Publication:
Optimizing Investments in Mozambique's Tuberculosis Response: Results of a Tuberculosis Allocative Efficiency Study

Abstract
This allocative efficiency analysis intended to assess Mozambique's progress towards TB strategic targets, and provide decision support for TB strategy using a combined TB epidemiological component and an economic and program analysis framework (Optima TB). Input data were collected from NTP sources, the WHO, and various TB implementers. Our model indicates declining future trends in TB prevalence, incidence and related deaths. However, the case detection rate (52 percent) remains one of the biggest hurdles. Mozambique, however, could cut TB prevalence and TB deaths by 20 percent, and TB incidence by 11 percent by allocating resources optimally. Specifically, this would entail (i) doubling the rate of household contact tracing for notified cases, (ii) screening all PLHIV during their routine outpatient visits, and (iii) focusing on community outreach activities among key populations such as prisoners, cross-border miners and community health workers. In addition, scaling up ART coverage from 55 percent (current/ 2017) to 90 percent by 2035 is projected to reduce new TB cases among PLHIV by over 50 percent (in 2035). Furthermore, our analysis shows that higher levels of TB spending lead to more rapid reductions in TB incidence. However, the rates of reduction associated with large increases in expenditure (up to 200 percent of current spending levels) begin to slow in the medium term and it is unlikely that the national TB response can deliver on the 2025 milestones and 2035 End-TB targets.
Link to Data Set
Citation
Mozambique National TB Program; World Bank; Optima Consortium for Decision Sciences; Burnet Institute. 2020. Optimizing Investments in Mozambique's Tuberculosis Response: Results of a Tuberculosis Allocative Efficiency Study. © World Bank. http://hdl.handle.net/10986/33907 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
    Epidemic Projections and Opportunities to Accelerate Control of Tuberculosis in Mozambique
    (World Bank, Washington, DC, 2021-09-08) World Bank
    Mozambique is one of the thirty highest tuberculosis (TB) burden countries in the world with respect to total incidence. Active case finding programs in Mozambique have been expanding, and community-based efforts now account for around twenty-five percent of detected cases. This involves both contact tracing of notified cases and other community-level interventions such as active house-to-house screening and testing, mobile van outreach in TB hotspots, and screening and testing of community health workers. However, there are opportunities for further expansion. This policy brief summarizes the findings of an allocative efficiency analysis using the Optima TB model, and highlights opportunities to maximize the impact of TB spending in Mozambique.
  • Publication
    Optimizing Investment in Romania's Tuberculosis Response
    (World Bank, Washington, DC, 2019-10-21) World Bank
    This policy brief summarizes the findings of an allocative efficiency study of Romania’s Tuberculosis (TB) response, which was conducted using the Optima-TB model. The analysis was conducted to support Romania in its decision-making on strategic TB investments during the current National Strategic Plan for the Control of Tuberculosis in Romania (NSP, 2015‒20) and up to 2030. The analysis highlights the potential for Romania to maximize its impact on the TB response by reallocating spending on unnecessary hospitalization to increase the coverage of ambulatory care, treatment of drug-resistant TB and enhanced and active case finding in congregate community settings and high-risk areas.
  • Publication
    Optimizing Investments in Belarus' Tuberculosis Response
    (Washington, DC, 2017-06-27) World Bank; Benedikt, Clemens; Wilson, David; Zhao, Feng; Shvanok, Hanna; Oleinik, Irina; Görgens, Marelize; Cheikh, Nejma; Fraser, Nicole
    This report summarizes the findings of an allocative efficiency study of Belarus’ Tuberculosis (TB) response, which was conducted using the Optima-TB model in 2016-17. Epidemic projections made in the Optima-TB model suggest that with the current level of TB spending (US$61.8 million in 2015) and the current allocation of resources to different TB response interventions, TB incidence, prevalence and deaths would continue to decline moderately in Belarus up to 2035, but 2020 national targets and global milestones as well as 2035 End-TB targets would be missed. Mathematical modelling analyses suggest that alternative program scale up scenarios and different service delivery modalities could improve outcomes of the TB response.
  • 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
    Optimising Investments in the Tuberculosis Response of Gauteng Province, South Africa
    (World Bank, Washington, DC, 2019-03) World Bank; Optima Consortium for Decision Sciences; Government of South Africa
    South Africa remains a high-burden country for tuberculosis (TB) and multi-drug resistant TB (MDR-TB) with an underlying generalised HIV epidemic. TB funding must therefore be allocated to interventions which provide high impact to prevent TB transmission, identify TB cases and treat them successfully. This report presents the findings from a pilot application of the Optima TB model in Gauteng Province, where many challenges remain to sustainably reduce TB. The modelling analysis focused on relevant intervention scenarios and optimal resource allocation to achieve the 2022 TB targets, using the mathematical optimisation feature of the tool. Findings suggest that further reductions in TB prevalence and deaths are possible through improved allocative efficiency. Several scenarios highlight opportunities especially in HIV negative populations by improving the TB care cascade with higher diagnosis rates, enhanced linkage to treatment and better MDR treatment outcomes using shorter drug regimens. The same budget allocated differently could, by 2022, reduce active TB infections by up to 40 and reduce TB deaths by up to 30 perent among HIV positive and HIV negative populations. The study provided valuable input into the refinement of the Optima TB model, especially for the HIV/TB co-epidemic setting. The model outputs support Gauteng's focus on improving the care cascade and innovating MDR-TB treatment.

