Publication:
A Case Study on How Allocative Efficiency Analysis Supported by Mathematical Modelling Changed HIV Investment in Sudan

Loading...
Thumbnail Image
Files in English
English PDF (939.83 KB)
505 downloads
English Text (42.15 KB)
38 downloads
Date
2015-11
ISSN
Published
2015-11
Author(s)
Editor(s)
Abstract
This brief presents a real-life example of how a group of government decision-makers, programme managers, researchers and development partners worked together to improve the allocation of HIV resources in Sudan and thereby better address the HIV objectives that the country strives to achieve. The initial modelling analysis showed that by reallocating funds towards antiretroviral treatment (ART) and prevention programmes in Sudan, 37 percent of new HIV infections could be averted with the same amount of funding. These allocations combined with additional technical efficiency gains would allow for increasing ART coverage from 6 percent in 2013 to 34 percent in 2017, and more than double programme coverage for key populations. The reallocations in the 2015 to 2017 HIV budget for the national response are projected to avert an additional 3,200 new infections and 1,100 deaths in these three years compared to initially planned allocations.The reallocations were achieved through a rigorous HIV allocative efficiency analysis and evidence-informed policy process, conducted by a multi-disciplinary team of national and international partners working for the common goal to make Sudan’s HIV response more manageable and sustainable. The case study discusses process and outcomes of this effort. It also offers some reflections on the application of mathematical modelling to strengthening decision-making of finite HIV resources, and some lessons learned about how to go ‘beyond modelling’ to application of modelled allocative efficiency improvements to improving actual budget allocations for better health outcomes.
Link to Data Set
Citation
World Bank. 2015. A Case Study on How Allocative Efficiency Analysis Supported by Mathematical Modelling Changed HIV Investment in Sudan. From Analysis to Action;. © World Bank. http://hdl.handle.net/10986/24989 License: CC BY 3.0 IGO.
Associated URLs
Associated content
Report Series
Other publications in this report series
Journal
Journal Volume
Journal Issue

Related items

Showing items related by metadata.

