This paper presents a model for estimating HIV/AIDS health care resource needs in low- and middle-income countries. The model presented was the basis for the United Nations' call for US$9.2 billion to address HIV/AIDS in developing countries by 2005 with US$4.4 billion to address HIV/AIDS health care and the rest to deal with HIV/AIDS prevention. The model has since been updated and extended to produce estimates for 2007. This paper details the methods and assumptions used to estimate HIV/AIDS health care financial needs and it discusses the limitations and data needs for this model.
Resource allocation and health financing
Estimating Resource Needs for HIV/AIDS Health Care Services in Low-Income and Middle-Income Countries
Estimating the cost of care giving on caregivers for people living with HIV and AIDS in Botswana: A cross-sectional study
Ama NO and Seloilwe ES: Journal of the International AIDS Society 13(14), 2010
Community home-based care is the Botswana Government's preferred means of providing care for people living with HIV. However, according to this study, primary (family members) or volunteer (community members) caregivers experience poverty, are socially isolated, endure stigma and psychological distress, and lack basic care-giving education. Community home-based care also imposes considerable costs on patients, their caregivers and families in terms of time, effort and commitment. The study estimated the cost incurred in providing care for people living with HIV through a stratified sample of 169 primary and volunteer caregivers drawn from eight community home-based care groups in four health districts in Botswana. The results show that the mean of the total monthly cost (explicit and indirect costs) incurred by the caregivers was US$ 90.45, while the mean explicit cost of care giving was $65.22. This mean of the total monthly cost is about one and a half times the caregivers' mean monthly income of $66.00 and more than six times the Government of Botswana's financial support to the caregivers. In addition, the cost incurred per visit by the caregivers was $15.26, while the total expenditure incurred per client or family in a month was $184.17. The study concludes that, as the cost of providing care services to people living with HIV is very high, the government of Botswana should substantially increase the allowances paid to caregivers and the support it provides for the families of the clients. The overall costs for such a programme would be quite low compared with the huge sum of money budgeted each year for health care and for HIV and AIDS.
Estimating the costs of induced abortion in Uganda: A model-based analysis
Babigumira JB, Stergachis A, Veenstra DL, Gardner JS, Ngonzi J, Mukasa-Kivunike P and Garrison LP: BMC Public Health 11(904), 6 December 2011
The demand for induced abortions in Uganda is high despite legal and moral proscriptions. Abortion seekers usually go to illegal, hidden clinics where procedures are performed in unhygienic environments by under-trained practitioners. This study was performed to estimate the costs associated with induced abortions in Uganda. Data were obtained from a primary chart abstraction study, an on-going prospective study, and the published literature. Results showed that the average societal cost per induced abortion was US$177, equivalent to $64 million in annual national costs. Of this, the average direct medical cost was $65 and the average direct non-medical cost was $19. The average indirect cost was $92, while patients incurred $62 costs on average while government incurred $14 on average. In conclusion, induced abortions are associated with substantial costs in Uganda and patients incur the bulk of the healthcare costs. This reinforces the case made by other researchers - that efforts by the government to reduce unsafe abortions by increasing contraceptive coverage or providing safe, legal abortions are critical.
Estimating the obstetric costs of female genital mutilation in six African countries
Adam T, Bathija H, Bishai D, Bonnenfant Y, Darwish M, Huntington D, Johansen E and the FGM Cost Study Group of the World Health Organization: Bulletin of the World Health Organization 88: 281–288, April 2010
This study's main objective was to estimate the cost to the health system of obstetric complications due to female genital mutilation (FGM) in six African countries. A multistate model was used, which depicted six cohorts of 100,000 15-year-old girls who survived until the age of 45 years. The risk of obstetric complications was estimated based on a 2006 study of 28,393 women. The annual costs of FGM-related obstetric complications in the six African countries studied amounted to I$ 3.7 million and ranged from 0.1 to 1% of government spending on health for women aged 15–45 years. In the current population of 2.8 million 15-year-old women in the six African countries, a loss of 130,000 life years is expected owing to FGM’s association with obstetric haemorrhage. This is equivalent to losing half a month from each lifespan. Beyond the immense psychological trauma it entails, FGM imposes large financial costs and loss of life. The cost of government efforts to prevent FGM will be offset by savings from preventing obstetric complications.
EU member states failing to meet aid targets
Vogel T: European Voice, 12 November 2009
Karel De Gucht, the European commissioner for development, has warned the ministers of European Union member states that just five of the 27 member states are on course to meet a self-imposed target of giving 0.56% of national income in aid to developing countries by 2010. That target was an interim benchmark on the way to a pledge agreed by the member states that they should give 0.7% of gross national income in aid by 2015. De Gucht has sent, to development ministers, papers that show projected assistance levels for 2009 and 2010 for each member state. So far, four countries – Denmark, Luxembourg, the Netherlands and Sweden – are above the 0.7% level and Ireland is above 0.56%.
