The Goals Model as a Tool for Allocating HIV/AIDS Resources & Strategic Planning

Transcription

1 The Goals Model as a Tool for Allocating HIV/AIDS Resources & Strategic Planning Steven Forsythe, PhD Senior Health Economist, Futures Institute Steven.Forsythe@gmail.com

2 How do the Tools Fit? Surveillance Data Census/UN Pop Division Estimates UNAIDS model epidemic patterns AIDS Accounts What is the prevalence of HIV/AIDS? What is the impact of HIV/AIDS? How much is being spent? EPP/AEM Spectrum NASA Costing and coverage data Existing effectiveness data What resources are required? How should we allocate resources? RNM/ASAP Costing Model Goals

3 Current Strategic Plans Goals Objectives Activities Budgets are not linked to goals! Budgets

4 Why is Goals Necessary? Informs resource allocation decisions with information from every published study on the costs and effectiveness of various interventions. Allows the user to see the trade-offs between various resource allocation strategies. Encourages dialogue among government & civil society regarding resource allocation decisions.

5 How was Goals Developed? Reviewed national strategic plans from 20 countries. Reviewed and evaluated 241 published and unpublished papers on the impact of HIV/AIDS interventions in developing countries and the costs of interventions. Developed the model in Excel (also being made available in Spectrum)

6 Resource Allocation in Strategic Plans Admin Advocacy Care Mitigation Prevention Research 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Bangladesh China Nicaragua Viet Nam Brazil El Salvador India Guatemala Senegal Honduras Thailand Gabon DR Congo Uganda Mozambique CAR Kenya Malawi S Africa

7 Distribution of Resources for National AIDS Strategic Plans Source: Review of National HIV/AIDS Strategies for Countries Participating in the World Bank s Africa Multi-Country AIDS Program (MAP), World Bank, 2005.

8 Distribution of Resources on Prevention 100% IEC Condoms VCT STI PMTCT Blood Safety Other 0.5% 0.7% 2.0% 2.3% 5.4% 6.7% 16.1% 17.0% 80% 60% 40% 20% 0% Madagascar Mauritania Burkina Ghana Cameroon Uganda Mozambique Zambia Source: Review of National HIV/AIDS Strategies for Countries Participating in the World Bank s Africa Multi-Country AIDS Program (MAP), World Bank, 2005.

9 Why Use Goals? To improve resource allocation for a country s HIV/AIDS programs How much funding will be required to reach the goals of the strategic plan? What goals can be achieved with the available resources? What is the effect of alternate patterns of resource allocation on goals and cost-effectiveness?

10 Programs Policy Interventions Structure of the Goals Model Budget $ Coverage Improved Policy environment Prevention Care and treatment Mitigation Program support $ $ $ $ % % % Behavior change -age at first sex -number of partners -condom use -STI treatment -safe injections Increased care, treatment & mitigation New HIV infections Treatment Coverage

11 Goals 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% HIV Prevalence/Incidence % 2.0% 1.5% 1.0% 0.5% 0.0% Coverage of Care & Treatment 0% 50% 100% Palliative OI Tx OI Pro ARV TB

12 Disclaimer Model output depends critically on assumptions about unit costs and impact Best studies are more likely to be published Poorly implemented programs will not have same impact as good programs Difficult to capture synergies Cost-effectiveness is not the only basis for resource allocation decisions

13 Approach Goals is intended to be a tool to assist interactive discussions among all stakeholder.

14 Experience to Date Goals works best when: Implemented by an interdisciplinary technical team Combined technical team and advocacy team in resource allocation workshops Carried out as a key component in: strategic planning, evaluation or proposal development (e.g., Global Fund application)

15 How has Goals been Applied? AN EXAMPLE FROM KENYA

16 Kenya s Principle Objectives Reducing HIV prevalence in Kenya by 20 to 30 percent among people aged 15 to 24 years by Increasing access to care and support for people infected and affected by HIV/AIDS in Kenya. Strengthening response, capacity and coordination at all levels.

17 Strengthened response, capacity and coordination at all levels Will $710 million over 5 years produce.. A 25% reduction in HIV prevalence among 15 to 24 years olds by 2005? Increased access to care and support for people infected and affected.

18 Uses of the different scenarios Current plan scenario: How much of an impact will currently planned funding have? Improved allocation scenario: What can be achieved with currently planned resources but programmed in a more cost-effective manner? Full cost scenario: What is the full cost of achieving the reduction of prevalence required by the strategic plan?

19 Comparison of Resource Needs and Resource Availability US$ Millions Source: Namibian \Ministry of Health, 2005.

20 Round 5 Global Fund Proposals Countries Years 1-2 Years 1-5 Immediately Approved 26 $382 millions $977 millions

21 Round 5 Global Fund Proposals Countries Years 1-2 Years 1-5 Immediately Approved 26 $382 millions $977 millions Provisionally Approved 37 $344 millions $797 millions

22 Round 5 Global Fund Proposals Countries Years 1 and 2 Years 1-5 Immediately approved 26 $382 milliones $977 milliones Provisionally approved 37 $344 millions $797 millions Zambia 1 $481 milliones $1,033 milliones

23 Conclusion Goals is useful for a country needs more than costs; it needs a measure of impact. Goals can improve the resource allocation process by reviewing the effectiveness of interventions. Goals requires significant amounts of data and time.