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Lancet. 2003 Oct 4; 362(9390):1152-1153.By AIDS day 2002, HIV/AIDS in Africa had killed 20.4 million and infected 29.4 million people. This number of deaths is seven times that in the Nazi holocaust, and it approaches the death toll associated with transatlantic slave trading. Treatment for AIDS includes monitoring of disease progression, psychosocial support, provision of adequate nutrition, teaching healthy living and survival skills, prophylaxis and treatment of opportunistic infections, and antiretroviral treatment. Such holistic treatment can now be provided at an all-inclusive cost of about US$600 dollars per year. Yet most African countries and donors still judge this amount to be too costly. The cost of not treating a person with AIDS includes the loss of output of each patient; loss of income of care-givers; cost of treatment in homes, clinics, and hospitals; funeral costs; death and survivor benefits; and the cost of orphan care and support. These costs are met by patients, families, employers, governments, and society at large. On economic grounds alone treatment should be provided for all those for whom the present value of expenses exceeds the cost of not giving treatment. Results of several studies show that this situation is now true for many classes of people and workers. The issue has become not whether we can afford to treat, but whether we can afford not to. Here, I review imagined obstacles and faulty arguments against large-scale treatment programmes, and show that unwillingness to pay is the main reason for inaction. (excerpt)
In: Operations research family planning database project summaries, [compiled by] Population Council. New York, New York, Population Council, 1993 Mar.  p. (PHI-01)In 1975, a USAID-Commission on Population (POPCOM) planning team reported that the key problem facing the National Family Planning (FP) Program in the Philippines was extending the program beyond its existing network of municipal-based clinics to the surrounding barrios. At that time, the number of new FP acceptors was declining, and there was a shift to less effective methods among current users. Because most clinics were urban-based, rural acceptors could not easily access FP services. The report recommended that supply depots be established in barrios and that motivators be used to distribute contraceptives and hygiene information and materials. An operations research project, which cost US $77,313, was developed to test the feasibility and cost-effectiveness of delivering FP/hygiene materials directly to households in rural areas. The Barrio Supply Point (BSP) operators were to visit and make available to every household free FP and hygiene materials. After the initial visit, BSP operators were to continue to serve as resupply agents. Although contraceptives were resupplied free, a nominal charge was required for hygiene materials. A quasi-experimental study design was employed. Pilot tests were conducted to determine what materials might be effectively distributed in addition to contraceptives. Project support was terminated in December 1978, before the project was fully implemented, because of the evolution of a national outreach program. Results of the pilot test showed that over 90% of households offered free condoms and oral contraceptives, or free contraceptives and bars of soap, accepted them. No data on use of these items were collected.
The use of economic and financial studies for the Expanded Programme on Immunization: third international meeting proceedings, June 13 - 15, 1990, Paris, France.
Paris, France, Centre International de l'Enfance, 1990. , 22 p.With the financial support of the US Agency for International Development (USAID) and the Centre International de l'Enfance (CIE), 23 meeting participants considered the extent to which financial studies of the Expanded Program on Immunization (EPI) have been used, factors contributing to their use or nonuse, types of information which could come out of financial studies which are most important for EPI managers, and recommendations which should be made about developing and using such studies in the future. Participants included 7 nationals involved in EPI management from Benin, Burkina Faso, Guinea, Haiti, Philippines, Sudan, and Turkey, as well as representatives from CIE, the Resources for Child Health (REACH) project, the world Health Organization (WHO), the Pan American Health Organization, the Association pour la Promotion de la Medecine Preventive, l'Organisation de Coordination et de Cooperation pour la Lutte contre les Grandes Endemies, and INSERM. Participants were introduced and presentations made on experiences with cost and cost-effectiveness studies from the perspectives of national EPI management and technical assistance/donor agencies. Participants were then divided into 2 working groups, 1 French-speaking and 1 mixed language, to consider questions about economic and financial studies, and the relevance of these studies to EPI management. Conclusions were reported in plenary sessions. The meeting closed with remarks from James Cheyne of WHO, a summary and commentary from Walter Batchelor of REACH, group recommendations for the future of EPI studies, and a summary by Dr. Pierre Claquin of REACH on participants' evaluation of the meeting and suggestions for the next meeting. Dr. Lucien Houllemare of CIE closed by stating that EPI financial management issues are broader than EPI and pertain to more general program development problems.
