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Cost analysis of an ARV care programme reaching universal access in Thyolo, Malawi
Presented by Marielle Bemelmans (Malawi).
G. Jouquet1, M. Bemelmans2, M. Massaquoi2, L. Arnould1, B. Mwagomba3, A. Bauernfeind1, M. Philips1
1Medecins Sans Frontieres-Belgium, Brussels, Belgium, 2Medecins Sans Frontieres-Belgium, Thyolo, Malawi, 3Ministry of Health, District Health Office, Thyolo, Malawi
Background: In a MoH-MSF supported HIV/AIDS programme in Thyolo, a high prevalence (21%) rural district in Malawi, universal access was reached with 11,520 patients ever started of which 79% are alive on ART at the end of 2007.
Scale-up was possible through extensive reorganisation of care, including decentralisation to health centres, community involvement, simplification, standardisation and task shifting.
This cost analysis looks at additional recurrent costs required for HIV/AIDS care, including ART, complementary to existing district health services.
Methods: A retrospective cost analysis of operational expenses for the entire HIV care programme was done over a period of 3 years (2005-2007), expressed as costs per number of active patients on ART. Data collection was based on MoH-MSF management tools.
Figures for 2007, the year of reaching universal access, are presented.
Results: The average annual recurrent costs for direct care per patient on ART was $237. The major part related to drugs with $158 for ARVs (67%) and other essential drugs (14%). Costs linked to consultation (13%) included mainly staff salaries ($19) and other running costs ($10). Laboratory costs accounted for only 6%.
Conclusions: In this programme, the average annual costs per patient on ART are mainly determined by the costs of drugs. Further price reductions could have a major impact on overall costs.
The human resource shortages and a high patient:staff ratio in Malawi leads to disproportional low personnel costs.
In this high prevalence district with a population of 600.000, the average annual cost for achieving universal access to ART is $3.2 per inhabitant. The current national health expenditure per capita is $13.2 p/year while the cost of the essential health package was estimated at $17.4 per inhabitant p/year (2004). Universal access to ART was reached for an additional $2.5 per capita, well within the estimated minimal basic health package costs (WHO).
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