HIV allocative efficiency studies are generally posing the question “How can HIV funding be optimally allocated to the combination of HIV response interventions that will yield the highest impact?”. In this context the government of Zambia approached the World Bank with a request to conduct an allocative efficiency analysis to inform the revised national AIDS strategic framework (R-NASF), prioritisation of the HIV response, and value for money considerations in the context of resource mobilisation. Four main policy questions were posed: (1) What are the estimated and projected HIV epidemic trends until 2030 and the transmission dynamics between sub-populations? (2) What is the optimised HIV resource allocation to minimise HIV incidence and AIDS mortality between 2014 and 2030? (3) What is the minimum spend required to meet moderate or ambitious national strategic impact targets? (4) What are the long-term financial commitments of HIV treatment and healthcare costs?
Zambia, recently reclassified as a low- and middle-income country (LMIC), had an estimated total population of 14.08 million in 2012. The country enjoys positive annual GDP growth—at 6.4% in 2013—and a fairly stable macroeconomic situation. Nevertheless, income levels are highly skewed and in 2010, 60.5% of the population were living below the national poverty line, which impacts negatively on health.