IDEAS home Printed from https://ideas.repec.org/a/plo/pgph00/0000463.html

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

Author

Listed:
  • 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
    as

    Download full text from publisher

    File URL: https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000463
    Download Restriction: no
    File URL: https://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0000463&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pgph.0000463?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    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, June.
    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. 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.
    5. Charnes, A. & Cooper, W. W. & Rhodes, E., 1978. "Measuring the efficiency of decision making units," European Journal of Operational Research, Elsevier, vol. 2(6), pages 429-444, November.
    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.
    7. repec:cfe:wpcefa:2012_02 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    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).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Chen, Kuan-Chen & Lin, Sun-Yuan & Yu, Ming-Miin, 2022. "Exploring the efficiency of hospital and pharmacy utilizations in Taiwan: An application of dynamic network data envelopment analysis," Socio-Economic Planning Sciences, Elsevier, vol. 84(C).
    2. Mehdi Rhaiem & Nabil Amara, 2020. "Determinants of research efficiency in Canadian business schools: evidence from scholar-level data," Scientometrics, Springer;Akadémiai Kiadó, vol. 125(1), pages 53-99, October.
    3. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Post-Print hal-01414677, HAL.
    4. Naveed Ul Haq, 2023. "Impact of FDI and Its Absorption Capacity on the National Innovation Ecosystems: Evidence from the Largest FDI Recipient Countries of the World," Foreign Trade Review, , vol. 58(2), pages 259-288, May.
    5. Jongmin Shon, 2022. "Does Competition Tame the Leviathan? A Case of Earmarked Spending for Transportation," Hacienda Pública Española / Review of Public Economics, IEF, vol. 241(2), pages 59-78, June.
    6. Fabio Carlucci & Andrea Cirà & Paolo Coccorese, 2018. "Measuring and Explaining Airport Efficiency and Sustainability: Evidence from Italy," Sustainability, MDPI, vol. 10(2), pages 1-17, February.
    7. Iparraguirre, José Luis & Ma, Ruosi, 2015. "Efficiency in the provision of social care for older people. A three-stage Data Envelopment Analysis using self-reported quality of life," Socio-Economic Planning Sciences, Elsevier, vol. 49(C), pages 33-46.
    8. Martijn J. Burger & Kostas Kounetas & Oreste Napolitano & Spyridon Stavropoulos, 2022. "Do innovation and human capital actually narrow the technology gap? Champions and laggards of European regional productive performance," Regional Studies, Taylor & Francis Journals, vol. 56(10), pages 1655-1670, October.
    9. Simar, Léopold & Wilson, Paul W., 2020. "Technical, allocative and overall efficiency: Estimation and inference," European Journal of Operational Research, Elsevier, vol. 282(3), pages 1164-1176.
    10. Joong Hoon Ko & Daecheol Kim, 2019. "The Effects of Maturity of Project Portfolio Management and Business Alignment on PMO Efficiency," Sustainability, MDPI, vol. 11(1), pages 1-16, January.
    11. Zhou, Yaoming & Kundu, Tanmoy & Goh, Mark & Chakraborty, Shankar & Bai, Xiwen, 2023. "A multi-stage multi-criteria data analytics approach to rank commercial service airports," Journal of Air Transport Management, Elsevier, vol. 111(C).
    12. Laura Carosi & Giovanna D'Inverno & Letizia Ravagli, 2014. "Global public spending efficiency in Tuscan municipalities," Discussion Papers 2014/175, Dipartimento di Economia e Management (DEM), University of Pisa, Pisa, Italy.
    13. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Annals of Operations Research, Springer, vol. 247(2), pages 787-806, December.
    14. Sebastian Kohl & Jan Schoenfelder & Andreas Fügener & Jens O. Brunner, 2019. "The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals," Health Care Management Science, Springer, vol. 22(2), pages 245-286, June.
    15. Rita Bastião & Nuno de Sousa Pereira, 2020. "Performance in the Delivery of Primary Health Care Services: A Longitudinal Analysis," CEF.UP Working Papers 2002, Universidade do Porto, Faculdade de Economia do Porto.
    16. Dinesh R. Pai & Fatma Pakdil & Nasibeh Azadeh-Fard, 2024. "Applications of data envelopment analysis in acute care hospitals: a systematic literature review, 1984–2022," Health Care Management Science, Springer, vol. 27(2), pages 284-312, June.
    17. Besstremyannaya, Galina, 2017. "Heterogeneous effect of the global financial crisis and the Great East Japan Earthquake on costs of Japanese banks," Journal of Empirical Finance, Elsevier, vol. 42(C), pages 66-89.
    18. Valentin Zelenyuk, 2019. "Data Envelopment Analysis and Business Analytics: The Big Data Challenges and Some Solutions," CEPA Working Papers Series WP072019, School of Economics, University of Queensland, Australia.
    19. Huguenin, Jean-Marc, 2015. "Adjusting for the environment in DEA: A comparison of alternative models based on empirical data," Socio-Economic Planning Sciences, Elsevier, vol. 52(C), pages 41-54.
    20. Carol C. Huang & Chris C. Hsu & Emilio Collar, 2021. "An Evaluation of the Operational Performance and Profitability of the U.S. Airlines," International Journal of Global Business and Competitiveness, Springer, vol. 16(2), pages 73-85, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pgph00:0000463. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: globalpubhealth (email available below). General contact details of provider: https://journals.plos.org/globalpublichealth .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.