2014年-世界发展银行全球_Using_Budgeting_for_Results_in_HIVAIDS_Programs___Lessons_from_Peru_4页_999kb

HIV/AIDS Program in Peru: Summary of Key Findings and Budgeting for Results

Core Content

Peru has made significant progress in reducing the HIV/AIDS burden over the past decade, particularly from 2000 to 2010, where the country saw a 43 percent reduction in HIV/AIDS cases. This was largely attributed to the introduction of free antiretroviral (ART) therapy in 2004 and the implementation of the 2007-2011 HIV/AIDS Strategy, which emphasized budgeting for results (BFR).

Main Points

1. HIV/AIDS Prevalence and Trends

• The HIV prevalence in Peru was estimated at 0.4 percent in 2010, below the Latin American and Caribbean (LAC) regional average of 0.5 percent.
• From 1983 to 2012, the number of reported HIV cases and deaths increased rapidly, but the Ministry of Health (MOH) reported a decline in new cases since 2008.
• As of December 31, 2012, 48,809 HIV cases and 29,454 AIDS cases had been reported, though these numbers may be an underestimation due to many people living with HIV (PLWHA) not knowing their status.
• UNAIDS estimates that there are around 76,000 PLWHA in Peru, while a World Bank-funded study estimates 67,000 people living with HIV/AIDS in 2013.

2. Budgeting for Results (BFR) and Equity in Coverage

• Since 2011, the Ministry of Finance (MEF) has implemented BFR, which links public budgets with service delivery to high-risk groups.
• BFR has improved equity in coverage, especially among women of childbearing age in the poorest quintiles (1-2), where knowledge about HIV transmission from mother to fetus increased from 30% in 2004 to 46% in 2012.
• The general ART coverage increased to 66%, while ART coverage for infected pregnant women reached 59% in 2012, and 75% of pregnant women were tested during antenatal care.
• However, only 18% of infected children are being treated, and native Amazon communities, an emerging at-risk group, are not adequately addressed in the program.

3. Costs and Resource Allocation

• The unit cost of adult HIV treatment in 2013 was US$409, with US$294 for ART and US$115 for medical consultations.
• The unit cost for children was US$555, with US$440 for ART (50% more expensive than adult ART) and US$115 for medical consultations.
• The cost of HIV testing for pregnant women was estimated at US$9, while screening, condom distribution, and peer Community Health Workers (CHWs) had a unit cost of US$103.
• From 2011 to 2013, the public system allocated 79% of total costs to high-risk groups, and 44% of program expenditures were directed to these groups through MEF.

4. Programmatic Innovations and Challenges

• The MEF has been central in decentralizing public HIV/AIDS financing, directly allocating funds to the MOH, regional governments, DIRESAs, and hospitals.
• Human resources, particularly Community Health Workers (CHWs), remain a key limitation in Peru's HIV response.
• CHWs are essential for reaching vulnerable populations, but their limited numbers and lack of integration into the formal health system pose challenges.
• The total cost of scaling up the program and closing the coverage gap among high-risk groups is estimated at US$32 million over the period 2014–2016.

Key Lessons from Peru

• Decentralized public financing is crucial for increasing equity in service coverage.
• ART coverage and laboratory capacity are vital for reducing HIV transmission among high-risk populations.
• Budgeting for results (BFR) enhances accountability and linking spending with outcomes.
• Community Health Workers (CHWs) should be considered as part of a strategic human resources plan, especially for vulnerable groups.
• Culturally appropriate interventions are necessary for native Amazon populations.

Challenges

• Only 44% of program expenditures are directed to high-risk groups.
• 43–48% of eligible infected individuals are receiving ART under WHO 2013 guidelines.
• Limited CHW numbers may hinder progress in HIV/AIDS reduction.
• Cultural and linguistic barriers exist for indigenous populations, requiring tailored strategies.

Conclusion

Peru’s HIV/AIDS program has demonstrated the effectiveness of budgeting for results, decentralized financing, and targeted interventions in reducing the disease burden. However, continued efforts are needed to address coverage gaps, improve human resources, and ensure equitable access to services, especially for high-risk and marginalized groups.