Users also downloaded

Showing related downloaded files

  • Publication
    Europe and Central Asia Economic Update, Fall 2024: Better Education for Stronger Growth
    (Washington, DC: World Bank, 2024-10-17) Izvorski, Ivailo; Kasyanenko, Sergiy; Lokshin, Michael M.; Torre, Iván
    Economic growth in Europe and Central Asia (ECA) is likely to moderate from 3.5 percent in 2023 to 3.3 percent this year. This is significantly weaker than the 4.1 percent average growth in 2000-19. Growth this year is driven by expansionary fiscal policies and strong private consumption. External demand is less favorable because of weak economic expansion in major trading partners, like the European Union. Growth is likely to slow further in 2025, mostly because of the easing of expansion in the Russian Federation and Turkiye. This Europe and Central Asia Economic Update calls for a major overhaul of education systems across the region, particularly higher education, to unleash the talent needed to reinvigorate growth and boost convergence with high-income countries. Universities in the region suffer from poor management, outdated curricula, and inadequate funding and infrastructure. A mismatch between graduates' skills and the skills employers are seeking leads to wasted potential and contributes to the region's brain drain. Reversing the decline in the quality of education will require prioritizing improvements in teacher training, updated curricula, and investment in educational infrastructure. In higher education, reforms are needed to consolidate university systems, integrate them with research centers, and provide reskilling opportunities for adult workers.
  • Publication
    World Development Report 2011
    (World Bank, 2011) World Bank
    The 2011 World development report looks across disciplines and experiences drawn from around the world to offer some ideas and practical recommendations on how to move beyond conflict and fragility and secure development. The key messages are important for all countries-low, middle, and high income-as well as for regional and global institutions: first, institutional legitimacy is the key to stability. When state institutions do not adequately protect citizens, guard against corruption, or provide access to justice; when markets do not provide job opportunities; or when communities have lost social cohesion-the likelihood of violent conflict increases. Second, investing in citizen security, justice, and jobs is essential to reducing violence. But there are major structural gaps in our collective capabilities to support these areas. Third, confronting this challenge effectively means that institutions need to change. International agencies and partners from other countries must adapt procedures so they can respond with agility and speed, a longer-term perspective, and greater staying power. Fourth, need to adopt a layered approach. Some problems can be addressed at the country level, but others need to be addressed at a regional level, such as developing markets that integrate insecure areas and pooling resources for building capacity Fifth, in adopting these approaches, need to be aware that the global landscape is changing. Regional institutions and middle income countries are playing a larger role. This means should pay more attention to south-south and south-north exchanges, and to the recent transition experiences of middle income countries.
  • Publication
    Classroom Assessment to Support Foundational Literacy
    (Washington, DC: World Bank, 2025-03-21) Luna-Bazaldua, Diego; Levin, Victoria; Liberman, Julia; Gala, Priyal Mukesh
    This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.
  • Publication
    World Development Report 2006
    (Washington, DC, 2005) World Bank
    This year’s Word Development Report (WDR), the twenty-eighth, looks at the role of equity in the development process. It defines equity in terms of two basic principles. The first is equal opportunities: that a person’s chances in life should be determined by his or her talents and efforts, rather than by pre-determined circumstances such as race, gender, social or family background. The second principle is the avoidance of extreme deprivation in outcomes, particularly in health, education and consumption levels. This principle thus includes the objective of poverty reduction. The report’s main message is that, in the long run, the pursuit of equity and the pursuit of economic prosperity are complementary. In addition to detailed chapters exploring these and related issues, the Report contains selected data from the World Development Indicators 2005‹an appendix of economic and social data for over 200 countries. This Report offers practical insights for policymakers, executives, scholars, and all those with an interest in economic development.
  • Publication
    State and Trends of Carbon Pricing 2024
    (Washington, DC: World Bank, 2024-05-21) World Bank
    This report provides an up-to-date overview of existing and emerging carbon pricing instruments around the world, including international, national, and subnational initiatives. It also investigates trends surrounding the development and implementation of carbon pricing instruments and some of the drivers seen over the past year. Specifically, this report covers carbon taxes, emissions trading systems (ETSs), and crediting mechanisms. Key topics covered in the 2024 report include uptake of ETSs and carbon taxes in low- and middle- income economies, sectoral coverage of ETSs and carbon taxes, and the use of crediting mechanisms as part of the policy mix.