  • Publication
    Kazakhstan Can Achieve Ambitious HIV Targets Despite Expected Donor Withdrawal by Combining Improved ART Procurement Mechanisms with Allocative and Implementation Efficiencies
    (PLoS, 2017-02-16) Shattock, Andrew J.; Benedikt, Clemens; Bokazhanova, Aliya; Duric, Predrag; Petrenko, Irina; Ganina, Lolita; Kelly, Sherrie L.; Stuart, Robyn M.; Kerr, Cliff C.; Vinichenko, Tatiana; Zhang, Shufang; Hamelmann, Christoph; Manova, Manoela; Masaki, Emiko; Wilson, David P.; Gray, Richard T.
    Despite a non-decreasing HIV epidemic, international donors are soon expected to withdraw funding from Kazakhstan. Here we analyze how allocative, implementation, and technical efficiencies could strengthen the national HIV response under assumptions of future budget levels. We used the Optima model to project future scenarios of the HIV epidemic in Kazakhstan that varied in future antiretroviral treatment unit costs and management expenditure—two areas identified for potential cost-reductions.
  • Publication
    Optimizing Investments in the National HIV Response of Mexico
    (World Bank, Washington, DC, 2018-03) Gutierrez, Catalina; Lavadenz, Fernando; Macias, Claudia; Petravic, Janka; Lavadenz, Luis
    Despite a substantial improvement in controlling new infections of HIV over the last ten years, Mexico is experiencing a low-level epidemic with approximately 180,000 people living with HIV (Spectrum, 2013), making it the fourth ranking country in Latin America with regards to the number of people with the disease (PLHIV). The objective of increasing coverage and reducing inequality in the country is reflected in the objectives of the Specific Action Program (PAE) for the national response to HIV, AIDS and STI of 2013-2018 (Secretaria de salud), which seeks to decrease the effect of HIV and STIs, implement prevention strategies and provide comprehensive care for vulnerable population groups and those living in poverty. The possibility of achieving the objectives of the PAE is closely related to the total amount of resources that Mexico can commit to fighting HIV and the way these resources are allocated. In the hopes of assisting the Government of Mexico in further strengthening its HIV investment, the authors try to answer the question How can HIV funding be optimally allocated to the combination of HIV response interventions that will yield the highest impact in the shortest period. The study found that despite the overall greater costs of treatment with ART, this is the most cost-effective program. ART not only reduces deaths but is an effective measure to prevent new infections due to the reduction of viral load to undetectable levels. As such, the most cost-effective allocation – with no additional resources of current Program funds, is to scale up treatment, by about 4 to 8 percent, to maximize ART coverage while slightly reducing overall allocations to general population prevention.This slight increase would avert 4,235 deaths and 3,371 new infections, and improve health outcomes by around 6 percent. To increase the value-for-money of existing resources, allocation efficiency would also require the strengthening of CENSIDA´s stewardship role, to ensure that the funds transferred are invested as they were initially earmarked.
  • Publication
    Evidence-based Implementation Efficiency Analysis of the HIV/AIDS National Response in Colombia
    (World Bank, Washington, DC, 2012-08) Moreno, Antonio; Álvarez-Rosete, Arturo; Luque Nuñez, Ricardo; del Carmen Moreno Chavez, Teresa; Rodriguez-García, Rosalía; Montenegro, Fernando; Moreno, Luis Ángel; Suarez Lissi, Alejandra; Magne Concardo, Pedro; Gaillard, Michel Eric
    This study on the implementation efficiency of the HIV/AIDS national response in Colombia seeks to examine how it has been implemented -- whether it has been done according to the available evidence about the epidemic and as the response was originally planned. The study approaches three specific dimensions of implementation efficiency: (i) programmatic; (ii) budgetary; and (iii) service delivery. The study uses a range of research techniques, including: (i) documentary analysis of key policies, official publications and reports; (ii) semi-structured interviews with representatives of the central government and territorial entities, international and community-based organizations, insurers, care providers, etc.; and (iii) case-study analysis to visualize the ways in which people are cared for in practice. The available data suggest that the HIV/AIDS response is succeeding in keeping the prevalence low and the epidemic concentrated. In