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Resource needs of 45 countries in
achieving the targets of universal access for prioritized services by 2010
W. Zeng1, D.S. Shepard1, J. Chilingerian2, C. Avila-Figueroa3
1Brandeis University, Schneider Institutes for Health Policy, Waltham, United States, 2Brandeis University, Heller School for Social Policy and Management, Waltham, United States, 3The Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
Background: To
manage the HIV/AIDS epidemic, international donors have pledged unprecedented
commitments for needed services. UNAIDS has projected that low and middle
income countries need $25 billion to meet the 2010 HIV/AIDS goal of universal
access to AIDS prevention and care, assuming countries' existing efficiency in
delivering HIV/AIDS services remains constant. This study develops an
alternative estimate of resource needs and gaps assuming that all study countries
maximized efficiency.
Methods: We
first used data envelopment analysis (DEA) to estimate the technical efficiency
of 61 countries in delivering HIV/AIDS services from 2002 to 2007. We considered national HIV/AIDS spending as the
input and volume of voluntary counseling and testing (VCT), prevention of
mother to child transmission (PMTCT), and antiretroviral treatment (ART) as the
outputs. We then employed a Tobit model to adjust the efficiency of national
AIDS programs for key social factors (governance, financing mechanisms, income
and AIDS epidemic). Finally, we constructed an input-oriented DEA model to
project resource needs in 2010 based on the 45 countries with data in 2006.
Results: The average
efficiency in implementing HIV/AIDS programs was moderate (50%), with substantial
inter-country variation. Using data from
2006, we found that Chad, China, Cote
d'Ivoire, Paraguay,
South Africa, and Thailand
were on the production frontier (with 100% efficiency). At maximal efficiency,
their annual projected resource needs were $6.2 billion, about 46% of their
UNAIDS estimate of $13.5 billion. Given
study countries' spending of $3.9 billion, improving efficiency could narrow
the gap from $9.6 to $2.3 billion.
Conclusions: Models
that do not incorporate efficiency may overestimate the resource requirement
for HIV/AIDS. Similar output-oriented
analyses project substantial increases in coverage from improved efficiency
with existing resources. Improvements in
social factors and the operation of national health care systems might
substantially increase efficiency, thereby reducing the resource needs to
address HIV/AIDS and increasing services.
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