Value for Money of Donor-Funded Health Programs: The Case of HIV/AIDS Programming in Mozambique

Abstract

Value for money represents a critical component of development assistance for health programming in low- and middle-income countries. The costs that local individuals pay to access and use these programs seldom figure into calculations of value for money, however. Instead, donor organizations and host-country governments often prioritize their perspectives of value for money in the planning, implementation, and evaluation of health programs. This imbalance affects beneficiary participation, diminishing the health and economic benefits of donor-funded programs. To understand how donor agencies, governments, and implementing organizations make decisions based on value for money, this project engaged in three arms of research: 14 semi-structured interviews; participant observation in the development of Mozambique’s fifth National Strategic Plan for HIV/AIDS Response; and a cost-effectiveness analysis of six HIV treatment interventions in Mozambique. The first of these methods aimed to analyze the definition and use of value for money in donor-funded health programs worldwide while the latter two methods situated the HIV/AIDS response in Mozambique within the greater global context. Based on this research, this project established six global themes: 1) value for money as a decision-making framework; 2) pressure on low- and middle-income countries to sustain programs; 3) limited temporal and technical scope of program evaluations; 4) current donor-funded initiatives to gather and analyze total economic costs of health activities; 5) limited data on the economic cost of healthcare for strategic planning; and 6) the economic, political, and moral case for considering beneficiary perspectives of value for money in decision-making. This project also identified and contextualized four cost-effective interventions for HIV treatment in Mozambique from the healthcare payer (i.e., government and donor) perspective as well as one cost-saving and one cost-effective intervention from the beneficiary (or patient) perspective. Given the widespread practice of considering value for money in decision-making, this project concluded with three recommendations for donor agencies, government bodies, and nongovernmental organizations in Mozambique and other low- and middle-income countries.