1. How Can Civil Society Measure Value for Money and Prove Its Worth? Amanda Glassman Center for Global Development July 26, 2012

2. Outline  Investment Framework  Current Spending Levels  Cost-Effectiveness: What Do We Know?  Going Forward

3. Community Mobilization Community Centered Design and Delivery Community Systems Source: Schwartlander et al. “Towards an improved investment approach for an effective response to HIV/AIDS” Lancet 2011: 377:2031-41

4. Conceptual Framework MANAGEMENT INFORMATION SYSTEMS Quality of care EFFICIENCY Cost/Output EFFICACY Cost/Outcome “in the lab” EFFECTIVENESS Cost/Outcome in practice IMPACT

5. Current Spending Levels Global Fund Round 10 Proposals, Requested Disbursements Source: Round 10 Call for Proposals: Community Systems Strengthening, 2011

6. What CSS Entails for the GF Source: Round 10 Call for Proposals: Community Systems Strengthening, 2011

7. Investment Framework Source: Schwartlander et al. “Towards an improved investment approach for an effective response to HIV/AIDS” Lancet 2011: 377:2031-41

8. …but is it cost-effective? Type of Intervention HIV Prevention Efficacy TOTAL Positive Effect Adverse Effect No Effect Behavioral --- 77 Structural: Microfinance, CCT 1---23 Diaphragm --- 11 Topical Agents (microbicides) Non-ARV based ARV-based PrEP --- 1 1 --- 11 --- 12 1 Systemic, oral PrEP 3---36 Treatment for prevention 1--- 1 Male circumcision 3---14 STI Treatment 1---89 Vaccines 1---34 Total 1113648 Source: Padian, McCoy, Karim, et al. Lancet 2011;378:269-78 and updated with latest trial results.

9. QualityPoorFairGood Impact Largest impact Some impact Potential impact No evidence of impact Counseling and Testing 24% Prevention with Positives 1% Tx as Prevention ? Male Circumcision 5% MSM – 1% Abstinence 8% Peer Ed. 7% STI TX 1% Inj. and non-Inj. Drug Use 0.3% Female Sex Workers 5% PMTCT 25% Mass Media 9% Small impact of CSS interventions Source: Padian, McCoy, Karim, et al. Lancet 2011;378:269-78 and updated with latest trial results.

10. Issues: Going Forward  No impact evaluation; not enough data