[Unpublished] 1994 Sep. Presented at the 122nd Annual Meeting of the American Public Health Association [APHA], Washington, D.C., 1994. iii, 28 p.Tuberculosis (TB) is the leading cause of morbidity and mortality from an infectious disease and is responsible for 3.9 million deaths/year. The incidence and severity of TB are exacerbated by the rapid spread of HIV infections. In 1993, a USAID task force presented a report on the TB situation in less developed countries and recommended agency actions (no policy decisions have been made). The World Health Organization (WHO) subsequently requested USAID assistance for a broad range proposal to tackle the problem of TB and implied that WHO had developed a cost effective TB strategy. USAID requested the country evaluations WHO referred to in its proposal, and this report is based on a review of those data. The country reports reviewed are from Burundi, Comoros, Ethiopia, Guinea, Rwanda, Somalia, Tanzania, Malawi, Mozambique, Afghanistan, China, India, the Philippines, Brazil, Cuba, Nicaragua, Algeria. A summary is presented for each country report (except Afghanistan), overall findings are discussed, and unmet needs are identified. In general, the reports summarized from a variety of authors indicate that TB can be controlled through an extraordinary devotion of resources. Only Cuba treats TB as a socioeconomic problem; most of the other reviewers were entirely concerned with the medical aspects of the complex multidrug therapy approach and almost ignored that fact that patient compliance averaged only 30% unless there was massive donor support. It is concluded that the following needs must be met to address TB: 1) political commitment to TB control must be strong; 2) the cost of TB to economic security must be established; 3) the public understanding of TB must be enhanced; 4) the serious barriers to treatment must be addressed; 5) the health care delivery systems in developing countries must be strengthened; and 6) the capacities to support TB control must be increased. It was recommended that existing projects could be supplemented by a program which would cost US $2-5 million/year in order to address some unmet needs in the technical areas of training, research, and advocacy in developing countries.
Arlington, Virginia, John Snow, Inc., Resources for Child Health Project (REACH), 1989 Apr. , 102 p. (USAID Contract No. DPE-5927-C-00-5068-00)A review of 28 reports from the cost-effectiveness literature published between 1979 and 1987 which evaluated the Expanded Program on Immunization (EPI) was undertaken by the Resources for Child Health Project (REACH) for the Program and Policy Coordination Bureau of the USAID as part of the Immunization Sustainability Study. The objectives were to assess the quality of cost-effectiveness studies of the EPI and to determine whether these data were a sufficient basis for generalization relationships between program costs and coverage levels in the future. In 1985, the Pan American Health Organization (PAHO) committed itself to the eradication of polio virus from the region by 1990. PAHO's preliminary analysis for 19 countries showed that more than $450 million was committed to the Plans of Action was 85% financed by government resources. By 1988, worldwide immunization coverage reported for the third doses of DPT and polio vaccine has surpassed the 50% level in both developing and developed countries. UNICEF was accelerating the EPI to achieve Universal Childhood Immunization (UCI). USAID funding for immunization increased from $30 million in 1985 to $51 million in 1988, and the agency strove for universal immunization by 1990. USAID also funded efforts made by PAHO, the Rotary International, and UNICEF toward global eradication of polio and universal childhood immunization by 1990. The average cost per fully immunized child was $13 which was within the specified range of $5-$15 per child presented at the Bellagio Conference in 1984. Routine services through fixed facilities cost $11.74 per fully immunized child. Immunization campaigns cost $15.62 per fully immunized child. Immunization programs in Africa have lower average costs than those in Asia between $12.26 and $16.41 for all strategies. For routing services through fixed facilities, the proportion of government contribution was 55% of total; it diminished to 40% for campaign strategies. International organizations and donor agencies covered EPI costs (such as vaccines, syringes, cold chain equipment, vehicles, and local training costs). The Mauritania national campaign had a cost-effectiveness ratio of almost 1/2 that of the campaigns in Cameroon and Senegal because of a smaller urban target population, while greater numbers of doses of vaccine were administered in Senegal than in Mauritania. A cost- effectiveness study protocol is needed to standardize basic costing and effectiveness terminology and methods and to address the needs of program managers and policy makers.
Sex education and family planning services for adolescents in Latin America: the example of El Camino in Guatemala.
