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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.