More Transparency, Efficiency Needed to Improve Impact of HIV Funding in Developing Countries

With the need for HIV services in developing countries rising and the availability of funding flat or declining, existing resources should be better leveraged to help provide life-saving services to more people in need, according to a new RAND Corporation study.

The report examines options for improving the impact of HIV funding and could provide insights for policymakers engaged in the Obama Administration's recently announced efforts to scale up treatment to 6 million people worldwide. The authors focused on funding for antiretroviral therapy (ART) by the world's two largest funders: the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF).

"The number of HIV/AIDS cases is going up, but donor funding isn't keeping pace," said Sebastian Linnemayr, the study's lead author and an associate economist at RAND, a nonprofit research organization. "That means we'll have to do a better job with existing resources — by being both more transparent and more efficient in the way donor funds are spent."

Using publicly available information, RAND researchers tracked how PEPFAR and GF allocated resources to the delivery of services in recipient countries. The authors found that 30% of PEPFAR's $4.7 billion budget in 2010, for example, went to indirect services such as health system strengthening, administration and overhead — more than was allocated for treatment (28%). The remainder went toward other direct services such as prevention, testing and counseling (24%), care and support (11%), and orphans and vulnerable children (7%).

While such a spending mix is to a degree intentional, PEPFAR and GF should more clearly state the trade-off between providing current and future services, with funding decisions justified accordingly, researchers said. Investment in health system strengthening, for example, may provide a payoff in terms of future cost reductions, but it reduces the money available immediately to provide services to people living with HIV.

The researchers could not evaluate with certainty how efficiently PEPFAR and GF provide services because expenditure data was not readily available or sufficiently detailed. The authors struggled, for example, to measure direct services provided, such as the number of people on anti-retroviral therapy. They recommended that such data be made available in a transparent fashion on a yearly basis and in a usable format.

"Only then can steps be taken to compare efficiency between funders and over time," said Gery Ryan, an author of the study and a senior behavioral scientist at RAND. "That is the key to making sure resources are used in a way that maximizes the number of people receiving these life-saving services."

The report, "Value for Money in Donor HIV Funding," is available at www.rand.org. Funding for the project was provided by the AIDS Healthcare Foundation. Other authors of the report are Jenny Liu and Kartika Palar.

RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.