Social Return on Investment: A Cost-Benefit Analysis of the HIV Integrated Care and Prevention Programs in Cambodia

Sovannary Tuot^{1, 2,} , Liza Tong³, Sopheab Heng⁴, Minh-Anh Luong⁵, Khuondyla Pal¹, Pheak Chhoun¹, Khimuy Tith⁶, Chanrith Ngin¹ and Siyan Yi^{1, 5}

¹Center for Population Health Research, KHANA, Cambodia

²Royal University of Phnom Penh, Cambodia

³International HIV/AIDS Alliance, UK

⁴School of Public Health at the National Institute of Public Health, Cambodia

⁵Center for Global Health Research, Public Health Program, Touro University California, USA

⁶Programs Department, KHANA, Cambodia

Cite this paper:
Sovannary Tuot, Liza Tong, Sopheab Heng, Minh-Anh Luong, Khuondyla Pal, Pheak Chhoun, Khimuy Tith, Chanrith Ngin and Siyan Yi. Social Return on Investment: A Cost-Benefit Analysis of the HIV Integrated Care and Prevention Programs in Cambodia. American Journal of Medical Sciences and Medicine. 2016; 4(2):26-35. doi: 10.12691/ajmsm-4-2-2

Abstract

Background: KHANA’s HIV Integrated Care and Prevention (ICP) project provided comprehensive care and support to HIV-affected communities through home and community-based care teams from 2007 to 2011. The aim of this study was to use Social Return on Investment (SROI) methodology to evaluate the social, health, and economic impacts of the ICP project, enabling the calculation of a ratio cost-to-benefit for the community in terms of HIV care, support, and treatment. Methods: The SROI methodology is a social cost-benefit analysis framework that measures and accounts for the values created by a program or series of initiatives. Values were mapped to common outcomes of the project, which were defined by key beneficiaries during a community consultation exercise. Five stages were used to calculate the SROI: establishing scope and identifying key stakeholders, mapping project outcomes, assigning a financial value to project outcomes, establishing project impact, and calculating inputs. Results: A combined five-year investment of approximately US$2,406,000 from the European Commission (EC), plus US$1,957,934 from the World Food Programme (WFP) and community inputs, generated total benefits worth US$10,894,835, after adjusting for the discount rate and Purchasing Power Parity (PPP). Monetized outcome values ranged from $30, avoided cost of informal school fees paid by orphans and vulnerable children (OVC), to $1,200, avoided burden of debt and asset loss caused by health costs prior to diagnosis. Beneficiaries gaining the most outcome value were people living with HIV (PLHIV), OVC, and their families (food security outcome 51% of total value, PLHIV 32%, and OVC 9%). The Return on Investment (ROI) was 1:2—every $1 invested in the ICP generated a return of approximately $2 worth of social, health, and economic value. Conclusions: The ICP program yielded substantial impacts in food security, wellbeing, improved health, and improved productive capacity, which enabled greater economic returns for the households. Results of this study have been used to inform project management, implementing partners, and policy-makers to further explore areas of benefit for PLHIV, OVC, and their families.

