AIDS 2012 - Turning the Tide Together

What Does it Cost to Raise an Orphan?

A Comparison of OVC Costs in Ethiopia and Botswana

Daniel Telake, Constance Formson, Steven ForsytheHealth Policy Initiate, Task Order 1

Why Cost OVC Programs?

• Budgeting for current and future needs• Resource allocation• Understand what are the cost drivers• Cost-effectiveness analysis

Background:Comparison of Two Countries

Ethiopia Botswana

Population 82,950,000 2,070,000

GDP per Capita $358 $7,403

Adult (15-49) HIV Prevalence 1.5% 25%

Population per km 72 3

Cost of 1 liter of milk $0.85 $1.63

Children orphaned by all causes 5,450,000 130,000

Orphans per capita 6.6% 6.3%

Total Adult Literacy 30 84

2

Approach

Sites Costed

• 19 Sites Costed in Ethiopia• 19 Sites Costed in Botswana

Location of Costed OVC Sites

Costing Approach

• Economic Costing – All resources were assigned a value, including

donated items• Initial study not designed to assess

effectiveness of services

Costing Approach

• All Costs Disaggregated to one of seven OVC Services– Economic Strengthening/Income Generation– Food & Nutrition– Shelter and Care/Clothing and Bedding– Education– Health Care– Psychosocial Support (PSS)– Child Protection/Legal Support

Results

Cost per OVC Reached

Ethiopia Botswana$0

$100$200$300$400$500$600$700$800$900

$1,000

$80

$946

Ethiopia

Median Number of OVC Reached

Ethiopia Botswana0

500

1,000

1,500

2,000

2,500

3,000

2,400

138

Variation in Unit Cost by Scale

0 1,000 2,000 3,000 4,000 5,000 6,000 7,000$10

$100

$1,000

$10,000

$100,000

Botswana Ethiopia

Number of OVC Reached/Year

Cost

per

OVC

Rea

ched

(US$

)

Percentage of Children Receiving Each Service

Economic S

trength

ening/I

GA

Food/N

utrition

Shelt

er & Care

Educati

on

Health

Care PSS

Child Protec

tion/Lega

l Support

0%

20%

40%

60%

80%

100%

7%

55%

15%

75%86% 86%

45%

9%

38%

5%

40%

11%

76%

1%

Ethiopia Botswana

Unit Cost by Service

Economic S

trength

ening/IGA

Food/N

utrition

Shelte

r & Care

Education

Health Care PSS

Child Protecti

on/Lega

l Support

$1

$10

$100

$1,000

$10,000

$181$64

$33 $21

$6 $4

$1

$220$433

$2,388

$512 $331 $220 $189

Ethiopia Botswana

Distribution of Costs

Ethiopia

Botswana

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

LaborMaterialsEquipmentTransportationOverhead

Conclusions

Conclusions

• The cost of the OVC program is substantially higher in Botswana (US$946) than in Ethiopia (US$80).

• Despite the lower cost in Ethiopia, the number of services provided per child is greater in Ethiopia.

Conclusions (2)• The higher cost in Botswana is in part due to

scale (Ethiopia’s OVC programs are, on average, 17 times larger than those in Botswana).

• The cost components in Botswana and Ethiopia are comparable, although Botswana’s program is more labor-intensive and Ethiopia’s programs have lower overhead costs.

• Some of the cost differences are due to cost of living, geographic and demographic differences.

Conclusions (3)

• The analysis cannot determine which program is more cost-effective, but this cost analysis is the first step in evaluating cost-effectiveness.