Calculating the Cost of Inaction: Using Economic Tools to Set Priorities for Supporting Children Affected by HIV/AIDS Chris Desmond FXB Center for Health and Human Rights

Goals and Pathways It is important to have clear goals for health. There are different ways of defining these goals and debates can be had. But even if the goals are agreed we need ways of evaluating how close alternative states are to these goals. If we can choose only intervention ‘a’ or ‘b,’ it helps to know which takes us closer to the goals. It is all well and good to say that we must get the resources to do both a and b – and we should – but what about while we are waiting for those resources?

False Science and False Criticism Economic analysis can help in identifying the relative value of alternative interventions. Economic analysis does not tell you which intervention you should do. You should agree with the conclusions of economic analysis to the extent that you agree with the values on which it is based. Often both economists and their critics ignore the foundation in values.

Alternative Foundations Efficiency and equity Efficient production of what? –Health? –Productivity? –Happiness? –Development? What is development? Equity of what? –Access or outcome? Whose priorities? –Our money, our priorities?

With or For Should outsiders work with or for the poor? If I am building a house, I welcome your help. Bring your skills, bring your ideas, bring your plans, and I will be grateful. But never forget that this is my house. True charity is for. True justice is with.

The Costs of Inaction The costs of inaction are relative to the action you think should have been undertaken. The first step, therefore, in identifying the costs of inaction is to identify desirable actions. What actions and how to determine their desirability?

Children Affected by HIV/AIDS Prevention of HIV among adolescents –Information provision or structural prevention HIV-specific services –Improved efficiency and access Family strengthening –Cash transfers or IGA Early childhood development –Centers or family learning

Summary Need to debate where we want to get to and how to get there. Economic tools can help keep policy makers on track – but they cannot identify the track. Priorities have to be set and trade-offs made, but we should be up front about the value judgments rather than hiding behind false science.

Solutions or Understanding Context matters Solutions can only take us so far Understanding can take us so much further Towards the Billion Minds Project?