European Commission's humanitarian aid department releases annual report
ECHO: 1 July 2009
According to the European Commission’s annual report, overall spending in 2008 was 937 million euros (about US$1.302 billion) across 60 countries. Of that, about three-quarters went to the top 25 recipient non-profit agencies and an aviation contractor. United Nations (UN) agencies took 46% of the overall spend, while 44% went to non-governmental organisations (NGOs). NGOs from the UK, France and Germany account for over half of NGO funding. More than half was spent in Africa. The top five countries and territories receiving the most funding, including food aid, were (in millions of euros) Sudan (161.3), Occupied Palestinian Territories (75.1), Democratic Republic of Congo (53.9), Ethiopia (48.5) and Kenya (36.7). The top five organisational recipients were (in millions of euros) the UN World Food Programme (228), the International Committee of the Red Cross (78.9), the UN Refugee Agency (53.5), the UN Relief and Works Agency (38) and the UN Children’s Fund, UNICEF (32.6).
Evaluating the cost-effectiveness of combination antiretroviral therapy for the prevention of mother-to-child transmission of HIV in Uganda
Kuznik A, Lamorde M, Hermans S, Castelnuovo B, Auerbach B, Semeere A et al: Bulletin of the World Health Organisation 90(8): 595–603, August 2012
The aim of this study was to model the cost-effectiveness in Uganda of combination antiretroviral therapy (ART) to prevent mother-to-child transmission of HIV. The cost-effectiveness of ART was evaluated on the assumption that it reduces the risk of an HIV-positive pregnant woman transmitting HIV to her baby from 40% (when the woman is left untreated) to between 3.8% and 25.8%. Compared with single-dose nevirapine, dual therapy and no therapy, 18 months of ART averted between 3.22 and 8.58 disability-adjusted life years (DALYs), at a cost of between US$34 and $99 per DALY averted. The corresponding figures for lifetime ART range from 11.87 to 31.6 DALYs averted, at a cost of between $172 and $354 per DALY averted. According to these findings, it appears ART is highly cost-effective for the prevention of mother-to-child HIV transmission, even if continued over the patients’ lifetimes. Given the additional public health benefits of ART, efforts to ensure that all HIV-positive pregnant women have access to lifelong ART should be intensified, the authors conclude.
Evaluation of results-based financing in the Republic of the Congo: a comparison group pre–post study
Zeng W; Shepard D; de Dieu Rusatira J; et al: Health Policy and Planning 33(3) 392–400, 2018
In this study on a pilot results based financing (RBF) in the Republic of the Congo from 2012 to 2014, the authors conducted pre- and post-household surveys and gathered health facility services data from both intervention and comparison groups. Using a difference-in-differences approach, the study evaluated the impact of RBF on maternal and child health services. The household survey found statistically significant improvements in quality of services regarding the availability of medicines, perceived quality of care, hygiene of health facilities and being respected at the reception desk. The health facility survey showed no adverse effects and significantly favourable impacts on: curative visits, patient referral, children receiving vitamin A, HIV testing of pregnant women and assisted deliveries. These improvements, in relative terms, ranged from 42% to 155%. However, the household survey found no statistically significant impacts on the five indicators measuring the use of maternal health services, including the percentage of pregnant women using prenatal care, 3+ prenatal care, postnatal care, assisted delivery, and family planning. Surprisingly, RBF was found to be associated with a reduction of coverage of the third diphtheria, pertussis, and tetanus immunization among children in the household survey. From the health facility survey, no association was found between RBF and full immunization among children.
Even Larry Summers Denounces World Bank’s “PEF” Ebola Bonds that Enriched Investors at the Expense of the sick in the Congo
Smith. Y: Naked Capitalism, USA, August 2019
The author reports that Larry Summers, a former World Bank chief economist, viewed the Banks Ebola financing scheme as a problem. As recounted by another former World Bank economist, Olga Jonas, the World Bank involvement of the private sector in funding countries affected by Ebola in the wake of the 2014-2016 outbreak led to the Pandemic Emergency Financing Facility (PEF) as a form of investor scheme for private financing. However, as Jonas points out, the PEF stipulates a payout of $45 million for Ebola if the officially confirmed death toll reaches 250 (which occurred in the DRC [Democratic Republic of the Congo] by mid-December 2018), but only if at least 20 deaths occurred in a second country. Given that the WHO lists only one multi-country outbreak amid more than 30 that occurred in a single country, this requirement is viewed as inappropriate. Rather than a lack of funds, the author argues that vigilance and public-health capacity have been the main deficiencies. When governments and the World Bank are prepared to respond to infectious-disease threats, money flows within days. The World Bank has said that the PEF is working as intended by offering the potential of ‘surge’ financing. However its triggers are said to guarantee that payouts will be too little because they kick in only after outbreaks grow large. The author concludes that the best investment of funds and attention is in ensuring adequate and stable financing for core public-health capacities, that the PEF has failed. It should end early — and that IDA funds should go to poor countries, not investors.
Examining equity in health insurance coverage: an analysis of Ghana’s National Health Insurance Scheme
Dake F: International Journal for Equity in Health 17(85) 1-10; 2018
This paper examines equity in coverage under Ghana’s National Health Insurance Scheme. Secondary data from the 2008 Ghana Demographic and Health Survey based on an analytical sample of 4821 females and 4568 males were analysed using descriptive, bivariate and multivariate methods. As at 2008, more than 60% of Ghanaians aged 15–59 years were not covered under the National Health Insurance Scheme with slightly more females than males covered. Coverage was highest among the highly educated, professionals, those from households in the richest wealth quintile and urban residents. Lack of coverage was most concentrated among poor people. The author calls for deliberate action to enrol the poor under the National Health Insurance Scheme.