Global Fund: Progress Report 2010 - unaids

3.4 Maximizing
impact: costeffectiveness
and economic
returns on
investment
49. The Global Fund seeks to maximize the costeffectiveness
of supported interventions for obtaining
given health outcomes, from proposal selection
by the Technical Review Panel to the measurement
of service unit costs that will enable country-specific
cost-effectiveness evaluations. Research and evaluations
show that ITNs, ACT, DOTS and HIV prevention
interventions are highly cost-effective in low- and
middle-income settings (11, 13, 21, 23, 35–42). ART
and treatment of MDR-TB are somewhat less costeffective,
but essential for a comprehensive response.
By investing in the most cost-effective interventions
(e.g. prevention) now, it is also possible to save
resources in the longer term by reducing the need
for more costly interventions such as treatment.
50. For ITNs, DOTS and ART, the estimates of unit
costs in Global Fund-supported programs presented
in Table 3.3 are in line with the assumptions employed
in cost-effectiveness analyses, confirming the costeffectiveness
of these interventions in most Global
Fund-supported programs.
51. In addition to contributing to the health MDGs,
supported interventions have important ancillary benefits
to national economies. The WHO Commission on
Macroeconomics and Health estimated that significant
investments in health could lead to a direct return
of over eight times the investment made per year (43).
The wider returns on investments to respond to HIV,
TB and malaria include:
• reductions in direct health care costs due to effective
diagnosis, prevention and treatment, reducing
cases and hospitalizations;
• reduced burden on the health system over time,
by reducing mortality among health care workers
and reducing the inpatient and outpatient burden
of these diseases;
• microeconomic contributions such as reduced
absen teeism, recruitment costs, improved
productivity among the workforce and increased
household income;
• macroeconomic contributions to economic and
human development.
52. Direct savings within health systems have been
noted as a result of investment in disease-specific programs.
In South Africa, for example, the monthly cost
to the health system decreased as adherence to ART
increased (44). Effective malaria prevention has led to
declining demand for treatment, for example, in Global
Fund-supported programs in Rwanda and Ethiopia (45).
53. The wider health system benefits of effective
disease programs include increased capacity in both
inpatient and outpatient settings, and the improved
working capacity of health workers. In Rwanda, effective
malaria prevention resulted in a 56 percent decline
in inpatient malaria cases, releasing the capacity of
hospital beds (45). Global Fund-supported ART in
Malawi contributed an additional 1,000 health worker
days per week to the health care system by keeping
HIV-positive staff alive (46).
54. At the microeconomic level, dollars spent on
disease interventions – notably ART and malaria control
– have brought economic returns in the form of
improved worker efficiency, reduced absenteeism from
work and reduced recruitment and re-training costs
to employers (36, 47, 48). For example, in Cambodia,
the rapid scale-up of free ART doubled the number
of people living with HIV who worked full-time (49).
The implementation of the Global Fund-supported
HIV program in Malawi resulted in a decline in worker
absenteeism by 40 percent (50), and made possible
the enrolment and retention of 1,850 teachers by the
end of September 2006 (51), by allowing them to
remain alive and in the classroom.
55. Investments in public health have the ability to
stabilize households. ART extends the lives of parents
living with HIV, allowing them to care for their children
and allowing children, who may themselves benefit
from ART (52), to stay in school. Every year in India
more than 300,000 children leave school to do household
or income-generating work as a result of their
parents’ TB (53).
56. The potential macroeconomic return on health
investments to countries is substantial. By strategically
investing in health, countries contribute to the
development of their economies and contribute to
MDG 1 (“eradicate extreme poverty and hunger”).
International comparisons and modeling studies suggest
that:
• Malaria reduces economic growth by up to
1.3 percent in endemic countries (36).
• AIDS lowers national gross domestic product growth
by up to 2.6 percent in high-HIV-prevalence countries
in sub-Saharan Africa (47). 2.6 percent per year
leads to a gross domestic product which is 67 percent
lower than it would have been without AIDS.
73 THE GLOBAL FUND 2010: INNOVATION AND IMPACT imprOviNG EFFectiveNess