THE PROBLEM

Kenya has a high HIV burden, with an estimated 1.1 million people living with HIV (PLHIV) and an adult prevalence of 4.5% (Kenya HIV Estimates, 2020). HIV/AIDS is the number one cause of death (29.3% of total deaths) and overall burden of disease (24.2% of total DALYs). The National AIDS Control Council (NACC) has prepared strategic planning documents, but reports challenges in generating accurate and consistent cost estimates. Kenya has begun institutionalizing HIV program cost knowledge management, including establishing standardized methods for data collection, coordination of costing exercises to minimize redundancies, and launching a technical working group (TWG) for HIV costing. The TWG is charged with promoting standards for costing studies and the creation of a unit cost data repository.

The government began an HIV costing case study in 2019, but Covid-19 and other factors have slowed progress. Pharos is to work with the NACC, key institutions in costing field, and other national stakeholders to complete the case study in summer 2021. This project should help the NACC strengthen the data and models, skills and knowledge, and processes that go into the national HIV costing system. In turn, stronger HIV costing will allow for more effective program analysis and allocation of scarce resources.

THE PHAROS SOLUTION

The Bill and Melinda Gates Foundation (BMGF) has engaged the Harvard T.H. Chan School of Public Health (HSPH) and Pharos to conduct an analysis of the costing infrastructure for Kenya’s national AIDS programs in order to enhance efficiency and sustainability. The review includes interviews with key stakeholders such as the Ministry of Health and the NACC, documentation of the national costing process, and identification of best practices, with the goal of helping to build a stronger system and institutional capacity to conduct HIV costing in the future.

The Pharos team began the formal Kenya HIV Costing Study by examining existing costing tools, data, processes, and capacity. The team used a data extraction tool based on the Global Health Cost Consortium (GHCC) reference case that had been applied by Pharos in a similar project in Zimbabwe. We use this tool to evaluate the quality and completeness of previous costing work against an established metric. Using findings from interviews with key stakeholders and an analysis of documents, the team is writing a case study making recommendations for further improvements on HIV costing infrastructure and institutionalization. Additionally, the team will create a slide deck summarizing the case study results and delivering clear recommendations and policy messages.

LOOKING AHEAD

Pharos has disseminated the findings from the Kenya HIV Costing case study and presented to the government and partners. This will join a regional project led by HSPH that includes case studies from Zimbabwe, Mozambique, and South Africa. This work will enhance HIV financing efficiency and improve sustainability of domestic resource mobilization, particularly important due to unprecedented challenges posed by the ongoing Covid-19 pandemic.

Status: Complete, September 2021

Team Members Involved: Robert Hecht, Steven Resch, Claire Young, Nathan Isaacs

For more information, contact Robert Hecht at [email protected].