recent years, the level of health coverage has increased and the quality of care services has improved. The identified problems in service delivery (mostly related to coverage and access) are linked to system fragmentation and integration, and to the nature of the coordination mechanisms, both at the national and the territorial level. The effectiveness of the response would benefit from re-energized leadership at both the national and local levels -- articulated through the existing programmatic framework and coordinating mechanisms. The complexity of the system and the lack of budgetary and expenditure information have impeded the evaluation of the budgetary efficiency of the HIV/AIDS response.
  • Publication
    Lesotho Public Investment Management Efficiency Review
    (World Bank, Washington, DC, 2012-05-24) World Bank
    Lesotho is a small landlocked country with a homogenous population of 2.1 million. Lesotho's gross domestic product (GDP) per capita was 1,023 dollars and gross national income (GNI) per capita was 1,080 dollars in 2010. The country also faces numerous challenges to its social and human development. In this context, more attention on the role and quality of public investment is warranted. To improve public accountability and transparency, the Government of Lesotho (GoL) introduced the automated integrated financial management information system (IFMIS) in April 2009. The study directly responds to an explicit request of technical assistance from the ministry of finance and development planning (MoFDP) and aims at supporting the GoL in its major reform efforts to enhance the efficiency of public investment management (PIM) and increase the "value for money" in capital spending. The overarching objective of this study is to support the GoL in its efforts to prioritize public resource allocation and enhance efficiency in capital spending, with the ultimate goal of contributing to improved governance, service delivery, and economic growth. The work is aligned with the World Bank country assistance strategy (CAS) 2010 to 2014, in particular its first pillar on fiscal adjustment and public sector efficiency. This report emphasizes the complementary aspects of the institutions, incentives, capacity, and process-related constraints to the functioning of PIM. The focus of this report will also complement ongoing public financial management (PFM) support by other development partners. The report is presented in four chapters, which are organized as follows: chapter one offers a macro-level country analysis; chapter two presents recent trends in public investments; chapter three focuses on institution mapping and the diagnostic assessment of the PIM system; and chapter four concludes with policy implications.
  • Publication
    Regulatory Study to Encourage Energy Efficiency through Investment in Rehabilitation of Coal-fired Generation Plant in India
    (Washington, DC, 2008-10) World Bank
    The Indian power sector suffers from considerable supply shortages. The Government of India (GoI) is addressing this problem both through a major new build program (including certain fiscal incentives for construction of larger and more efficient plant) and through rehabilitation (renovation and modernization or (R&M) as it is known in India) of existing coal fired plant. Around two-thirds of India's existing 65,000 MW of coal fired plant capacity is owned by State Government utilities, but much of this is reported to be in a poor condition, with low load factors and station heat rates of up to a 4,000 kcal/kWh. Current R&M activity is not keeping pace with the requirements. R&M implementation has lagged significantly behind the requirements over the 10th plan period (2002-07), and during the current 11th plan period nearly 13,000 MW of R&M is targeted. Specifically: section two sets out the context of the study; section three summarizes the constraints and barriers to energy efficient R&M in India, which are set out in further detail in annex four; section four provides a framework for the main options identified, given present state of the Indian power market and describes the key lessons from our review of international best practice, which are described in annex five; section five identifies the various options considered for this study; section six analyses the various options identified in terms of their effectiveness in addressing the barriers and constraints identified in section three; and section seven sets out our conclusions and recommendations for a regulatory framework that can more effectively support energy efficient R&M in India.

