Economic Burden of HIV and AIDS on Productivity and Household Welfare in Ghana

Abstract

A chasm exists between HIV policy and effective implementation of interventions on the field calling to question Ghana’s ability to meet the fast track 90-90-90 target which seeks to end AIDS by 2030. In contributing to the advocacy debate, this study aims to comprehensively appraise the economic impact of HIV on the Ghanaian society by addressing four concerns: Estimating the impact of HIV on the Ghanaian economy, explaining how HIV affects the economic conditions of Ghanaian households, computing the total societal cost for one person living with HIV in Ghana and illustrating how persons living with HIV and AIDS experience and cope with HIV. The study deployed a sequential explanatory design to document the economic burden of HIV in Ghana. The pragmatic approach deployed a retrospective mixed methods technique which leveraged structural corroboration throughout the sections of the study for purposes of cross validation. To investigate the economic impact of HIV on GDP in Ghana for the period 1990 to 2019 a classical double log Cobb Douglass function was used while the Cost of Illness approach (COI) was relied upon to compute the economic burden of HIV on households. The COI approach further allowed for the compounding of institutional and household costs to establish a unit cost of HIV per PLHIV in Ghana. Additionally, a narrative approach was used to appraise the intangible burden and coping strategies of PLHIV households for addressing pain and scaling up social participation for themselves and their caregivers. Results The study found an overwhelming burden of HIV in Ghana with significant opportunities to optimise HIV and AIDS interventions, bridging the gap between policy and practice without increasing the current investment portfolio for the national programme. The study finds significant but declining growth inhibiting as well as welfare, freedom and productivity depleting effects of HIV and AIDS in Ghana. Noticeable differences between PLHIV households and the general population were found, confirming the abiding economic burden of HIV in Ghana. Disease intensity and productivity were not sensitive to many demographics except for pre and post diagnosis household welfare which showed significant influence on disease outcomes and longevity of PLHIV. Catastrophic health expenditure (CHE) has declined over the years but remains high even among wealthy communities. Using the threshold of 40 percent ability to pay, 18 percent of all PLHIV in the Greater Accra region and 35 percent of all PLHIV in other regions experienced CHE. Unit costs of HIV per year amount to US$1,380 out of which OOP household expenditure accounts for 77 percent. Indirect costs predominate OOP expenditure while institutional expenditure is accounted for primarily by direct costs. Two thirds of institutional expenditure is comprised of human resource and other overhead costs. Significant opportunities for scaling up cost effectiveness and improving compliance with ART protocols remain.