Download Getting more value for money

Getting more value for money:
working with countries and partners toward greater
effectiveness and efficiency
Peter Stegman, Senior Economist
Overview of project (HIV activities)
Areas of work
What we do
Key questions
What is the cost/person
reached?
HTC
Male Circumcision
MARPs
General Population
Gender-Based Violence
Medicated assisted therapy
PMTCT
Treatment (Adult and pediatric)
HIV in the workplace
Treatment as prevention
Develop costing tools
and collect costing data
Build models to project
costs and impacts of
interventions
Conduct analysis, cost
comparisons, and costeffectiveness studies
Generate scenarios
based on data analysis
and projections
How do unit costs differ across
service delivery models?
What are the resources required
to achieve goals?
What is the impact of
intervention X? (on infections
averted, # treated, HIV
prevalence, costs averted, etc.)
How can resources be
reallocated to achieve goals
more efficiently?
What is the cost of a more
sustainable approach? (emerg.
vs. expanded response)
How can countries ensure
sustainability of financing?
Capacity building (to develop costing tools, conduct analysis, and use info for decision-making)
Knowledge management: Share and disseminate information and best practices, generate tools for
replicating work, encourage collaboration
Costing TO: Contribution to E2 work
• Generate evidence to promote a more efficient,
effective, sustainable response to the HIV epidemic
• Encourage country ownership by generating
country-specific data to facilitate strategic planning and
by training and supporting counterparts to produce and
use data
• Bridge learning by generating and sharing
evidence about efficiency, effectiveness, and
sustainability of HIV/AIDS interventions
Costing TO: 3 examples of our work
1. Which service delivery model of voluntary male
medical circumcision (VMMC) can rapidly expand
coverage of VMMC services with the lowest unit cost
and the highest savings per infection averted?
2. How can HTC be delivered in order to ensure that
early treatment is available to the largest number of
infected individuals?
3. How can low and middle income countries transition
away from donor funding of HIV and AIDS programs
without diminishing quality, coverage, and
sustainability?
1. MC in Tanzania, 2009-11
Objectives:
• Determine unit costs and impact of scaling up VMMC on HIV
prevalence and incidence
• Estimate the costs of scaling up VMMC nationally
• Identify service delivery models that most efficiently provide VMMC
Approach:
• Used Decision-Makers’ Program Planning Tool (DMPPT)
• Three regions: Iringa, Mbeya, Kagera
• Assessed demographic, behavioral & epidemiological data; salaries;
consumables & equipment prices; training & management costs
• Target coverage of 80% in selected provinces
Results:
• Delivering MC services via targeted campaigns could prove to be
more efficient than routine services offered through health care
centers
2. HIV Testing and Counseling
• While unit costs for HTC are known, there is uncertainty among
policymakers about the most appropriate and effective service
delivery model and the optimal allocation of HTC resources.
• Recent costing studies suggest that hospital based HTC is more
cost effective at identification of HIV+ individuals but door-to-door
models are more cost effective for early detection.
• Botswana has multiple service delivery modes for HTC within the
contexts of facility based delivery, community delivery and mobile
services. HPI Costing TO is trying to assess the cost of HTC per
infected person eligible for early treatment
• Botswana is a test case to learn from and develop a set of tools
and methodology to apply in different country contexts (e.g. both
concentrated and generalized epidemics)
3. Transitional Financing
• HIV and AIDS programs are among the GoB’s most expensive
and successful social protection investment
• GoB finances the majority of the HIV program and donor funding
as a share of all resources is expected to decline in the near
future
• Government of Botswana needs to explore approaches to
increasing fiscal space for HIV (and health overall), despite
shrinking revenues from sources such as diamonds
• The ART, OVC and PMTCT programs are the three most
expensive programs in the national response to HIV and AIDS:
are there opportunities to increase program efficiency?
• Transitional financing analysis in Botswana can identify
approaches to increasing sustainability of funding
Contributions of Costing Task Order
• Promote efficiency by:
– Modeling impact of changes in HIV treatment regimens/ service
delivery
– Increasing availability of data to inform program and policy decisionmaking
• Increase sustainability of resources by:
– supporting countries in estimating their resource needs and
generating resources in order to achieve the stated targets
– identifying ways to increase program efficiency and promote
domestic resource generation
• Support resource allocation decision-making by:
– Providing decisionmakers with country-specific data to facilitate
strategic planning
– Developing new intervention-specific costing and modeling tools (MC,
early treatment as prevention, MARPs, GBV, MAT, combination
prevention)
Contributions of Costing Task Order
• Build country ownership and capacity by:
– Increasing cadre of individuals who can provide support/ conduct
analyses
– Increasing ability of counterparts to use information for decisionmaking
• Encourage information sharing by:
– Developing and disseminating costing tools and protocols and
capacity building approaches that are replicable and contribute to
best practices
– Disseminating cost information through a number of sources,
including the unit cost database and the International AIDS and
Economics Network (IAEN).
Conclusion
The HPI Costing Task Order supports countries and
partners by enhancing existing capacity and providing
tools and analysis aimed at promoting greater resource
allocation and technical efficiencies and feeding lessons
learned and best practices back into global concerns
around HIV and AIDS program sustainability.
For more information on the HPI Costing Task Order
please visit our website
http://www.healthpolicyinitiative.com/costing