HIV/AIDS and Education IAEN Current Issues in the Economics of HIV/AIDS by Alan Whiteside Director, Health Economics and HIV/AIDS Research Division University of Natal Thanks to USAID UNAIDS DFID Peter Badcock-Walters Tom Cobbley 1
Outline of Presentation The scale of the epidemic Describe the dynamics Demographics A case study HIV prevalence in adults in sub-saharan Africa, end 2 2 2 39% 1 2% 5 1% 1 5% 1% No data unavailable outside region Source: UNAIDS, 22. 2
Number of people living with HIV/AIDS in sub-saharan Africa, 198-2 Millions 3 25 2 15 1 5 198 1983 1986 1989 1992 1995 1998 2 Source: UNAIDS, 22 National trends in HIV prevalence % HIV positive 45 4 35 3 25 2 15 Botswana Swaziland South Africa Namibia 1 5 199 1991 1992 1993 1994 1995 1996 1997 1998 1999 2 3
Outline of Presentation The scale of the epidemic Describe the dynamics Demographics A case study Epidemic Curves, HIV Numbers HIV prevalence A A 1 A 2 B T 1 T 2 Time 27Aug - Report I: Epidem gy & Lit. p. 27 4
Epidemic Curves, HIV and AIDS Numbers HIV prevalence A A 1 A 2 AIDS - cumulative B B 1 T 1 T 2 Time 27Aug -Report I: Epidem gy & Lit. p. 27 Epidemic Curves, HIV, AIDS & Impact Numbers HIV prevalence A A 1 A 2 AIDS- cumulative Impact B B 1 T 1 T 2 Time 27Aug -Report I: Epidem gy & Lit. p. 27 5
Numbers infected, sick and dead, ASSA2 Total population Millions 6 5 4 3 2 1 1985 1987 1989 1991 1993 1995 1997 1999 2 23 25 27 29 9 8 7 6 5 4 3 2 1 Millions Numbers HIV, AIDS sick and HIV deaths Total population Total HIV Total number AIDS sick Cumulative HIV deaths A model of future AIDS and non-aids Deaths number of deaths 12 1 8 6 4 2 Other deaths AIDS Deaths 1995 2 25 2 25 year 6
All orphans and orphans due to AIDS by HIV prevalence, Uganda, by year Total Number 2 million 1.5 million 1 million HIV Prevalence 12% 6% Total Orphans AIDS Orphans HIV Prevalence.5 million 1985 199 1995 2 25 2 Year Outline of Presentation The scale of the epidemic Describe the dynamics Demographics What we know What we are doing - the MTT 7
Estimated increase in adult death rates relative to the 1985 rates Women NYHQ HIV/AIDS Unit 1-May-3 3.5 3. Ratio 2.5 2. 1.5 1. 1994 1996 1997/8 1998/99 1999/2.5. 15-19 2-24 25-29 3-34 35-39 4-44 45-49 5-54 55-59 6-64 Age Declining life expectancy Changes in life expectancy in selected African countries with high and low HIV prevalence: 195-25 Source: UNAIDS, 22. Report on the global HIV/AIDS epidemic 8
Projected population structure with and without the AIDS epidemic, Botswana, 22 Age in years 8 75 7 65 6 55 5 45 4 35 3 25 2 15 1 5 Males Females Projected population structure in 22 Deficits due to AIDS 14 12 1 8 6 4 2 2 4 6 8 1 12 14 Population (thousands) Source: US Census Bureau, World Population Profile 2 Under Five Mortality 2 and 2 Rate per 1 live births With AIDS With AIDS With AIDS 15 15 15 1 1 1 5 Without AIDS 5 5 2 2 Without AIDS 2 2 Without AIDS 2 2 Botswana Cote d Ivoire South Africa 29 9
AIDS orphans in South Africa 2 15 1 33 5 1995 1996 1997 1998 1999 2 2 22 23 24 25 26 27 28 29 2 By 2, orphans will account for 15-25% of all children in 12 countries in SSA Central African Republic Burundi South Africa Non-AIDS AIDS Rwanda Malawi Namibia Zambia Mozambique Zimbabwe Botswana Swaziland Lesotho 5 1 15 2 25 1
Outline of Presentation The scale of the epidemic Describe the dynamics Demographics A case study HIV/AIDS Impact on Education The primary impact of HIV/AIDS is to explode the scale of existing systemic and management problems in education; Labour attrition, recruitment & training Access, enrolment & gender equity Increase orphaning & drop out rates Reduce household/school fee income Learner transition, graduation rates & quality AIDS makes dysfunctional systems worse. 11
Education MIS: The Need Need for EMIS to: providing system input, performance & output data more regularly and efficiently capturing/monitoring key indicators of HIV/ AIDS impact regularly and efficiently Their key feature should be the capacity to capture monthly time-series data. HIV/AIDS Data Requirements Labour: Establishment and temporary & permanent loss by reason, age, gender, type and school (To inform recruitment & training, loss of contact time/quality can link to payroll) Enrolment: Temporary & permanent loss by reason, age, gender, grade and school (To inform access, gender equity, orphaning & pregnancy rates) Transition & graduation rates: Ex-EMIS (To project output & tertiary supply) Orphaning: Incidence by month (trends) Fees: Loss through school exemptions Geographic variation: Analysis by school. 12
The Response A decentralised District Education Management and Monitoring Information System (DEMMIS)* has been developed to test viability of monthly data capture; The pilot system has been designed to capture key indicators of HIV/AIDS impact on a monthly basis, to guide response at the school, circuit and district levels; The System The DEMMIS system captures monthly statistics on teachers, learners, support staff and school governing bodies; Provides time-series data on enrolment, absenteeism, attrition, contact time, drop-out, pregnancy, orphaning and fees all by gender and grade; Copy to school, one to the Circuit and District; Indicators of HIV/AIDS impact can be quickly and easily derived from these; Linked to a District Managers Resource Kit with FactSheets and Management Response Checklist 13
