HIV/AIDS Intervention Packages in Five Countries: A Review of Budget Data

More than ever, global health funding agencies must get better value for money from their investment portfolios; to do so, each agency must know the interventions it supports and the sub-populations targeted by those interventions in each country. In this study we examine the interventions supported by two major international AIDS funders: the Global Fund to Fight AIDS, Tuberculosis, and Malaria (‘Global Fund’) and the President’s Emergency Plan for AIDS Relief (PEPFAR). The Global Fund typically posts PDF copies of its program grant agreements (PGA) to its public-facing website; some of these documents provide limited information on the portfolio of interventions supported by grant monies. Consequently, we first construct a sampling frame over 2002-12 of 20 of the Global Fund’s ‘high-impact countries’. From this frame, five countries – Ethiopia, Nigeria, South Africa, India, the Philippines – are purposively selected for data extraction from the PGAs, as these countries represent significant funding levels and diverse regions and epidemics. In these five countries, we use extracted Global Fund data and publicly available PEPFAR data to compare the financed intervention package. We find that only 35% of publicly posted Global Fund PGAs in 20 high-impact countries provide any budget information on intervention package. In Ethiopia, Nigeria and South Africa, a significant proportion of Global Fund spending goes to care and treatment, whereas in India and the Philippines the Global Fund spends a higher proportion on prevention than treatment. PEPFAR consistently spends a higher share on prevention than the Global Fund in every country examined. Neither the Global Fund nor PEPFAR report enough data to analyze intervention package by target population. The absence of information on intervention package and service delivery areas in the Global Fund’s PGAs raises a troubling concern: many publicly available grant documents are not clear on what interventions, sub-populations, or disease-control objectives are being funded in their budgets, data which are essential for informing national and international policymakers seeking value for money.