South African ART policies between 2013/ /15: An analysis of ARV Expenditure

Transcription

1 South African ART policies between 2013/ /15: An analysis of ARV Expenditure Gavin Surgey Teresa Guthrie 31 March 2015 DRAFT [Do not quote without prior permission]

2 Background Over 2.5m people on treatment in South Africa Globally 13m people on treatment at end 2013 (UNAIDS gap report, 2014) Recent policy change from CD4<350 to CD4<500 means more people eligible for treatment South Africa spent in excess of R15bn per year on HIV (public funds 2013/14) Greatest proportion goes towards Anti-Retroviral Treatment (ART) Approximately R7.6bn, 48% for ART (2013/14) Approximately R4bn, 24% for ARV (2013/14)

3 Purpose of Analysis A greater need to understand how planning and budgeting for ART take place Each year a consistent overspend of budget on ART has taken place In 2013/14, 110% of the conditional grant was expended, yet number of people on treatment was below target. The ARVs form the single largest cost component within the HIV expenditure (R4bn) In preparing for the new GF grant application, there is need to consider the resource requirements to reach and, past spending adequacy so as to inform future planning

4 Research Questions How much money should be set aside for the provision of antiretrovirals i. 2014/15 at 350CD4, and ii. 2015/16 at 500CD4 criteria and at different scale rates? What were the amounts allocated provincially for ARVs (both CG and voted funds)? What is the contribution of the Global Fund to ARV financing? Are the provincial (or total national) allocated funds for ARVs adequate? What is provincial spending on ARVs in 2013/14 (both CG and voted)? What is the variation between provincial unit cost of ARVs per patient?

5 Methods & Sources National Resource Needs Estimations: National ART Costing Model (NACM) Budgeting Allocations and Process: HIV Conditional Grant Business Plans, DoH Quarterly Performance CG Reports Expenditure Analysis: BAS (for public funds) and EFRs and quarterly expenditure (for GF)

6 Synopsis of people on treatment (Actual vs targets) Number of patients remaining in care Number of new patients initiated on ART Prov 2013/ /15 target 2013/ /15 target EC FS GP KZN LP MP NC NW WC ZA Source: Provincial DORA Reports 2014/15

7 Estimated total cost of ARVs per year (ZAR mil, 2013/ /16) Total drug cost for ARVs (adults and children, all lines) per year ZAR Millions 2013/14 (Dec 2012 tender) /15 (Dec 2012 tender, Feb 2014 tender update, eligibility at 350) /16 (Dec 2012 tender, Feb 2014 tender update, eligibility at 500 and PMTCT B+) 2015/16 (Dec 2012 tender, Feb 2014 tender update, universal test and treat) - basic scale-up rapid scale-up slow scale-up basic scale-up rapid scale-up slow scale-up Source: Meyer-Rath, G (2015) National ART Cost Model, South Africa. Health Economics and Epidemiology Research Office, Boston University/ University of the Witwatersrand, Johannesburg.

8 ARV budget allocations through the CG (2013/14 &2014/15 per province) Business Plan allocation of expenditure for ARVs 2013/14 Allocation ZAR 2014/15 Allocation ZAR EC FS GP KZN LP MP NC NW WC Total Source: Conditional Grant Business Plans 2013/14 & 2014/15

9 Global Fund s contribution to ARVs (Expenditure Nat. 2012/ /15) ARVs (ZAR) 2012/ / /15 NDOH R R R ,24 WCDOH R R R Total R R R Source: GF EFRs (2012/13 & 2013/14) & quarterly expenditure records NDOH and WCDoH (2014/15)

10 Public expenditure on ARVs (per province for 2013/14 - CG & ES) Based on Percentage DOH HIV CG DOH Voted Grand Total that is ARV only (avg 4% of total ARV spend) Eastern Cape Gauteng KwaZulu Natal ( ) Mpumalanga Northern Cape Western Cape North West Free State Limpopo Grand Total Source: BAS 2013/14 (spending on ART broken down by cost category)

11 Unit Costs of ARVs (ZAR, 2013/14) Avg tender price Northern Cape Western Cape Free State Eastern Cape Gauteng Limpopo Mpumalanga KwaZulu Natal Average (excl.nw) Source: Authors own calculations (BAS 2013/14 and DHIS number of people on treatment) This shows the variation in unit cost per ARV across provinces. The red line indicates the average ARV drug costs based on tender prices.

12 2013/14 Comparison of figures Data Source Description Grand Total NACM Estimate of need BAS Actual Govt Expenditure GF Donor Funds Total ARV Expenditure (BAS + GF)

13 Conclusion Total expenditure(govt and donor) was R4bn in 2013/14 National estimation of ARV need was R3.7bn for 2013/14 8.5% underestimation of national need Govt expenditure on ARV in line with national expenditure 2.8% over the NACM estimation Global Fund accounted for 5.9% of total ARV spend in 2013/14?