Efficiency and Effectiveness: Making Smart Investments to Save More Lives

Content From: Marie McLeod, Director of Country Support, PEPFAR, and Martin Sirengo, MMed, The National AIDS and STIs Control Programme (NASCOP), KenyaPublished: May 31, 20133 min read


The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is supporting partner countries to promote efficiency and effectiveness in their national HIV programming. This includes supporting countries to make smart investments by identifying strategies that have the greatest impact and save the most lives. It also includes supporting partner countries to use evidence to make critical decisions that affect health services.

PEPFAR works with partner countries to find solutions that support national health priorities. Countries examine the performance of current and planned programs, looking at program cost, efficiencies, effective interventions, and local context. PEPFAR strengthens country-led programs by providing tools and information to decision-makers, creating action plans to achieve desired outcomes, and building local capacity. With trained staff working with tools that can be updated and adjusted, national health programs can more closely monitor program efficiency and effectiveness.

For example, in Kenya, the Government of Kenya wanted to promote efficiency and better allocate resources based on impact. With PEPFAR support through USAID’s Health Policy Project, a technical working group was formed to analyze the efficiency and effectiveness of HIV programs, and assess potential gains across the Kenyan HIV/AIDS response. The working group included representatives from the National AIDS Control Council and National HIV/AIDS and STD Control Program of Kenya, and other agencies.

The group conducted an analysis of prevention of mother-to-child HIV transmission (PMTCT) programs that examined the cost implications and effectiveness of various PMTCT regimens. This cost-effectiveness analysis helped to identify the most efficient strategies for averting HIV infections. The analysis found that one available option would not increase the number of infections averted, while other options would prevent more infections but would require additional resources.

With the data in hand on costs and impact, the Government of Kenya was able make a fully-informed decision on their prevention program. They opted to implement Option B+, a simplified test and treat approach to PMTCT for HIV-positive pregnant women. Option B+ not only helps prevent mother-to-child transmission, but it also can help avert adult infections due to the use of antiretroviral treatment, which is proven to reduce the spread of HIV. The data for Kenya showed that Option B+ could avert 3,600 to 5,800 additional infant infections, and 8,300 to 10,600 additional adult infections compared to the Government’s existing PMTCT approach – ultimately saving more lives.

A similar analysis is being conducted to inform the Government of Kenya’s rollout of pre-exposure prophylaxis to key populations and serodiscordant couples. More broadly, this approach to examining the efficiency and effectiveness of health programs is now being used in Kenya’s malaria program, and will subsequently be replicated in other health programs. In 2013, analyses of efficiency and effectiveness are also being implemented in other African countries, including Mozambique.