The Long Run Costs and Financing of HIV/AIDS in Cambodia Saphonn Vonthanak, MD. MSc. PhD Heng Sopheab, MD. MPH. PhD Chhea Chhorvann, MD. MPH. PhD Ung Luyna and Ros Seilava 1
The Steering Committee Acknowledgement Chaired by National AIDS Authority & Co-chaired by NCHADS Members 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) 2
Process 1. HIV/AIDS Projections for different intervention scenarios 2. The costing for each scenario 3. Fiscal Space analysis for financing the long term costs 4. Projections of resource availability and needs 3
Methods HIV/AIDS projections Secondary epidemiologic data Goals model HIV/AIDS Costing Spectrum AIDS impact model Resource Needs Model HIV/AIDS program financing Secondary data Medium term macroeconomic dataset of MEF ODA database from CDC National AIDS spending assessment report (NASA) Primary data (interviews) Development partners, Private sector and Government institutions 4
Scenarios for Cambodia Different scenarios Prevention Program High risk groups Low risk groups Linked response Others Care and Treatment Program Structural change Current coverage Structural change Best coverage Hard choice 1 Hard choice2 by 2015 by 2015 by 2015 by 2015 5
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Projected Numbers of New HIV Cases (1) 18,000 16,000 15,475 14,000 12,000 10,000 9,031 11,951 12,945 10,891 8,801 CC BC HC 1 HC 2 SC WC 8,000 7,865 7,310 6,968 6,594 6,000 4,000 2,000 2,806 5,509 4,834 4,430 4,221 3,891 3,423 3,169 2,664 2,418 2,128 2,105 2,090 2,075 2,058 2,039 2,017 1,994 1,968 1,942 1,915 1,888 1,861 1,834 1,806 1,779 1,753 1,727 1,702 1,677 1,652 1,626 1,600 1,572 1,543 0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 7
Projected Numbers of New HIV Cases (2) 4,000 3,500 3,000 2,664 2,500 2,000 2,418 2,128 2,105 2,090 2,075 2,058 2,039 2,017 1,994 1,968 1,942 1,915 1,888 1,861 1,834 1,806 1,779 1,753 1,727 1,702 1,677 1,652 1,626 1,600 1,572 1,543 1,500 1,000 500 CC BC HC 1 HC 2 SC WC 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 8
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Projected Cost of HIV/AIDS Millions of 2009 Dollars 120.0 110.0 100.0 90.0 80.0 70.0 60.0 50.0 114.0 113.2 112.1 111.1 100.6 101.6 102.4 103.2 103.8 104.5 105.1 105.8 106.5 107.3 108.1 109.1 110.0 93.3 86.0 78.0 70.0 65.7 64.2 66.9 67.2 67.4 67.4 67.4 67.3 67.2 67.2 67.1 67.1 67.1 67.2 67.3 67.4 67.5 67.7 67.8 61.9 62.0 59.5 56.8 53.7 55.6 53.7 58.4 59.2 59.2 59.1 58.7 57.2 58.3 57.9 57.4 57.0 56.6 56.3 56.0 55.8 55.6 55.4 55.4 55.3 55.3 55.3 55.3 40.0 2009 2010 2011 2012 CC BC HC1 HC2 SC WC 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 10
11 HIV/AIDS program financing
Share of HIV/AIDS to Health and Social Spending of the Government
Total of HIV/AIDS Expense in Cambodia
Projections of Resource Availability and Needs Assumptions in the base case scenario GDP will grow at 7% per annum Public expenditure as a percentage of GDP will be 15% Social spending is 30% of public expenditures HIV/AIDS spending will be 1.5% of social spending through 2031 Donor funding would gradually decline from 90% of all HIV/AIDS funds to 50% by 2020 14
Resources Needs for HIV/AIDS under Hard Choice 2 Compared to Projected Resources under the Baseline Financing Scenario (US$million) 80 70 60 50 40 30 20 10 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 External Government HC2
Resource Needs for Hard Choice 2 Compared to Projected Resources Available under the Pessimistic Financing Scenario (US$ million) 80 70 60 50 40 30 20 10 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 External Government HC2 16 Pessimistic 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) 80 70 60 50 40 30 20 10 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 External Government HC2 17 Optimistic 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 100.00 90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 External Government HC2 18
Conclusion The 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. 19
Conclusion The 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 shortterm. 20
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 costeffectiveness of different possible interventions in HIV/ AIDS program, so that it can better set priorities and mobilize resources accordingly.
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