How could HIV and AIDS resources be allocated to achieve the greatest possible impact? This paper begins with a theoretical discussion of this issue, describing the key elements of an “evidence-based allocation strategy.” While it is noted that the quality of epidemiologic and economic data remains inadequate to precisely define such an optimal strategy, there do exist tools and research which can lead countries in a way that they can make better allocation decisions. Furthermore, there are clear indications that most countries are not allocating their HIV and AIDS resources in a way which is likely to achieve the greatest possible impact. For example, it is noted that neighboring countries with a similar prevalence of HIV nonetheless often allocate their resources in radically different ways.
These differing allocation patterns appear to be attributable to a number of different issues, including a lack of data, contradictory results in existing data, a perceived need to overemphasize a multisectoral response, a lack of political will, a general inefficiency in the use of resources when they do get allocated, poor planning and a lack of control over the way resources get allocated.
There are a number of tools currently available which can improve the resource allocation process. Tools such as the Resource Needs Model (RNM) can provide policymakers with a clearer idea of resource requirements, whereas other tools such as Goals and the Allocation by Cost-Effectiveness (ABCE) models can provide countries with a clearer vision of how they might reallocate funds.
Next, examples from nine different countries provide information about how countries are trying to make their resource allocation strategies more “evidence based”. By identifying the challenges and successes of these nine countries in making more informed allocation decisions, it is hoped that future resource allocation decisions for all countries can be improved.
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