Post on 05-Jan-2016
Saphonn Vonthanak, MD. MSc. PhDHeng Sopheab, MD. MPH. PhD
Chhea Chhorvann, MD. MPH. PhDUng Luyna and Ros Seilava
The Long Run Costs and Financing of HIV/AIDS in Cambodia
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Acknowledgement
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The Steering CommitteeChaired by National AIDS Authority & Co-
chaired by NCHADSMembers of the steering committee are
representative from; UNAIDS, WHO, CDC-GAP, FHI, USAID, KHANA, CPN+, Ministry of Health, Ministry of Economy & Finance, Ministry of Planning, Chamber of Commerce, Council for the Development of Cambodia.
The Technical Team (Epidemiologists and Economists)
Technical support from the Results for Development Institute (Professor Richard Skolnik, Dr. Steven Forsythe, and Dr. Robert Hecht)
Process
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1.HIV/AIDS Projections for different intervention scenarios
2.The costing for each scenario3.“Fiscal Space” analysis for financing the long term costs
4.Projections of resource availability and needs
MethodsHIV/AIDS projections
Secondary epidemiologic dataGoals model
HIV/AIDS CostingSpectrum AIDS impact modelResource Needs Model
HIV/AIDS program financingSecondary data
Medium term macroeconomic dataset of MEFODA database from CDCNational AIDS spending assessment report (NASA)
Primary data (interviews)Development partners, Private sector and
Government institutions
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Scenarios for Cambodia
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Different scenarios
Prevention Program
Care and Treatment Program
Structural change
High risk groups
Low risk groups
Linked response Others
Current coverage
Structural change
Best coverage
Hard choice 1
Hard choice2
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Projected Numbers of New HIV Cases (1)
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Projected Numbers of New HIV Cases (2)
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Projected Cost of HIV/AIDS
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HIV/AIDS program financing
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Share of HIV/AIDS to Health and Social Spending of the Government
*Note that the two line has different denominator, the blue line has social spending as denominator and the red line has health spending as denominator
Total of HIV/AIDS Expense in Cambodia
Projections of Resource Availability and Needs
Assumptions in the base case scenarioGDP will grow at 7% per annumPublic expenditure as a percentage of GDP
will be 15%Social spending is 30% of public
expendituresHIV/AIDS spending will be 1.5% of social
spending through 2031Donor funding would gradually decline from
90% of all HIV/AIDS funds to 50% by 2020
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Resources Needs for HIV/AIDS under Hard Choice 2 Compared to Projected Resources
under the Baseline Financing Scenario (US$million)
Resource Needs for Hard Choice 2 Compared to Projected Resources Available
under the Pessimistic Financing Scenario (US$ million)
16Pessimistic Financing Scenario: Donor funding would decline from 90% of all HIV/AIDS funds to 50% by 2015
Resource needs for Hard Choice 2 Compared to Projected Resources Available
under the Optimistic Financing Scenario (US$ million)
17Optimistic Financing Scenario: Donor funding would decline slowly from 90% of all HIV/AIDS funds to 50% by 2025
Resource Needs for Hard Choice 2 Compared to Projected Resources Available under the Baseline
Financing Scenario of External funding and Gradual Increase of Government Spending on HIV/AIDS as a
% of Spending from 1.5% to 2.5% by 2019
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ConclusionThe current HIV/AIDS programs in Cambodia
in Cambodia is likely to lead to further declines in HIV prevalence and incidence over the next two decades.
HIV/AIDS resource requirements will continue to increase over the next two decades.
Difference in price tags is substantial and Cambodia will need to focus on getting the best value for money form its HIV/AIDS program, by focusing HIV/AIDS investments on those areas that are most cost-effective.
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ConclusionThe Cambodian HIV/AIDS program is very
dependent on external financing. Over the longer term, Cambodia should be able to meet the costs of its HIV/AIDS program through increasing fiscal space for HIV/AIDS that will come with economic growth.
However, if development partners withdraw financing from the HIV/AIDS program too quickly, Cambodia could face substantial difficulty in making up the deficit in the short-term.
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Implications• Cambodia will have to focus investments on
HIV/AIDS in those areas that are most cost-effective
• Despite important successes against HIV/AIDS in Cambodia, there remains room for improving program efficiency.
• Cambodia will need to better manage the flow of external resources to its HIV/AIDS program; it will also need to significantly increase its own allocation to HIV/AIDS
• Cambodia continue to periodically assess the cost-effectiveness of different possible interventions in HIV/AIDS program, so that it can better set priorities and mobilize resources accordingly.
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