1. 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 Forsythe Health Policy Initiate, Task Order 1

2. Why Cost OVC Programs? Budgeting for current and future needs Resource allocation Understand what are the cost drivers Cost-effectiveness analysis

3. Background: Comparison of Two Countries EthiopiaBotswana Population82,950,0002,070,000 GDP per Capita$358$7,403 Adult (15-49) HIV Prevalence1.5%25% Population per km723 Cost of 1 liter of milk$0.85$1.63 Children orphaned by all causes5,450,000130,000 Orphans per capita6.6%6.3% Total Adult Literacy3084 2

4. Approach

5. Sites Costed 19 Sites Costed in Ethiopia 19 Sites Costed in Botswana

6. Location of Costed OVC Sites

7. Costing Approach Economic Costing – All resources were assigned a value, including donated items Initial study not designed to assess effectiveness of services

8. 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

9. Results

10. Cost per OVC Reached

11. Median Number of OVC Reached

12. Variation in Unit Cost by Scale

13. Percentage of Children Receiving Each Service

14. Unit Cost by Service

15. Distribution of Costs

16. Conclusions

17. 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.

18. 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.

19. Conclusions (3) The analysis cannot determine which program is more cost-effective, but this cost analysis is the first step in evaluating cost-effectiveness.