaborative Group. Their multiple-country analysis on financing HIV/AIDS work contributed to the Group’s report, the highlights of which appear in a recent Lancet article.
More...From Health Labor Market Analysis to Result-Based Financing: Insights from a Post-Conflict Country, Cote d'Ivoire
Jan 28 2009As in most African countries, Cote d’Ivoire is facing a crisis in human resources for health (HRH) worsened by a high HIV-AIDS prevalence (4.7%) and a civil war from 2002 to 2007. Many health workers have fled from the northern regions to seek refuge in the capital city, Abidjan. At a World Bank event on January 14, 2009, Gilbert Kombe shared insights from Health Systems 20/20 work to develop innovative and sustainable interventions to address the health labor crisis.
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Using Round 9 of the Global Fund for Health Systems Strengthening
Oct 27 2008Health Systems 20/20 and the Health Workforce Advocacy Initiative have teamed up to develop a toolkit of materials to help Global Fund applicants better understand how they can use Round 9 of the Global Fund to strengthen their countries’ health systems as well as what resources are available to support them in doing so.
More...Why Strengthening Health Systems Matters
Oct 21 2008
USAID's flagship health systems strengthening project, Health Systems 20/20, was invited to share their experience with the Office of the U.S. Global AIDS Coordinator (OGAC) related to building health systems at the country level.
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