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A Little Planning Goes a Long Way: Multilevel Allocation of HIV Prevention Resources

Author

Listed:
  • Gregory S. Zaric

    (Ivey School of Business, University of Western Ontario, London, Canada, gzaric@ivey.uwo.ca)

  • Margaret L. Brandeau

    (Department of Management Science and Engineering, Stanford University, Stanford, California)

Abstract

Background. HIV prevention funds are often allocated by decision makers at multiple levels. High-level decision makers may allocate funds to regions, and regional decision makers then allocate those funds to specific programs. Often, funds are allocated proportionally (e.g., in proportion to HIV incidence) rather than efficiently (i.e., to maximize HIV infections averted). The authors investigate the impact of efficient and proportional allocation methods at 2 different decision levels. Methods. The authors developed an optimization model of resource allocation at 2 levels—an aggregate upper level and multiple local levels—and considered efficient allocation and allocation proportional to HIV incidence. Using data from 40 U.S. states, they compared 4 strategies for allocating HIV prevention funds. Results. The greatest health benefit (HIV infections averted) occurred when efficient allocations were made at both levels. When funds were allocated proportionally at the higher level and efficiently at the lower level, the health benefit was about 5% less than when efficient allocations were made at both levels. When funds were allocated efficiently at the higher level and proportionally at the lower level, the health benefit was 15% less than when efficient allocations were made at both levels. The least health benefit (23% less than when efficient allocations were made at both levels) occurred with proportional allocation at both levels. Conclusions. Efficient allocation only at the higher level cannot overcome poor allocations at lower levels. Moreover, efficient allocation at the lower level is likely to yield greater gains than efficient allocation at the higher level. Thus, upper-level decision makers, such as donor organizations, should develop incentives to promote efficient allocation by lower-level decision makers.

Suggested Citation

  • Gregory S. Zaric & Margaret L. Brandeau, 2007. "A Little Planning Goes a Long Way: Multilevel Allocation of HIV Prevention Resources," Medical Decision Making, , vol. 27(1), pages 71-81, January.
  • Handle: RePEc:sae:medema:v:27:y:2007:i:1:p:71-81
    DOI: 10.1177/0272989X06297395
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    Citations

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    Cited by:

    1. Alastair I Matheson & Lisa E Manhart & Patricia B Pavlinac & Arianna R Means & Adam Akullian & Gillian A Levine & Julie Jacobson & Erin Shutes & Judd L Walson, 2014. "Prioritizing Countries for Interventions to Reduce Child Mortality: Tools for Maximizing the Impact of Mass Drug Administration of Azithromycin," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-6, May.
    2. Stephanie Earnshaw & Katherine Hicks & Anke Richter & Amanda Honeycutt, 2007. "A linear programming model for allocating HIV prevention funds with state agencies: a pilot study," Health Care Management Science, Springer, vol. 10(3), pages 239-252, September.
    3. Linus Nyiwul, 2021. "Epidemic Control and Resource Allocation: Approaches and Implications for the Management of COVID-19," Studies in Microeconomics, , vol. 9(2), pages 283-305, December.
    4. Xuecheng Yin & İ. E. Büyüktahtakın, 2021. "A multi-stage stochastic programming approach to epidemic resource allocation with equity considerations," Health Care Management Science, Springer, vol. 24(3), pages 597-622, September.
    5. Monali Malvankar-Mehta & Bin Xie, 2012. "Optimal incentives for allocating HIV/AIDS prevention resources among multiple populations," Health Care Management Science, Springer, vol. 15(4), pages 327-338, December.
    6. Natalie Privett & Feryal Erhun, 2011. "Efficient Funding: Auditing in the Nonprofit Sector," Manufacturing & Service Operations Management, INFORMS, vol. 13(4), pages 471-488, October.
    7. Margaret Brandeau & Gregory Zaric, 2009. "Optimal investment in HIV prevention programs: more is not always better," Health Care Management Science, Springer, vol. 12(1), pages 27-37, March.

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