Antiretroviral Therapy in Botswana: Comparing Costs, Service Utilization, and Quality at Three Levels of Care

Resource Type: Brief
Authors: Heather Cogswell, Sharon Nakhimovsky, Jose Gutierrez, Sophie Faye, Christopher Cintron, Romana Haider, and Carlos Avila
Published: September 2016

Resource Description: Under Botswana’s ambitious Treat All Strategy, nearly 350,000 people living with HIV will require antiretroviral therapy (ART) by 2020. With almost half of Botswana’s health expenditure already allocated to HIV, the Ministry of Health (MOH) will need to mobilize additional resources and achieve efficient use of available resources to sustain successful ART coverage. To support the MOH, the USAID-funded Health Finance and Governance project (HFG) estimated costs and service utilization of adult outpatient ART care at Botswana’s public health facilities. With patient numbers already rising under “Treat All,” understanding the current cost variations is essential to identify opportunities to improve efficiency and for the future sustainability of Botswana’s ART programming.

HFG collected data from 120 facilities providing adult ART outpatient services in Botswana, including all 29 hospitals in the country and a representative sample of 73 clinics and 18 health posts. Clinical records from each facility were examined for a probability sample of 2,241 patients on 1st line ART and 152 patients on 2nd line ART. HFG estimated that, in 2014, the national average ART unit cost was US$283 (BWP2,540) per patient per year.



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