Special Feature: How Can We Get More Value From HIV Funding in the Developing World?

HIV testing

Photo by UK Dept. for International

The RAND study examined options for improving value for money in HIV funding by looking at the largest funder, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and using funding for antiretroviral therapy (ART) as the leading example of direct treatment. An analysis of available funds and the services they buy shows opportunities to meet the increasing needs with existing funding.

Why is efficiency important in HIV/AIDS relief funding?

HIV cases continue to rise, while funding has plateauedClick to Enlarge

The number of people with HIV is increasing, yet funding peaked in 2008. Increasing funding seems unlikely, and reducing the level of care available to those in need is an absolute last resort. Making treatment services more efficient is the only way to meet the world's needs in the current funding climate.

How much funding for HIV/AIDS relief is used for direct services?

Currently, about 30% of PEPFAR's funds do not go to direct services, and actual treatment is less than a thirdClick to Enlarge

Direct services, such as treatment, prevention, and education, accounted for only 70% of PEPFAR's funding in 2010. However, treatment accounts for only 28% of total spending, while prevention and other efforts get 42% of available funds. Also, data do not include information on overhead used by medical providers, so funds used for treatment might be less.

How are funds spent that do not directly pay for treatment?

Indirect and overhead funds are used in each step of providing aidClick to Enlarge

At PEPFAR, overhead funding is used at each level between headquarters and the field where care is provided. Some of these funds cover administration, technical assistance, general costs of doing business in the countries, and efforts to strengthen the local health systems. How crucial each of tasks are to providing care is unclear from the current information available.

How big a difference would efficiency make in providing care?

Two hypothetical scenarios showing the power of efficiency improvementClick to Enlarge

Effects could be dramatic. A 25% reduction of indirect services would fund the care of 400,000 additional patients. Reducing costs of delivering services could also increase the treatment capabilities – for instance, reducing the cost of providing ART to $460 USD (a reduction of less than 25%) could provide treatment for 600K more people.

How can care provided by PEPFAR and other non-governmental organizations (NGOs) be improved?

NGOs need to focus on efficiency, from the contractors who directly provide care, to the countries that build the health infrastructure and oversee local efforts, to the internal processes of the organizations themselves. More information is needed to link costs to outcomes, and more information needs to be made public about indirect services to determine which specific aspects can be improved.

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