[Unpublished] 1984. ix, 54,  p.This report examines the organizational development of Centro del Adolescente "El Camino," an adolescent multipurpose center which offers sex education and family planning services in Guatemala City. The project is funded by the Pathfinder Fund through a US Agency for International Development (USAID) population grant from 1979 through 1984. Information about the need for adolescent services in Guatemala is summarized, as is the organizational history of El Camino and the characteristics of youngg people who came there, as well as other program models and philosophies of sex education in Guatemala City. Centro del Adolescente "El Camino" represents the efforts of a private family planning organization to develop a balanced approach to serving adolescents: providing effective education and contraceptives but also recognizing that Guatemalan teenagers have other equally pressing needs, including counseling, health care, recreation and vocational training. The major administrative issue faced by El Camino was the concern of its external funding sources that an adolescent multipurpose center was too expensive a mechanism for contraceptive distribution purposes. A series of institutional relationships was negotiated. Professionals, university students, and younger secondary students were involved. Issues of fiscal accountability, or the cost-effectiveness of such multipurpose adolescent centers, require consideration of the goals of international funding agencies in relation to those of the society in question. Recommendations depend on whether the goal is that of a short-term contraception distribution program with specific measurable objectives, or that of a long-range investment in changing a society's attitudes about sex education for children and youth and the and the provision of appropriate contraceptive services to sexually active adolescents. Appendixes are attached. (author's modified)
Washington, D.C., USAID, 1979 Dec. 246 p. (A.I.D. Program Evaluation Report No. 1.)USAID sponsored a workshop in April 1979 to identify from research and experience the circumstances under which direct family planning services or developmental activities are most effective in reducing population growth in specific developing countries. Background papers prepared for the workshop on family planning efforts in Java, Colombia, and Thailand showed that family planning alone, without socioeconomic developmental additions, had lowered fertility levels significantly. However, these programs did not consider other factors which might have been responsible as well. Most of the crosscultural studies which have been done show that family planning and development activities taken together will have the greatest impact of fertility declines. Political commitment to these programs is necessary. Such commitment facilitates localized family planning activity, the most effective delivery system system. Administrative capability and socioeconomic/cultural acceptability of family planning are factors of major importance also. The workshop examined experience and made projections as to whether various countries, based on certain demographic and socioeconomic trends, will be able to achieve annual crude birth rates of 20/1000 by the year 2000. Countries were classified as certain, probably, possible, and unlikely. Flexibility of approach is urged.
[Unpublished] 1982. Presented at Conference on Financing Health Services in Developing Countries, Washington, D.C., June 13-16, 1982. 3 p.Focus in this presentation is on cost-effectiveness trends and comparisons among contraceptive social marketing programs. Social marketing programs require brand name products. Over time sales increase and costs/couple years of protection decrease. Advertising becomes less important and there are more customers. In 1981, excluding funds from donor organizations, the costs per couple years of protection for most programs was under $10. In 1981 the US Agency for International Development (USAID) spent $7.2 million on social marketing. In theory, the price charged could be increased to cover all expenses so the project can become self-sufficient. One possibility is to reduce the cost of packaging. Another possibility is to raise prices, cut the cost of commodities (e.g., buy from India), cut project margins for distributors, cut advertising, or fire managers. Yet, it would still be difficult to meet all project costs. Alternatives are the following: continue indefinitely with donor financing; use system to sell profitable items; and get local government to finance deficit.
Summary of the expert meeting on AID demographic and family planning data collection and analysis needs (september 21-22, 1983).
[Unpublished] 1983. v, 37 p.The purpose of the meeting is identified as providing USAID with guidance on the collection, analysis, and use of demographic and family planning data. The context for the meeting was the cutbacks in USAID's demographic portfolio, and the resultant need to examine the tradeoffs involved in various areas of data collection and analysis assistance. 4 major donor organizations--USAID, the United Nations Fund for Population Activities, the World Bank, and the Rockefeller Founation--described their data collection and analysis programs and activities. Discussion focused on 3 areas of concern: 1)data collection methods; 2) data collection/analysis tools and techniques; and 3) types of data. In addition, a number of issues were raised, including the use of data to influence policy makers, the need for country of region-specific decisions about data collection and analysis, the need for training, the importance of an archive function to preserve the data from the World Fertility Survey (WFS) and other surveys, and the need for cost-effectiveness and cost-benefit analyses. Conclusions reached form a series of recommendations for USAID, 2 mechanisms were used to elicit recommendations on USAID priorities from participants. 1st, a list of points of general agreement was drawn up. These points were read to the group, discussed, and revised accordingly. They appear as Table ES-1, "Points of General Agreement on AID Priorities." The 2nd mechanism was a poll of particopants, asking them to assign priority rankings to a list of suggested potential areas of USAID activity. This list was discussed and revised by participants before the scoring took place. (author's modified)