Skip to main content

01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

How much can we gain from improved efficiency? An examination of performance of national HIV/AIDS programs and its determinants in low- and middle-income countries

BMC Health Services Research > Ausgabe 1/2012
Wu Zeng, Donald S Shepard, Jon Chilingerian, Carlos Avila-Figueroa
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-74) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

All authors have made substantial contributions to the intellectual content of the paper. WZ contributed to the conception and design, acquired the data, analyzed and interpreted the data, and drafted and revised the manuscript. DSS contributed to the conception and design of the study, acquired the data, interpreted the data, and critically revised the manuscript. JC contributed to the critical revision of the manuscript for important intellectual content, and provided technical support. CA contributed to the acquisition of data, interpretation of data, obtaining funding, and providing technical support. All authors read and approved the final manuscript.



The economic downturn exacerbates the inadequacy of resources for combating the worldwide HIV/AIDS pandemic and amplifies the need to improve the efficiency of HIV/AIDS programs.


We used data envelopment analysis (DEA) to evaluate efficiency of national HIV/AIDS programs in transforming funding into services and implemented a Tobit model to identify determinants of the efficiency in 68 low- and middle-income countries. We considered the change from the lowest quartile to the average value of a variable a "notable" increase.


Overall, the average efficiency in implementing HIV/AIDS programs was moderate (49.8%). Program efficiency varied enormously among countries with means by quartile of efficiency of 13.0%, 36.4%, 54.4% and 96.5%. A country's governance, financing mechanisms, and economic and demographic characteristics influence the program efficiency. For example, if countries achieved a notable increase in "voice and accountability" (e.g., greater participation of civil society in policy making), the efficiency of their HIV/AIDS programs would increase by 40.8%. For countries in the lowest quartile of per capita gross national income (GNI), a notable increase in per capita GNI would increase the efficiency of AIDS programs by 45.0%.


There may be substantial opportunity for improving the efficiency of AIDS services, by providing more services with existing resources. Actions beyond the health sector could be important factors affecting HIV/AIDS service delivery.
Authors’ original file for figure 1
Authors’ original file for figure 2
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2012

BMC Health Services Research 1/2012 Zur Ausgabe