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Costing model of a national AIDS program: application to Rwanda
Presented by Angelique Kanyange Rwiyereka, United States.
A.K. Rwiyereka1, D.S. Shepard1, J. Humuza2, W. Zeng1, C. Avila-Figueroa3
1Brandeis University, Heller School/ Health Policy and Management, Waltham, MA, United States, 2Joint Learning Initiative on Children and HIV/AIDS, Kigali, Rwanda, 3UNAIDS, Geneva, Switzerland
Background: As low and middle income countries develop plans for universal access to HIV/AIDS services, better methods are needed to estimate resource requirements. Existing financial projection models, developed for international application, cannot represent the organization of services, unit costs, and service needs within a specific country. We developed a country-specific framework and adapted it to Rwanda to project resource needs under alternative scenarios for 2010.
Methods: We identified major components of an AIDS program, with unit costs and quantities for each service. We developed two scenarios: a "maximal model” with 100 percent coverage of all services and a “limited model” where service levels would just meet the UNGASS goal by 2010. Models included innovative strategies such as male circumcision and initiatives to address gender based violence. Exact data on coverage was supplemented, as needed, with information from comparable components in other African countries (i.e., Uganda, Kenya, Tanzania Botswana and Ghana) and expert opinion.
Results: With a population of 9 million people and an HIV prevalence of 3%, Rwanda’s services under the maximal model would cost US $1.08 billion per year, or approximately $120 per person. Under the limited model, services would cost $199 million or $22 per capita, or 78% lower than the maximal model. The biggest difference between this national model and UNAIDS financing estimates lies in the national model’s more comprehensive estimation of service needs for orphans, vulnerable children, and social services for persons living with HIV-AIDS. Those component services represented 37% of the costs in our national model, compared to only 9% in the limited model. Costs under the limited model are about twice funds budgeted in Rwanda’s strategic plan of Rwanda for 2005.
Conclusions: Existing financing models may understate support costs. Achieving coverage equivalent to the UNGASS goals would require increases in efficiency and available resources that, together, total 100%.