Getting resources to those who need them: the evidence we need to budget for underserved populations in sub-Saharan Africa

By  Dr. Lawrence Long  Professor Sydney Rosen  Dr. Brooke Nichols  Dr. Bruce Larson  Nhlanhla Ndlovu  Professor Gesine Meyer-Rath  |  | 

Introduction: In recent years, many countries have adopted evidence-based budgeting (EBB) to encourage the best use of limited and decreasing HIV resources. The lack of data and evidence for hard to reach, marginalized and vulnerable populations could cause EBB to further disadvantage those who are already underserved and who carry a disproportionate HIV burden (USDB). We outline the critical data required to use EBB to support USDB people in the context of the HIV epidemics of sub-Saharan Africa (SSA).

Discussion: To be considered in an EBB cycle, an intervention needs at a minimum to have an estimate of a) the average cost, typically per recipient of the intervention; b) the effectiveness of the intervention and c) the size of the intervention target population. The methods commonly used for large, accessible populations at relatively low risk of HIV acquisition are not sufficient for generating valid estimates for USDB populations. USDB populations may require additional resources to learn about, access, and/or successfully participate in an intervention, increasing the cost per recipient. USDB populations may experience different health outcomes and/or other benefits than in less vulnerable populations, influencing the effectiveness of the interventions. Finally, USDB population size estimation is critical for accurate programming but is difficult to obtain with almost no national estimates for countries in SSA. We explain these limitations and make recommendations for addressing them.

Conclusions: EBB is a strong tool to achieve efficient allocation of resources, but in SSA the evidence necessary for USDB populations may be lacking. Rather than excluding USDB populations from the budgeting process, more should be invested in understanding the needs of these populations.

Publication details

Journal of the International AIDS Society