The Pilot Pilot districts in the KwaZulu Natal Province, South Africa s worst affected, were selected on the basis of their demographic mix; Pilot initiated in 95 schools in the Dannhauser District, in February 2; This illustrative sample, over 1 months, involved 32 schools: 2 Primary, 6 Secondary, 5 Combined and 1 Pre-Primary; The Geography KwaZulu Natal is South Africa s most populous province at around 8 million; It has a school enrolment of almost 2,7 million, taught by about 75 teachers in almost 3 schools; It is also the worst affected by HIV/AIDS with an antenatal HIV prevalence rate of over 36% in 22; 14
Change in enrolment figures 133 132 131 13 129 128 127 +42 Feb- -21 Mar- Apr- -35-29 -13 May- Jun- Jul- -13 Aug- Annualized 2.6% decline -43 Sep- -33 Oct- -32 Nov- Absenteeism rates days lost as % of available time 12.% 1.% Learners Educators 8.% 6.% 4.% 2.%.% Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- 15
Loss of contact time - educators 12.% 1.% 8.% Absent Leave taken Annualized 8.4% loss of time 6.% 4.% 2.%.% Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Learners that left the system cummulatively 6 5 4 3 2 1 29 517 Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- 13 177 learners in Feb 3.9% cumulative loss 5% annualized loss 16
Cumulative Loss of Educators 2 15 16 1 5 1 Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- 371 educators in Feb 4.3% cumulative loss 5% annualized loss Normal Attrition: Teacher Attrition in KZN: A Case Study In 1999 6.79% of educators left the system according to payroll data analysis - Estimated that.69% left because of AIDS Around 6.1% could be considered normal attrition HIV/AIDS Attrition: Only the beginning: AIDS deaths are increasing sharply and will reach close to 5% a year by 2 17
Conclusions The total number of educators needed will decrease The training requirement will, however, increase as educators leave the system faster than the decline in the need. Total decline by 28 in demand 4 946 Total educators leaving by 28 64 418 Training requirement 2-28 59 472 Schools : 32 Enrolment: 13177 Annualized : 1.5% Number of learners orphaned reported month by month Month 1 Parent 2 Parent Feb 33 9 Mar 7 1 Apr 7 May 11 2 Jun 3 Jul 31 4 Aug 17 1 Sep 17 2 Oct 1 Nov 7 2 Grand Total 143 21 18
Cumulative rate of orphaning, excluding drop-outs 16 14 12 1 8 6 4 2 33 9 1 Parent 2 Parent 143 21 Jul- Feb- Mar- Apr- May- Jun- Aug- Sep- Oct- Nov- What goes around comes around part 1 19
improves What goes around comes around Autonomy of HIV in Complex Societies - A systems model of the S n Africa AIDS epidemic Above average survivors Religion provides NGO involvement Business sector involvement provides Leadership in society provides promotes Govt policies influences Mores & customs (multiple sets of these) AIDS education & awareness Promote / hamper Promote / hamper Social cohesion Spiritual & political authority affects uptake of increases Funding for health care, infrastructure, sanitation Business sector involvement AIDS testing & counselling increases Sex industry interventions increases Treating STD s Economic organisation Beliefs Circumcision create Tension of two worlds affects reduce Condom prevents Role of women Notions of masculinity create use reduces HIV Transmission Mother to child treatment I n f l u e n c e promiscuity prevent increass Microbicides challenges & influences challenges & influences retroviral treatment Selfconfidence Personal responsibility reduces Increaces? decreases? changes Life force, procreation, sex urge Drives Viral mutation Improves Immunisation Medical interventions for HIV-AIDS Individual Behaviour Healthy Education Stable & settled workers Chastity, Fidelity lifestyle HIV Epidemic (prevalence) hampers prevents Migration & mobility Housing & land weakens perceptions of risk risk taking & risk avoidance Support increaces reduces cures Anti- brings better Migrant & mobile workers Urbanisation affects Safety, crime & war affect Hazardous occupations affects extends Diet & nutrition extends Latency Period (avg8 yrs) Treating opportunistic diseases affect create reduces improve sustains Incapacity & absenteeism in private sector & civil service causes more orphans scarce educators die provides skilled people support creates vacancies reduces productivity Reduces demand AIDS related Disease & Deaths (death rate) African traditional healers Jobs Economy G i v e s r i s e t o Drain on Above average survivors: chaste & faithful, long term thinkers, tertiary educated, non-migrant families, settled LT employees, high income, cohesive & candid societies, grandparents affect Cost of hiring & retraining Weather & climate change affect Cost to individuals & households : medication, care, burial, & orphans Determines nature of sustains inhibits Population stops growing, and ages skilled workers die Who dies & who survives: (population. Demographics & particularities) Global competition & economy Shareholder expectations & values Above average mortality : unemployed, orphans, soldiers, sex workers, hazardous occupations, migrants, temps, contract workers, newly prosperous, young women, uncircumcised men, & partners of all the above affect drive Business sector involvement values, profits, patents, prices, research 2
Conclusion We are only beginning to track the effects of AIDS in education. We have not tracked the financial cost We have not tracked the development cost Human capital Manpower planning 21