Users also downloaded

Showing related downloaded files

  • Publication
    Media and Messages for Nutrition and Health
    (World Bank, Washington, DC, 2020-06) Calleja, Ramon V., Jr.; Mbuya, Nkosinathi V.N.; Morimoto, Tomo; Thitsy, Sophavanh
    The Lao People’s Democratic Republic (Lao PDR) has experienced rapid and significant economic growth over the past decade. However, poor nutritional outcomes remain a concern. Rates of childhood undernutrition are particularly high in remote, rural, and upland areas. Media have the potential to play an important role in shaping health and nutrition–related behaviors and practices as well as in promoting sociocultural and economic development that might contribute to improved nutritional outcomes. This report presents the results of a media audit (MA) that was conducted to inform the development and production of mass media advocacy and communication strategies and materials with a focus on maternal and child health and nutrition that would reach the most people from the poorest communities in northern Lao PDR. Making more people aware of useful information, essential services and products and influencing them to use these effectively is the ultimate goal of mass media campaigns, and the MA measures the potential effectiveness of media efforts to reach this goal. The effectiveness of communication channels to deliver health and nutrition messages to target beneficiaries to ensure maximum reach and uptake can be viewed in terms of preferences, satisfaction, and trust. Overall, the four most accessed media channels for receiving information among communities in the study areas were village announcements, mobile phones, television, and out-of-home (OOH) media. Of the accessed media channels, the top three most preferred channels were village announcements (40 percent), television (26 percent), and mobile phones (19 percent). In terms of trust, village announcements were the most trusted source of information (64 percent), followed by mobile phones (14 percent) and television (11 percent). Hence of all the media channels, village announcements are the most preferred, have the most satisfied users, and are the most trusted source of information in study communities from four provinces in Lao PDR with some of the highest burden of childhood undernutrition.
  • Publication
    South Asia Development Update, April 2024: Jobs for Resilience
    (Washington, DC: World Bank, 2024-04-02) World Bank
    South Asia is expected to continue to be the fastest-growing emerging market and developing economy (EMDE) region over the next two years. This is largely thanks to robust growth in India, but growth is also expected to pick up in most other South Asian economies. However, growth in the near-term is more reliant on the public sector than elsewhere, whereas private investment, in particular, continues to be weak. Efforts to rein in elevated debt, borrowing costs, and fiscal deficits may eventually weigh on growth and limit governments' ability to respond to increasingly frequent climate shocks. Yet, the provision of public goods is among the most effective strategies for climate adaptation. This is especially the case for households and farms, which tend to rely on shifting their efforts to non-agricultural jobs. These strategies are less effective forms of climate adaptation, in part because opportunities to move out of agriculture are limited by the region’s below-average employment ratios in the non-agricultural sector and for women. Because employment growth is falling short of working-age population growth, the region fails to fully capitalize on its demographic dividend. Vibrant, competitive firms are key to unlocking the demographic dividend, robust private investment, and workers’ ability to move out of agriculture. A range of policies could spur firm growth, including improved business climates and institutions, the removal of financial sector restrictions, and greater openness to trade and capital flows.
  • Publication
    Economic Recovery
    (World Bank, Washington, DC, 2021-04-06) Malpass, David; Georgieva, Kristalina; Yellen, Janet
    World Bank Group President David Malpass spoke about the world facing major challenges, including COVID, climate change, rising poverty and inequality and growing fragility and violence in many countries. He highlighted vaccines, working closely with Gavi, WHO, and UNICEF, the World Bank has conducted over one hundred capacity assessments, many even more before vaccines were available. The World Bank Group worked to achieve a debt service suspension initiative and increased transparency in debt contracts at developing countries. The World Bank Group is finalizing a new climate change action plan, which includes a big step up in financing, building on their record climate financing over the past two years. He noted big challenges to bring all together to achieve GRID: green, resilient, and inclusive development. Janet Yellen, U.S. Secretary of the Treasury, mentioned focusing on vulnerable people during the pandemic. Kristalina Georgieva, Managing Director of the International Monetary Fund, focused on giving everyone a fair shot during a sustainable recovery. All three commented on the importance of tackling climate change.
  • Publication
    Remarks at the United Nations Biodiversity Conference
    (World Bank, Washington, DC, 2021-10-12) Malpass, David
    World Bank Group President David Malpass discussed biodiversity and climate change being closely interlinked, with terrestrial and marine ecosystems serving as critically important carbon sinks. At the same time climate change acts as a direct driver of biodiversity and ecosystem services loss. The World Bank has financed biodiversity conservation around the world, including over 116 million hectares of Marine and Coastal Protected Areas, 10 million hectares of Terrestrial Protected Areas, and over 300 protected habitats, biological buffer zones and reserves. The COVID pandemic, biodiversity loss, climate change are all reminders of how connected we are. The recovery from this pandemic is an opportunity to put in place more effective policies, institutions, and resources to address biodiversity loss.
  • Publication
    The Journey Ahead
    (Washington, DC: World Bank, 2024-10-31) Bossavie, Laurent; Garrote Sánchez, Daniel; Makovec, Mattia
    The Journey Ahead: Supporting Successful Migration in Europe and Central Asia provides an in-depth analysis of international migration in Europe and Central Asia (ECA) and the implications for policy making. By identifying challenges and opportunities associated with migration in the region, it aims to inform a more nuanced, evidencebased debate on the costs and benefits of cross-border mobility. Using data-driven insights and new analysis, the report shows that migration has been an engine of prosperity and has helped address some of ECA’s demographic and socioeconomic disparities. Yet, migration’s full economic potential remains untapped. The report identifies multiple barriers keeping migration from achieving its full potential. Crucially, it argues that policies in both origin and destination countries can help maximize the development impacts of migration and effectively manage the economic, social, and political costs. Drawing from a wide range of literature, country experiences, and novel analysis, The Journey Ahead presents actionable policy options to enhance the benefits of migration for destination and origin countries and migrants themselves. Some measures can be taken unilaterally by countries, whereas others require close bilateral or regional coordination. The recommendations are tailored to different types of migration— forced displacement as well as high-skilled and low-skilled economic migration—and from the perspectives of both sending and receiving countries. This report serves as a comprehensive resource for governments, development partners, and other stakeholders throughout Europe and Central Asia, where the richness and diversity of migration experiences provide valuable insights for policy makers in other regions of the world.