This background paper examines costing practices, cost-effectiveness data and prioritization processes in national HIV/AIDS strategic plans. The first section is a literature review on costing and prioritization in the first generation of national strategic plans (NSPs). The second section uses the World Bank AIDS Strategy and Action Plan’s Self-Assessment Tool Guidelines for costing and prioritization to provide a detailed assessment of 7 current-generation NSP documents (Botswana, Cameroon, Cote d’Ivoire, Malawi, Mozambique, Peru, and the Philippines). Through a simple scoring scale, patterns across these documents become evident. Botswana meets the most SAT criteria for the costing and prioritization categories (combined); Mozambique meets the fewest. With respect to prioritization guidelines, few countries mentioned cost-effectiveness as a key factor in selecting interventions to prioritize. With respect to costing/financing guidelines, few countries indicate that a transparent financial system is in place to track disaggregated spending for unit costs identification.
The third section examines global financing data availability and compares per capita and per infection costs based on 3 data sources. A minority of countries report any expenditure towards most-at-risk populations to UNAIDS. Section 4 presents a discussion of challenges to the strategic planning process as well as the need for systematic assessment tools. The paper closes with 7 key messages to improve national strategic plans:
- Develop functional and transparent national financial systems
- Track, report and share full cost and financing data
- Conduct self-assessment and impact studies at the country level
- Propose and deliver funding for most-at-risk populations
- Develop more specific ASAP guidelines for NSPs
- Create a refined, integrated system for assessment
- Set and achieve rigorous targets for improved NSPs
Although there are startling shortcomings in the current generation of national HIV/AIDS strategic plans and financial tracking, it is critical that countries implement basic costing and prioritization policies in the short term in order to maximize impact in the long term.
