Financing continues to be a barrier to hepatitis elimination programmes being implemented at scale. Previous investment cases for hepatitis C elimination have shown that hepatitis C elimination is cost-effective, with savings in health systems achieved within a decade. However, much of the work to date has focussed solely on the investment case, leaving countries still facing the challenge of how to finance their viral hepatitis programme. To help address this the World Hepatitis Alliance (WHA) launched a financing for viral hepatitis programme in 2017.
Financing for hepatitis C in-country programme
Working with our members, governments and the Clinton Health Access Initiative (CHAI) we have costed a comprehensive hepatitis C programme, developed the investment case and, critically, explored different financing options in Nigeria, Cambodia and India Punjab State. Each of these health systems has made progress in the fight against hepatitis C but are not currently on track to eliminate by 2030, and required a data-driven investment case to support their plans.
Nigeria had launched a national programme but had yet to secure the financial resources to reach the programme targets within each state. The costing and investment case work highlighted that investing in their hepatitis C programme now could yield savings close to $1.6 billion USD by 2030, with a more aggressive elimination efforts achieving the most rapid and highest cost benefit in later years, despite the need for more investment at the start, mainly due to the significant number of new infections prevented.
Already in Nigeria, civil society has been using it to call for action at the national and state level. The national program has appointed state managers to ensure that hepatitis remains on the state’s health agenda. Importantly, in 2020, Nasarawa State in Nigeria committed to a five-year elimination target and began to allocate funding for the cause.
Moving forward WHA is continuing to work with our members on an advocating for greater domestic financing and further details on this project can be found here.
India Punjab State
India Punjab State had already established a hepatitis C program with a limited budget, however; although it was a regional leader in hepatitis C programming, the state needed an investment case to advocate for budget line expansion.
The investment case highlighted that further investment in their hepatitis C programme now could result in savings of close to $188 million USD by 2030. This investment case along with the detailed costing analysis has helped spot opportunities for the state program to further build on their strong hepatitis C program. The projections have also helped identify challenges that the program would face and how to mitigate these challenges once they scale up treatment.
Cambodia was looking to establish a national budget line in order to launch their hepatitis C programme. Sufficient program investment in Cambodia could yield savings close to $18.3 million USD by 2030.
Advocate and civil society efforts, bolstered by these analytical arguments for elimination, have begun to translate into action. The investment case has been utilized by the leading government department and shared with stakeholders to foster critical, ongoing discussions on 2021 budget advocacy.
National Viral Hepatitis Programme Financing Strategy Template
This website was launched by WHA in 2017 and it sets out the steps required to finance and cost a comprehensive viral hepatitis programme. It reflects the way in which we have developed and delivered the in-country work, setting out how to cost and create the investment case for a hepatitis programme before looking at financing options. A number of financing options, both domestic and external are explored as with no global fund for viral hepatitis, it is likely that countries may need to look at a number of different financing sources and strategies to fully fund national plans.
The website is a tool for both policy makers and civil society advocates.