1. The AIDS Financial Crisis: Life or Death for Millions July 25, 2012 Sebastian Linnemayr, Ph.D.

2. Value for Money 2 12-15-11 Available free from RAND website:

3. Value for Money 3 12-15-11 Four Options for Meeting the Growing Demand for HIV Services Option 1: Increase funds: desirable but unlikely Option 2: Ration care: ethically indefensible Option 3: Improve efficiency by switching allocation of resources to activities with highest payoff –Between different direct services (e.g., prevention vs. treatment) –Between direct services and indirect services (e.g., treatment vs. capacity building) Option 4: Improve efficiency by reducing costs of delivering services (any type)

4. Value for Money 4 12-15-11 The approach Case studies PEPFAR and Global Fund Look at the whole full funding stream Focus in the literature largely on the local, clinic-level costs We find that…

5. Value for Money 5 12-15-11 A large fraction of funds are spent above the Service Delivery Level (PEPFAR example)

6. Value for Money 6 12-15-11 Fewer Funds Are Allocated to Treatment Than to Indirect Services and Overhead Overhead and indirect services 30% Overall Funding by PEPFAR, by Intended Use (FY 2010)

7. Value for Money 7 12-15-11 PEPFAR Recognizes the Importance of Improving Efficiency PEPFAR is evolving from an emergency response approach towards an approach in which “programs must demonstrate value and impact to be prioritized within complex and resource-constrained environments” (Padian, Holmes, McCoy, Lyerla, Bouey, and Goosby; JAIDS 2011)

8. Value for Money 8 12-15-11 Conclusion: HIV Donors Must Find Better Ways to Leverage Existing Funds There are two ways to improve efficiency: –Switch allocation of resources to activities with highest payoff –Reduce costs of delivering services System needs to be put in place to link costs to outcomes Improvement in efficiency needs to be focal point at all levels