Calculating indirect costs from international PEPFAR implementing partners

Abstract

BackgroundUNAIDS estimates global HIV investment needs in low- and middle-income countries (LMICs) at $26 billion per year in 2020. Yet international financing for HIV programs has stagnated amidst despite the increasing number of people requiring and accessing treatment. Despite increased efficiencies in HIV service delivery, evaluating programs for greater efficiencies remains necessary. While HIV budgets have been under scrutiny in recent years, indirect costs have not been quantified for any major global HIV program, but may constitute an additional avenue to identify program efficiencies. This analysis presents a method for estimating indirect costs in the President’s Emergency Plan for AIDS Relief (PEPFAR).MethodsUtilizing PEPFAR country operational plan (COP) funding data from 2007 to 2016 for international organizations (IOs) and universities and standard regulatory cost bases, we calculated modified total direct costs on which indirect cost rates may be applied by partner and funding agency. We then apply a series of plausible indirect cost rates (10%–36.28%) to develop a range for total indirect costs that have accrued over the period.FindingsOf $37.01 billion in total COP funding between 2007 and 2016, $22.24 billion (60.08%) was identifiably allocated to IOs ($17.95B) and universities ($4.29B). After excluding funding for sub-awards ($1.92B) and other expenses ($3.89B) to which indirect rates cannot be applied, $16.44B remained in combined direct and indirect costs. From this, we estimate that between $1.85B (8.30% of total international partner funding) and $4.34B (19.51%) has been spent on indirect costs from 2007–2016, including $157-$369 million in 2016.InterpretationTo our knowledge, this is the first analysis to quantify the indirect costs of major implementing partners of a global HIV funder. However, lack of transparency in the indirect cost rates of non-University international partners creates an opaque layer of programmatic costs. Given the current funding environment and evolution of HIV programming in PEPFAR countries, the findings motivate a re-examination of the current policies and the return on investment in indirect cost recovery across the PEPFAR program.

Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States

“…Materials costs for both the modified partner services and the social network strategy included standard costs (printing, phone, social media messaging charges), as well as incentives for the visit and referral of others. Overhead costs were included at 20% across all strategies [22]. A list of costs and assumptions can be found in Table 1.…”

Quantifying the cost of in-kind contributions to a multidonor-funded health research capacity-building programme: the case of the Consortium for Advanced Research Training in Africa

“…Further the analysis conducted to assess university contributions in the PEPFAR (The U.S. President's Emergency Plan for AIDS Relief) study excluded African universities due to lack of sufficient data. 22 A report by the Association of Commonwealth Universities (2013) described the nature of various contributions made by African governments and universities to donor-supported doctoral training programmes across the continent but did not quantify their monetary value. 23 Attempts at quantifying the value of such contributions raise methodological challenges, are time consuming and are hampered by the limited documentation and challenges in validation of actual time spent by university faculty and staff on such programmes.…”

“…23 Attempts at quantifying the value of such contributions raise methodological challenges, are time consuming and are hampered by the limited documentation and challenges in validation of actual time spent by university faculty and staff on such programmes. 22 Recently, a study documented 30 funders who supported health research capacity building in sub-Saharan Africa, 24 indicating that there is the possibility to apply or adapt our approach to many other programmes. This paper is a case study which seeks to quantify the in-kind contributions of members of the Consortium for Advanced Research Training in Africa (CARTA) to the implementation of the programme.…”