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Technical efficiency of national HIV/AIDS spending in 78 countries between 2010 and 2018: A data envelopment analysis

Author

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  • Kasim Allel
  • Gerard Joseph Abou Jaoude
  • Charles Birungi
  • Tom Palmer
  • Jolene Skordis
  • Hassan Haghparast-Bidgoli

Abstract

HIV/AIDS remains a leading global cause of disease burden, especially in low- and middle-income countries (LMICs). In 2020, more than 80% of all people living with HIV (PLHIV) lived in LMICs. While progress has been made in extending coverage of HIV/AIDS services, only 66% of all PLHIV were virally suppressed at the end of 2020. In addition to more resources, the efficiency of spending is key to accelerating progress towards global 2030 targets for HIV/AIDs, including viral load suppression. This study aims to estimate the efficiency of HIV/AIDS spending across 78 countries. We employed a data envelopment analysis (DEA) and a truncated regression to estimate the technical efficiency of 78 countries, mostly low- and middle-income, in delivering HIV/AIDS services from 2010 to 2018. Publicly available data informed the model. We considered national HIV/AIDS spending as the DEA input, and prevention of mother to child transmission (PMTCT) and antiretroviral treatment (ART) as outputs. The model was adjusted by independent variables to account for country characteristics and investigate associations with technical efficiency. On average, there has been substantial improvement in technical efficiency over time. Spending was converted into outputs almost twice as efficiently in 2018 (81.8%; 95% CI = 77.64, 85.99) compared with 2010 (47.5%; 95% CI = 43.4, 51.6). Average technical efficiency was 66.9% between 2010 and 2018, in other words 33.1% more outputs could have been produced relative to existing levels for the same amount of spending. There is also some variation between WHO/UNAIDS regions. European and Eastern and Southern Africa regions converted spending into outputs most efficiently between 2010 and 2018. Rule of Law, Gross National Income, Human Development Index, HIV prevalence and out-of-pocket expenditures were all significantly associated with efficiency scores. The technical efficiency of HIV investments has improved over time. However, there remains scope to substantially increase HIV/AIDS spending efficiency and improve progress towards 2030 global targets for HIV/AIDS. Given that many of the most efficient countries did not meet 2020 global HIV targets, our study supports the WHO call for additional investment in HIV/AIDS prevention and control to meet the 2030 HIV/AIDS and eradication of the AIDS epidemic.

Suggested Citation

  • Kasim Allel & Gerard Joseph Abou Jaoude & Charles Birungi & Tom Palmer & Jolene Skordis & Hassan Haghparast-Bidgoli, 2022. "Technical efficiency of national HIV/AIDS spending in 78 countries between 2010 and 2018: A data envelopment analysis," PLOS Global Public Health, Public Library of Science, vol. 2(8), pages 1-23, August.
    • Handle: RePEc:plo:pgph00:0000463
    DOI: 10.1371/journal.pgph.0000463
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    References listed on IDEAS

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    1. William W. Cooper & Lawrence M. Seiford & Joe Zhu (ed.), 2011. "Handbook on Data Envelopment Analysis," International Series in Operations Research and Management Science, Springer, number 978-1-4419-6151-8, February.
    2. Drummond, Michael F, 1989. "Output Measurement for Resource Allocation Decisions in Health Care," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 5(1), pages 59-74, Spring.
    3. Robyn M Stuart & Cliff C Kerr & Hassan Haghparast-Bidgoli & Janne Estill & Laura Grobicki & Zofia Baranczuk & Lorena Prieto & Vilma Montañez & Iyanoosh Reporter & Richard T Gray & Jolene Skordis-Worra, 2017. "Getting it right when budgets are tight: Using optimal expansion pathways to prioritize responses to concentrated and mixed HIV epidemics," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-13, October.
    4. repec:cfe:wpcefa:2012_02 is not listed on IDEAS
    5. Sérgio Santos & Carla Amado & Mauro Santos, 2012. "Assessing the efficiency of mother-to-child HIV prevention in low- and middle-income countries using data envelopment analysis," Health Care Management Science, Springer, vol. 15(3), pages 206-222, September.
    6. Simar, Leopold & Wilson, Paul W., 2007. "Estimation and inference in two-stage, semi-parametric models of production processes," Journal of Econometrics, Elsevier, vol. 136(1), pages 31-64, January.
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    Cited by:

    1. Muñoz, Ismael G. & Baker, David P., 2026. "Revisiting the education-HIV gradient in Africa: Cohort variation analysis of a temporal shift and speculation on causes," Social Science & Medicine, Elsevier, vol. 388(C).

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