Keywords:
cost-benefit analysis integrated care and prevention HIV SROI Cambodia

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	UNAIDS, Joint United Nations Program on HIV/AIDS. Global AIDS response progress reporting 2014: construction of core Indicators for monitoring the 2011 United Nations political declaration on HIV and AIDS. Geneva, Switzerland: UNAIDS; 2014.
[2]	Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., Aboyans, V., et al. “Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010”. Lancet 2012; 380(9859): 2095-128.
[3]	Trapero-Bertran, M., Oliva-Morena, J. “Economic impact of HIV/AIDS: a systematic review in five European countries”. Health Economic Review 2014; 4(15).
[4]	Hutchinson, A.B., Farnham, P.G., Dean, H.D., Ekwueme, D.U., Rio, C., Kamimoto, L., et al. “The economic burden of HIV in the United States in the era of highly active antiretroviral therapy: evidence of continuing racial and ethnic differences”. Journal of Acquired Immune Deficiency Syndrome 2006; 43(4): 451-7.
[5]	UNAIDS, Joint United Nations Program on HIV/AIDS. How AIDS changed everything. Geneva, Switzerland: UNAIDS; 2015.
[6]	The Henry J. Kaiser Family Foundation, UNAIDS. Financing the response to HIV in low- and middle-income countries: International assistance from donor governments in 2012. Menlo Park, California: The Henry J. Kaiser Family Foundation; 2013.
[7]	Rich, M.L., Miller, A.C., Niyigena, P., Franke, M.F., Niyonzima, J., Socci, A., et al. “Excellent clinical outcomes and high retention in care among adults in a community-based HIV treatment program in rural Rwanda”. Journal of Acquired Immune Deficiency Syndromes 2012; 59(3): 35-42.
[8]	Koenig, S., Ivers, L.C., Destine, R., Leandre, F., Grandpierre, R., Mukherjess, J., et al. “Successes and challenges of HIV treatment programs in Haiti: aftermath of the earthquake”. HIV Therapy 2010; 4(2): 145-160.
[9]	National Center for HIV/AIDS, Dermatology, and STDs (NCHADS). Estimation of the HIV Prevalence among General Population in Cambodia, 2014. Phnom Penh, Cambodia: NCHADS; 2015.
[10]	National Center for HIV/AIDS, Dermatology, and STDs (NCHADS). Annual report 2014. Phnom Penh, Cambodia: NCHADS; 2015.
[11]	UNAIDS, Joint United Nations Program on HIV/AIDS. Cambodia takes MDG prize for excellence in its AIDS response. Geneva, Switzerland: UNAIDS; 2010.
[12]	KHANA. KHANA Network Household Economic Livelihood Survey Analysis. Phnom Penh, Cambodia: KHANA; 2010.
[13]	UNDP. The Socio-Economic Impact of HIV/AIDS Epidemic at the Household Level in Cambodia. Phnom Penh, Cambodia: UNDP, Sanigest International, Center for Advance Studies; 2010.
[14]	New Economics Foundation (NEF). Social Return on Investment: Valuing What Matters, London: New Economics Foundation; 2004.
[15]	Cabinet Office. A guide to Social Return on Investment. London, UK: Cabinet Office, Office of the Third Sector; 2009.
[16]	Biswas, K., Kummarikunta, G., Biswas, A., Tong, L. Social return on investment: CHAHA programme. Hove, UK: International HIV/AIDS Alliance; 2010.
[17]	Brady, R. The true cost of stigma: evaluating the social return on investment of the stigma and discrimination component of the Alliance’s Africa Regional Programme II. Hove, UK: International HIV/AIDS Alliance; 2011.
[18]	Sopheab, H., Chhea, C., Tuot, S. Midterm review of the integrated care and prevention project regarding PLHIV and OVC. Phnom Penh, Cambodia: KHANA; 2010.
[19]	World Bank. Trading economics, Cambodia GDP per capita PPP US dollar, 2010. World Bank, 2010.
[20]	Harrison, M. Valuing the Future: the social discount rate in cost-benefit analysis, Visiting Researcher Paper, Productivity Commission, Canberra; 2010.
[21]	Heng, S., Chhea, C., Tuot, S. Mid-term review of the Integrated Care and Prevention Project (ICP) regarding people living with HIV (PLHIV) and orphans and vulnerable children (OVC). Phnom Penh, Cambodia: KHANA; 2010.
[22]	Heng, S., Tuot, S. End of project evaluation: Change in HIV Integrated Prevention, Care and Impact Mitigation Efforts from 2009-2011. Phnom Penh, Cambodia: KHANA; 2012.
[23]	The National Multi-sectoral Orphans and Vulnerable Children Task Force. Orphans, children affected by HIV and other vulnerable children in Cambodia: A situation and response assessment in 2007. Phnom Penh, Cambodia: National Multi-sector OVC Task Force; 2008.
[24]	Vaughan, K., Kok, M.C., Witter, S., Dieleman, M. Costs and cost-effectiveness of community health workers: evidence from a literature review. Human Resources for Health 2015; 13(71).
[25]	Viswanathan, M., Kraschnewski, J., Nishikawa, B., Morgan, L.C., Thieda, P., Honeycutt, A., et al. “Outcomes of community health worker interventions”. Evidence Report/Technology Assessment 2009; 181
[26]	KHANA. Children affected by HIV/AIDS: Appraisal of needs and resources in Cambodia. Summary report. Phnom Penh, Cambodia: KHANA; 2000.
[27]	Zhang, X., Li, M., Feng, Y., Bu, K., Fu, G., Liu, X., et al. “Study on economic burden caused by antiretroviral treatment for people living with HIV/ADIS and influencing factors in Nanjing”. Zhonghua Liu Xing Bing Xue Za Zhi 2015; 36(5): 440-444.
[28]	Barennes, H., Frichittavong, A., Gripenberg, M., Koffi, P. “Evidence of high out of pocket spending for HIV care leading to catastrophic expenditure for affected patients in Lao People’s Democratic Republic”. PLoS One 2015; 10(9).
[29]	Perelman, J., Alves, J., Miranda, A.C., Mateus, C., Mansinho, K., Antunes, F., et al. “Direct treatment costs of HIV/AIDS in Portugal”. Review. Revista de Saúde Pública. 2013; 47(5).
[30]	World Health Organization. Nutrition and HIV/AIDS. Geneva, Switzerland: WHO; 2005.
[31]	Anema, A., Vogenthaler, N., Frongillo, E.A, Kadiyala, S., Weiser, S.D. “Food insecurity and HIV/AIDS: current knowledge, gaps, and research priorities”. Current HIV/AIDS Reports 2009; 6(4): 224-231.
[32]	Ivers, L.C., Cullen, K.A., Freedberg, K.A., Block, S., Coates, J., Webb, P. “HIV/AIDS, undernutrition and food insecurity”. Clinical Infectious Disease 2009; 49(7): 1096-102.
[33]	Weiser, S.D., Tsai, A.C., Gupta, R., Frongillo, E.A., Kawuma, A., Senkungu, J., et al. “Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting”. AIDS 2012; 26(1): 67-75.
[34]	Weiser, S.D., Fernandes, K.A., Brandson, E.K., Lima, V.D., Anema, A., Bangsberg, D.R., et al. “The association between food insecurity and mortality among HIV-infected individuals on HAART”. Journal of Acquired Immune Deficiency Syndrome 2009; 52(3): 342-349.
[35]	Banke-Thomas, A.O., Madaj, B., Charles, A., van den Broek, N. “Social return on investment (SROI) methodology to account for value for money of public health interventions: a systematic review”. BMC Public Health 2015; 12(582).
[36]	Schwartlander, B., Stover, J., Hallett, T., Atun, R., Avila, C., Gouws, E., et al. “Towards an improved investment approach for an effective response to HIV/AIDS”. Lancet 2011; 377(9782): 2031-41.