The authors use mathematical models to predict the potential impact that low to moderate usage rates of antiretroviral (ARV) therapy might have in developing countries. They also review the current state of HIV/AIDS treatment programs in resource-poor settings and identify the essential elements of a successful treatment project, noting that one key element is integration with a strong prevention program. They apply program experience from Haiti and Brazil and the insights gleaned from their modelling to address the emerging debate regarding the increased availability of ARVs in developing countries.
Resource allocation and health financing
Predicting the Impact of Antiretrovirals in Resource-Poor Settings
Producing national health accounts: A guide for low income countries
National health accounts are designed to answer precise questions about a country's health system. They provide a systematic compilation and display of health expenditure. They can trace how much is being spent, where it is being spent, what it is being spent on and for whom, how that has changed over time, and how that compares to spending in countries facing similar conditions. They are an essential part of assessing the success of a health system and of identifying opportunities for improvement. This Guide to producing national health accounts from the World Health Organisation, with special applications for low-income and middle- income countries, provides practical help in developing this socio-economic information.
Financing HIV/AIDS in Botswana, Lesotho, Mozambique, South Africa, Swaziland and Zimbabwe
The gravity of the HIV/AIDS situation in Botswana, Lesotho, Mozambique, South Africa, Swaziland and Zimbabwe calls for prioritisation, protection and targeting of HIV/AIDS spending, says a comparative study by the Human Sciences Research Council (HSRC), South Africa that assesses the readiness and ability of six African countries to respond to the HIV/AIDS epidemic. The study says revenue neutral efforts have not been very successful and that it will be important for all these countries to share lessons and experiences before and after they embark on the Global Fund process. Furthermore, the ability to absorb the vastly increased resources will be a critical determinant of whether these resources are translated into increased outputs and ultimately increased outcomes.
Generalized cost-effectiveness analysis for national-level priority-setting
Cost Effectiveness and Resource Allocation 2003, 1:8 (19 Dec 2003)
Cost-effectiveness analysis (CEA) is potentially an important aid to public health decision-making but, with some notable exceptions, its use and impact at the level of individual countries is limited. A number of potential reasons may account for this, among them technical shortcomings associated with the generation of current economic evidence, political expediency, social preferences and systemic barriers to implementation. However, health policy-makers and programme managers can use results as a valuable input into the planning and prioritization of services at national level, as well as a starting point for additional analyses of the trade-off between the efficiency of interventions in producing health and their impact on other key outcomes such as reducing inequalities and improving the health of the poor.
PUBLIC HEALTH APPROACHES TO EXPAND ANTIRETROVIRAL TREATMENT
The objective of this paper is to review experiences of ARV programmes already under way in countries with very big HIV epidemics but severely constrained resources, as in most of Africa and part of the Caribbean. Its aim is to show how some of the key policy issues for scaling up HIV/AIDS treatment have been dealt with and to identify common elements that should be considered by all who seek to provide HIV/AIDS care on a significant scale. The paper demonstrates that ARV programmes now under way in developing countries have successfully capitalised on existing resources and infrastructure through the use of standardised treatment regimens, simplified monitoring procedures and making use of available human resources, including communities and family members.
Decentralization in Zambia: Resource Allocation and District Performance
This article examines quality of services following decentralization to districts in Zambia, and an analysis of data assessing allocation choices, as well as some indicators of the performance of the health systems under decentralization. Decentralization allowed the districts to make decisions on internal allocation of resources and on user fee levels and expenditures. Findings suggest that decentralization may not have had either a positive or negative impact on services.
Integrating community priorities in health planning, resource allocation and service delivery
The aim of this report commissioned by the Southern African Regional Network on Equity in Health (EQUINET) was to review the evidence for community participation in health, in terms of community contribution to health planning, resource allocation, and service delivery. In terms of resource allocation, it has been observed that communities in Africa and other developing countries have mostly been mobilised to participate in cost recovery programs such as payment of user fees or community-based health care prepayment schemes, as stipulated under the Bamako Initiative of 1988 and as supported by the World Bank through its World Development Report of 1993 'Investing In Health'. Public participation in resource allocation has also been interpreted in terms of people's contributions of efforts such as labour or money to construct or renovate health facilities or other services such as water projects and schools, with substantial assistance from their governments or external donors.
The Costs of Anti-Retroviral Treatment in Zambia
This report analyses the costs and resource requirements associated with the provision of antiretroviral (ARV) therapy in the public health sector in Zambia. It provides per-patient cost estimates for highly active anti-retroviral therapy, voluntary counselling and testing, several opportunistic infections, and prevention of mother-to-child transmission services. These per-patient cost estimates are used to project total program costs, which are then compared to currently budgeted resources with an emphasis on financial sustainability.
DEMYSTIFYING ANTIRETROVIRAL THERAPY IN RESOURCE- POOR SETTINGS
This paper produced by the Access to Essential Medicines Campaign uses the example of a poor township 30 kilometres outside Cape Town to find out if antiretroviral therapy is possible in severely resource-constrained environments and to discover the best ways to deliver these drugs. AZT first became available in Khayelitsha township's two maternity wards in early 1999, and the programme has subsequently become one of the continent's biggest. Treatment was initially limited to opportunistic infections, but in May 2001, this was broadened to include antiretroviral therapy (ART), making the project the first to use antiretrovirals in government health facilities outside the context of clinical trials.
THE COSTS OF ANTI-RETROVIRAL TREATMENT IN ZAMBIA
This report from Partners for Health Reformplus analyses the costs and resource requirements associated with the provision of antiretroviral (ARV) therapy in the public health sector in Zambia. It provides per-patient cost estimates for highly active anti-retroviral therapy (HAART), voluntary counselling and testing, several opportunistic infections, and prevention of mother-to-child transmission services. These per-patient cost estimates are used to project total program costs, which are then compared to currently budgeted resources with an emphasis on financial sustainability.