This paper looks at whether aid partnerships established early or late matter significantly for aid quantities, and how this in turn affects aid fragmentation. It also details how aid partnerships have evolved over time and how donors have, if at all, shifted priorities. Furthermore the authors seek to evaluate the effect of current aid reform on aid fragmentation. It found that donor countries allocate larger shares of their aid budgets to recipients that entered early in their portfolios, while they have allocated smaller aid quantities to new partnerships. This has direct consequences for aid fragmentation, with many donors disbursing small amounts to a recipient. Fragmentation appears to be a product of portfolio expansion and it increases direct transaction and indirect costs creating dysfunctional bureaucracy and political behaviours by lowering the level of bureaucratic quality. Aid is less efficient in countries when it is fragmented. Donors' decisions to give less aid to late recipients, coupled with the sheer expansion in the number of their partnerships, has direct consequences on aid fragmentation.
Resource allocation and health financing
It should not be assumed that earmarked donor funding automatically increases the allocation of developing-country resources towards programmes that yield the greatest health benefits. Sometimes it does, sometimes it does not - how the funding is designed can influence this. This is true particularly in the longer term, once the earmarked funding has ended. This is according to an article in Volume 82, Number 9, of the Bulletin of the World Health Organization.
International donors must continue meeting their commitments to HIV/AIDS, even in the face of the economic downturn, United Nations (UN) Secretary-General Ban Ki-Moon has urged. In 2006, the Assembly pledged to achieve universal access to comprehensive HIV prevention, treatment, care and support by 2010. UNAIDS has said that achieving these targets in the timeframe would require an estimated US$25 billion. In 2008, the Global Fund to Fight AIDS, Tuberculosis and Malaria was forced to cut funding by 10% and the World Bank projects that the global recession could place the treatment of more than 1.7 million at risk by the end of 2009. ‘I fear that many governments are resigned to reducing programmes and diminished expectations,’ said Miguel D'Escoto, President of the UN General Assembly. ‘But it is precisely when times are difficult that our true values and the sincerity of our commitment are most clearly evident. If we allow cuts now, we will face increased costs and great human suffering in the future.’
In 2001, Kenya was one of nine countries to receive financial backing to introduce the Haemophilus influenzae type b (Hib) vaccine. How cost-effective has it been? Recently the Kenyan government agreed to co-finance the costs of the vaccine from 2006 to 2011, gradually increasing its contributions. The study concluded that Hib vaccine is a highly cost-effective intervention in Kenya. Although the level of disease is relatively low, the investment required for disease prevention is also low.
In this study, researchers compared two task-shifting approaches to the dispensing of antiretroviral therapy (ART): Indirectly Supervised Pharmacist’s Assistants (ISPA) and Nurse-based pharmaceutical care models against the standard of care which involves a pharmacist dispensing ART. A cross-sectional mixed methods study design was used. Patient exit interviews, time and motion studies, expert interviews and staff costs were used to conduct a costing from the societal perspective. Six facilities were sampled in the Western Cape province of South Africa, and 230 patient interviews conducted. The ISPA model was found to be the least costly task-shifting pharmaceutical model. However, patients preferred receiving medication from the nurse. This related to a fear of stigma and being identified by virtue of receiving ART at the pharmacy. While these models are not mutually exclusive, and a variety of pharmaceutical care models will be necessary for scale up, it is useful to consider the impact of implementing these models on the provider, patient access to treatment and difficulties in implementation.
South Africa suffers a particularly severe lack of pharmacists, a problem that could possibly be addressed by task shifting. In this study, researchers compared the costs of two task-shifting approaches to the dispensing of anti-retroviral therapy (ART) - indirectly supervised pharmacist's assistants (ISPA) and nurse-based pharmaceutical care models - against the standard of care, where only a pharmacist may dispense ART. They sampled six facilities in the Western Cape province of South Africa, and interviewed 230 patients. Data from patient exit interviews, time and motion studies, expert interviews and staff cost calculations were collated to estimate cost from the societal perspective. The ISPA model was found to be the least costly task-shifting pharmaceutical model. However, patients preferred receiving medication from the nurse. This related to a fear of stigma and being identified by virtue of receiving ART at the pharmacy. While these models are not mutually exclusive, and a variety of pharmaceutical care models will be necessary for scale up, the authors argue that it is useful to consider the impact of implementing these models on the provider, patient access to treatment and difficulties in implementation.
This paper estimates the monetary costs of the 19 million unsafe abortions that take place every year around the world. This includes the direct costs of treatment related morbidity and mortality to health systems, and indirect costs to the national economy and households – the cost to women when they suffer from abortion complications whilst they receive treatment and recuperate from such treatment.
As the need for anti-retroviral therapy (ART) grows without commensurate increase in the amount of available resources, it is critical to assess the health and economic gains being realised from increasingly large investments in ART. This study estimates total programme costs and compares them with selected economic benefits of ART for an estimated 3.5 million ART patients in low-and middle-income countries whose treatment is co-financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria. Using 2009 anti-retroviral prices and ART programme costs, the authors estimate that the cost of maintaining these patients is US$14.2 billion for the period 2011–2020. This investment is expected to save 18.5 million life-years and return $12 to $34 billion to the economy through increased labour productivity, averted orphan care and deferred medical treatment for opportunistic infections and end-of-life care. These results suggest that, in addition to the large health gains generated, the economic benefits of treatment will substantially offset, and likely exceed, programme costs within 10 years of investment.
The International AIDS Economics Network (IAEN) Preconference in Durban in July 2016 demonstrated the strong political will to prioritise financing and harness economics to sustain the global HIV response and end AIDS, with high-level participation by ministers of health from Lesotho, Namibia, Botswana, Uganda, and Zimbabwe, along with the heads of UNAIDS and PEPFAR and experts from the CDC and the World Bank. At the policy level, a high-level panel discussed how evidence generated by economists can help facilitate engagement between the ministries of health and treasury and with civil society to keep health and HIV as a top priority in many countries. They also argued that investment cases should be made alongside human rights cases. These messages were echoed throughout the main conference. The face of HIV economics has changed, with young researchers from low- and middle-income countries making most of the presentations. The community’s focus has also changed in other promising ways. In 2000 health economists were just starting to explain why it makes economic sense to introduce antiretroviral (ARV) medicines into low-resource settings, and responsibility for financing HIV programs was seen to lie squarely in the hands of rich countries. In contrast, today energy is channeled towards sustaining the response and striving toward the 90-90-90 targets as efficiently as possible. Critically, the International AIDS Economics Network are supporting countries to mobilize ever more domestic resources and take ownership of their national programs.
Economists said at the international AIDS conference on HIV pathogenesis and treatment in Paris on July 14 that nations with a high HIV/AIDS burden should spend more of their resources on antiretrovirals, a move which directly contradicts current medical opinion. The medical community has said that handing out antiretrovirals would be a waste of resources; could worsen drug resistance; and instead it urged preventative measures. Three pilot studies presented at the meeting from the Ivory Coast, Senegal, and Uganda--funded by UNAIDS--found that with a little help to set up medical infrastructure, drugs can be delivered, even to remote areas, without increasing drug resistance. (Access requires registration.)