Ghana HIV Sustainability Assessment and Roadmap
THE PROBLEM
Ghana is a lower-middle income country with a low-level generalized HIV epidemic of 1.66% prevalence rate among the adult population. In 2022, there were an estimated 354,927 people living with HIV and 16,574 new HIV infections. Notably, HIV prevalence is significantly higher among certain key population groups, such as men who have sex with men (18.1%) and female sex workers (4.6%).
Ghana has systematically responded to the HIV epidemic since the country’s first case was detected in 1986. The national program is led by the Ghana AIDS Commission (GAC) and the National AIDS/STI Control Program (NACP). Ghana has made mixed but strong progress, as highlighted by their progress towards the UNAIDS fast-track goals of 95-95-95 for 2025. Compared to marks of 66-85-79 in 2021, Ghana reached 72-87-68 in 2022: 72% of people living with HIV knew their status; 87% who knew their status were on treatment; and 68% of those on treatment were virally suppressed. However, Ghana is still projected to fall short of the fast-track targets in 2025.
Compounding this challenge is the estimated increase in the cost of Ghana’s national HIV response from $133 million in 2023 to over $145 million by 2025. Projected commitments from international donors ($42 million) and the Government of Ghana ($32 million), which is facing an ongoing economic crisis, fall short of estimated resource needs, resulting in a funding gap of over $68 million in 2025. Ghana’s progress combatting HIV is under threat unless concerted efforts are made to make its response more financially sustainable and efficient.
THE PHAROS SOLUTION
Pharos has been engaged by the GAC and UNAIDS to conduct a sustainability assessment and create a sustainability roadmap to ensure that the gains in Ghana’s national HIV program are preserved in a challenging fiscal environment.
The project will be completed in three phases:
Exploratory and Diagnostic Phase: The Pharos team will engage with country stakeholders and conduct a desk review to better understand Ghana’s HIV program, fiscal environment, and steps already taken to address sustainability. The GAC will convene a technical working group to provide strategic direction, facilitate engagement with stakeholders, coordinate with an investment case concurrently being developed by Avenir Health, and facilitate ownership of the final plan by the Ghanaian government. We will also begin to construct an HIV financing model to test various options to generate additional resources and enhance efficiency. These may include allocations from general revenues, earmarked funds for HVI, a share of the National Health Insurance Fund, debt swaps, and other innovative sources. Efficiencies may be realized by improved procurement, rationalizing Human Resources, and expanding integration of HIV with other primary care services.
HIV Sustainability Assessment Phase: The Pharos team will visit Ghana to further flesh out and validate our desk review findings while exploring actions to improve sustainability of the HIV response. The mission will focus on assessing and prioritizing key sustainability risks in terms of severity, anticipated impact, and probability of occurrence, and identifying preliminary mitigating actions that can be included in the Sustainability Roadmap. There will be a special focus on options for domestic resource mobilization for HIV. At the end of the first visit, our team will draft a Sustainability Assessment, synthesizing findings from the desk review and country visit.
Sustainability Roadmap Phase: Pharos will update the Sustainability Assessment based on feedback from our collaborators and start drafting the HIV Sustainability Roadmap. We will visit Ghana a second time to present the Roadmap and hold a 1-2 day national workshop to agree on priority actions, implementation steps, and accountability mechanisms. Pharos will finalize the Roadmap and propose a monitoring and evaluation framework.
Status: Ongoing, November 2023 – Current
Team Members Involved: Jeremy Otridge, Mila Dorji, Stephen Resch, Felix Asante, Ama Fenny, Jaon Tallada, Robert Hecht
For more information, contact Jeremy at [email protected].