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Rethink HIV: Strengthening Health Systems Assessment, McGreevey et al

Assessment Paper

RethinkHIV seeks answers to the question: “How can additional spending, US$ 2 billion per annum over five years, a total of US$10 billion, best be spent across a range of treatment, prevention, research, etc, measures in sub-Saharan Africa (SSA) to respond to HIV/AIDS?” Among the prospective options is an effective bridging between actions focused specifically on HIV/AIDS, and actions that aim to strengthen health systems. The strengthening health systems component considers below these possible solutions:   

  • Universal testing, informing, and counselling can be achieved with a voucher of US$5 paid to each of the 400 million adults who accept to learn their HIV status. The cost is substantial at US$2 billion, but benefits of knowledge could cut new infections by a quarter million annually, and the b/c ratio would range between a low of 2.5 and a high of 15; 
  • Deployment of community health workers to the rural population at a cost of US$2.64 billion could cut maternal deaths by 0.3 million annually and child deaths by mill ions more, with b/c ratios ranging from about 1.1 to 9.5;
  • Reducing the opportunistic infection of cryptococcal meningitis (CM) at a cost of US$1.5 billion can yield a ratio of benefits to costs between 2.7 and 20; and,
  • An Abuja Goals Fund (AGF) can offer a cash on delivery (COD) incentive for meeting agreed goals of spending 15 percent or more of public revenues on public health, yielding a ratio of benefits to cost between 1.1 and 8.

The analysis of these solutions applies cost-benefit analysis (CBA) to provide guidance for resource allocation at the margin between these and other potential solutions to health deficiencies in SSA. Each of the solutions reviewed offers positive returns of benefits compared to the incremental costs that would be incurred to implement them. The analysis considers scenarios in which the value of a year of life is set at US$1,000 or US$5,000 to include the range of income levels in SSA. The net present value (NPV) of future years of life is assessed using both a three percent and a five percent discount rate. Once these values for a life-year are adjusted to yield net present value of all the years of life that can be saved by a solution, we calculate the ratio of these two measures of benefits to the costs identified.  

By William McGreevey, Associate Professor, Department of International Health at Georgetown University, with Carlos Avila and Mary Punchak, Georgetown University.

The working paper used by the Expert Panel is available for download here, the finalized paper has been published in the Rethink HIV book by Cambridge University Press.