Saphonn Vonthanak, MD. MSc. PhDHeng Sopheab, MD. MPH. PhD

Chhea Chhorvann, MD. MPH. PhDUng Luyna and Ros Seilava

The Long Run Costs and Financing of HIV/AIDS in Cambodia

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Acknowledgement

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The Steering CommitteeChaired by National AIDS Authority & Co-

chaired by NCHADSMembers 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)

Process

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1.HIV/AIDS Projections for different intervention scenarios

2.The costing for each scenario3.“Fiscal Space” analysis for financing the long term costs

4.Projections of resource availability and needs

MethodsHIV/AIDS projections

Secondary epidemiologic dataGoals model

HIV/AIDS CostingSpectrum AIDS impact modelResource Needs Model

HIV/AIDS program financingSecondary data

Medium term macroeconomic dataset of MEFODA database from CDCNational AIDS spending assessment report (NASA)

Primary data (interviews)Development partners, Private sector and

Government institutions

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Scenarios for Cambodia

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Different scenarios

Prevention Program

Care and Treatment Program

Structural change

 High risk groups

Low risk groups

Linked response Others            

Current coverage                    

Structural change                    

Best coverage                

Hard choice 1                  

Hard choice2                  

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Projected Numbers of New HIV Cases (1)

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Projected Numbers of New HIV Cases (2)

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Projected Cost of HIV/AIDS

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HIV/AIDS program financing

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Share of HIV/AIDS to Health and Social Spending of the Government

*Note that the two line has different denominator, the blue line has social spending as denominator and the red line has health spending as denominator

Total of HIV/AIDS Expense in Cambodia

Projections of Resource Availability and Needs

Assumptions in the base case scenarioGDP will grow at 7% per annumPublic expenditure as a percentage of GDP

will be 15%Social spending is 30% of public

expendituresHIV/AIDS spending will be 1.5% of social

spending through 2031Donor funding would gradually decline from

90% of all HIV/AIDS funds to 50% by 2020

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Resources Needs for HIV/AIDS under Hard Choice 2 Compared to Projected Resources

under the Baseline Financing Scenario (US$million)

Resource Needs for Hard Choice 2 Compared to Projected Resources Available

under the Pessimistic Financing Scenario (US$ million)

16Pessimistic 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)

17Optimistic 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

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ConclusionThe 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.

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ConclusionThe 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 short-term.

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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 cost-effectiveness of different possible interventions in HIV/AIDS program, so that it can better set priorities and mobilize resources accordingly.

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