Costs of Scaling HIV Programme Activities to a National Level in Sub-Saharan Africa: Methods and Estimates

HOME       WHAT'S NEW     SITE MAP     DISCUSSION LIST     CONTACTS      LINKS  

African Development Forum 2000           AIDS: The Greatest Leadership Challenge

  About ADF 2000

  Partners

  ADF '99

Home >  Documents > Costs of Scaling HIV Programme Activities to a National Level in Sub-Saharan Africa: Methods and Estimates

PREVIOUS PAGE < CONTENTS > NEXT PAGE

IV. SCALING-UP THE COVERAGE OF POTENTIAL TARGET GROUPS

The approach used in the model is to cost HIV/AIDS interventions using country-specific estimates of the potential target groups (PTG) that are to be reached by prevention and care activities. For each intervention considered, a relevant target group is defined using epidemiological, behavioral and intervention-specific data. The concept of a PTG is used to ensure that the scaling-up of interventions is based upon what may be potentially feasible levels of implementation, given current levels of infrastructure and capacity development. Combined with information on project average or unit costs, this approach makes it possible to estimate the costs of scaling-up associated with different levels of coverage.

A. Definition of potential target groups

The definition of the PTG for various HIV/AIDS interventions is shown in table 4.1. A more detailed discussion of the PTG approach is presented in annex 1. The RDM allowed for urban and rural differences in the size of the PTG for each country. The interaction between the PTG, the coverage levels and the delivery mode of the intervention will yield the volume of activities that require to be costed when scaling-up. Details of the coverage levels and calculation of the volume of activities are given in sections B and C.

Table 4.1: Potential Target Groups (PTG) for HIV/AIDS Intervention Activities

Figure 4.2 Interaction between the PTG, Coverage and Activities Required to be Costed -
The Example of MTCT

Figure 4.2 provides an example of how the model defines the PTG and how intervention-specific measures of delivering the intervention and capacity limits will affect the size of the PTG in the case of mother-to-child Transmission (MTCT). Since MTCT interventions are primarily provided by secondary and tertiary level health facilities, scaling-up MTCT prevention activities refers to increasing the coverage among pregnant women attending antenatal facilities. There are two interventions related to MTCT that are being costed: screening among the antenatal population that attends antenatal services, and the delivery of antiretroviral/feeding intervention.

In this example, the size of the two PTG reflects capacity constraints, which determine the proportion of women having access to and attending antenatal services. What determines the coverage levels is the proportion of the women being tested for HIV (and thus knowing their HIV status), and the proportion of women who agree to take the ARV regimen of drugs. The volume of activities to be costed and the corresponding cost estimates relate to the specific coverage targets.

B.Coverage of target groups: Baseline and target levels

A key constraint that affects the feasible increase in coverage is the level of health infrastructure. Once a certain coverage level of target groups is achieved, further increases in coverage cannot be attained without additional investments in health infrastructure. In the model used for estimating the costs of scaling-up, it was assumed that the increase in coverage would proceed up to the point where no additional investment could be used without additional investments in capacity development and infrastructure. As this clearly varies by country, the feasible increase in coverage was estimated country by country.

Another important constraint is that the feasible increase in coverage depends on the initial situation of each country. In principle, one would expect that the coverage of target groups by 2005 would be higher in countries where there are already strong HIV/AIDS programmes than in countries where existing programmes are weak or fragmented. To take this into account, countries were classified by the strength of their existing HIV/AIDS activities in three categories (very low, low, medium or strong existing programme strength). Strong programme countries included Uganda and Senegal, countries that have successfully abated the HIV epidemic. Very low strength programme countries included a number of countries that are currently in conflict (such as Liberia and Eritrea), or where conflict has only recently abated (such as Somalia). The classification is shown in table 4.2.

Table 4.2 : Estimated Strength of HIV/AIDS Programme Activities by Country

Note: Due to a lack of data, estimates were not made for countries in italics.

The potential coverage of current HIV/AIDS interventions that was thought to be feasibly achieved by the year 2005 was projected for each of the HIV/AIDs strategies. Due to the paucity of information regarding current levels of coverage of care activities, baseline coverage estimates for care strategies were not made. Instead, the potential increases in coverage for care that could be achieved between 2000 and 2005 were estimated taking into account the ability of the current health system to absorb a higher level of activity.

Table 4.3: Estimates of Baseline and Target Levels of Coverage for the Year 2005 for HIV/AIDS Interventions by Programme Strength

In all cases, it should be recognized that these coverage estimates are very approximate. In each case, the increase in coverage from the baseline to 2005 is based on what was felt to be realistically achievable in a five-year time-period, given the capacity constraints. Given the low levels of coverage among the PTGs, these figures highlight that there are large sections of the population that could potentially be reached with existing infrastructure within country.

Table 4.4: Increase in Coverage for Basic HIV/AIDs Care by 2005 (in percentage points)

C. Calculation of the volume of Scaled-up Activities needed to achieve 2005 coverage targets

The PTG for each intervention were calculated taking into account the nature of the target group and the capacity constraints. This information was combined with the baseline and target coverage figures to obtain the volume of scaled-up activities that are required in order to achieve the 2005 coverage targets. These figures were then multiplied by the average costs (presented in chapter 5) to determine the total costs of scaling-up. Figure 4.2 presents a graphical illustration of how the volume of activities for the in-school and out-of-school youth interventions are calculated. For youth-focused activities, demographic inputs are used to calculate the number of males and females in each age group (6-11 and 12-16). Calculations are done on an urban and rural basis (although only the urban calculations are shown in figure 4.2). Having calculated the number of males and females in each age-group, country-specific primary and secondary school enrolment rates are used to calculate the number of males and females who are in and out of school.

In this particular example, the potential target group for the youth in school is the number of males and females who are enroled in primary and secondary school. It is obtained from the enrolment rates. The interventions to reach this target group are based on teacher training for the in-school youth and peer-education activities for out-of- school youth. The number of teachers to be trained is determined from the pupil-teacher ratio and the desired coverage of the potential target group. The example shows that 2,492 urban primary and 496 urban secondary school teachers will have to be trained in order to reach a 50% coverage of the PTG.

A full list of the parameters and data sources used to model the PTG are found at the end of annex 1.

Figure 4.3 Calculation of PTG for Youth-Focused Interventions (Hypothetical Country)

 [Go to Top]

PREVIOUS PAGE < CONTENTS > NEXT PAGE

3-7 December 2000, Addis Ababa, Ethiopia

Copyright  © 2000 Economic Commission for Africa (ECA)
For questions regarding this web site contact the webmaster
Last updated: January 05, 2001 14:40.