Projecting the impact of AIDS Projecting the impact of AIDS on the education system on the education system

Accelerating the education sector response to Accelerating the education sector response to HIV/AIDS in AfricaHIV/AIDS in Africa

Sub-regional seminar on HIV/AIDS education, Mombasa, Kenya

12 November, 2002

Kamal Desai, PCD, Imperial College, London

Overview of this talkOverview of this talk

IntroductionIntroduction– Population-level effects of HIV/AIDSPopulation-level effects of HIV/AIDS– Impacts of HIV/AIDS on education systemsImpacts of HIV/AIDS on education systems– Need for projection modelsNeed for projection models

Situational analysis of HIV/AIDS on the population Situational analysis of HIV/AIDS on the population – example– example

Education sector analysis of HIV/AIDS – exampleEducation sector analysis of HIV/AIDS – example

Next steps -- refining estimates and sensitivity Next steps -- refining estimates and sensitivity analysisanalysis

IntroductionIntroduction

Population level effects of HIV/AIDS:Population level effects of HIV/AIDS:

Decline in fertility rates (20% decline TFR) Decline in fertility rates (20% decline TFR) Decline in life expectancy at birth (up to 15 years)Decline in life expectancy at birth (up to 15 years) Slower population growthSlower population growth Mother-to-child transmission (30-40%)Mother-to-child transmission (30-40%) Rise in numbers of orphansRise in numbers of orphans Shifting paradigms of new HIV infectionsShifting paradigms of new HIV infections . . .. . .

Introduction (2)Introduction (2)

00001-E-45– 27 June 2000

Changes in life expectancy in selected African countries with high HIV prevalence, 1950 to 2000

South-Africa

35

40

45

50

55

60

65

1950-55 1955-60 1960-65 1965-70 1970-75 1975-80 1980-85 1985-90 1990-95 1995-00

Botswana

Uganda

Zambia

Zimbabwe

Source: United Nations Population Division, 1998

Decline in life expectancy at birth for 5 eastern/southern Decline in life expectancy at birth for 5 eastern/southern African countries (source: UNAIDS 2001)African countries (source: UNAIDS 2001)

Introduction (3)Introduction (3)

The Impact of HIV/AIDS on Education :The Impact of HIV/AIDS on Education :

SupplySupply: in terms of numbers of teachers : in terms of numbers of teachers and the capacity to train themand the capacity to train them

DemandDemand: in terms of numbers and : in terms of numbers and characteristics of the school-age characteristics of the school-age populationpopulation

Introduction (4)Introduction (4)

Need for models:Need for models:

Enhance understandingEnhance understanding - to understand complex systems by - to understand complex systems by exploring the impact of assumptions which have to be made exploring the impact of assumptions which have to be made explicitexplicit

Estimate the impact of HIV/AIDSEstimate the impact of HIV/AIDS on education (teachers and on education (teachers and pupils) - predicting the probable present/future impacts of pupils) - predicting the probable present/future impacts of HIV/AIDS (especially in absence of field studies or other data HIV/AIDS (especially in absence of field studies or other data collection)collection)

Identify data requirementsIdentify data requirements -- for sensible planning in face of -- for sensible planning in face of HIV/AIDSHIV/AIDS

Impact of interventions - exploring their potential effectivenessImpact of interventions - exploring their potential effectiveness Assist planners to mitigate impact of HIV/AIDSAssist planners to mitigate impact of HIV/AIDS Powerful advocacy toolsPowerful advocacy tools

Introduction (5)Introduction (5)

Would like to estimate:Would like to estimate:

For country population – absolute numbers of For country population – absolute numbers of infecteds, HIV prevalence, incident cases by infecteds, HIV prevalence, incident cases by age/sex, AIDS cases, infants born with HIVage/sex, AIDS cases, infants born with HIV

For education sector – HIV prevalence in For education sector – HIV prevalence in teachers, AIDS-related attrition, absenteeism, teachers, AIDS-related attrition, absenteeism, required recruitment, school-aged children required recruitment, school-aged children orphaned by AIDSorphaned by AIDS

Situational Analysis of HIV/AIDS on Situational Analysis of HIV/AIDS on populationspopulations

based on SPECTRUM model (USAID, based on SPECTRUM model (USAID, Futures Group)Futures Group)

assumes UN Pop Div medium variant assumes UN Pop Div medium variant demographic assumptions (TFR, country-demographic assumptions (TFR, country-specific life tables)specific life tables)

HIV/AIDS epidemiological assumption HIV/AIDS epidemiological assumption (vertical transmission, life expectancy, (vertical transmission, life expectancy, fertility)fertility)

Situational Analysis (2) – country ASituational Analysis (2) – country A

Population of 11 millionPopulation of 11 million Annual growth rate 2.5%Annual growth rate 2.5% Life expectancy at birth 41 yearsLife expectancy at birth 41 years TFR = 6.0 births per femaleTFR = 6.0 births per female Adult HIV prevalence (ages 15-49) – 20% in 2001Adult HIV prevalence (ages 15-49) – 20% in 2001

Projected adult HIV prevalence

0%

5%

10%

15%

20%

25%

30%

1980 1985 1990 1995 2000 2005 2010 2015

Sentinel surveillance sites in ZambiaSentinel surveillance sites in Zambia

HIV prevalence in Zambia sentinel HIV prevalence in Zambia sentinel sitessites

Population of country A in presence and absence of Population of country A in presence and absence of HIV/AIDS (age groups and for 15-49 year age group)HIV/AIDS (age groups and for 15-49 year age group)

0

5

10

15

2019

80

1990

2000

2010

1980

1990

2000

2010

Year

Po

pu

lati

on

(m

illio

ns

)

Difference in absence of AIDS

In presence of AIDS

Total

15-49 year age group

•By 2015, the actual total population is predicted to be 14.1 million compared to 18.2 million in the absence of HIV/AIDS, a reduction of 22.5% due to the epidemic.•The 15-49 year age group will similarly experience 22% reduction

The absolute number infected with HIV and The absolute number infected with HIV and prevalence of HIV by sex prevalence of HIV by sex

0

200

400

600

800

1000

1200

1400

1600

1980 1985 1990 1995 2000 2005 2010 2015

Year

Nu

mb

er

infe

cte

d

(th

ou

sa

nd

s)

0

5

10

15

20

25

30

35

40

45

50

Pro

po

rtio

n (

%)

Number infected with HIV (both sexes)

Prevalence in menPrevalence in women

• Absolute number of HIV positive individuals in all age groups and in both sexes is 1.04 million in 2002, a figure growing to 1.51 million in 2015. • Prevalence is estimated at 21.2% in women and 17.7% in men in 2002 and is projected to remain essentially constant at this level to 2015

New HIV infections in men and women by New HIV infections in men and women by age-group in country A for years 1985, 2000 age-group in country A for years 1985, 2000 and 2015 and 2015

0

5

10

15

20

25

30

3510

-14

15-1

920

-24

25-2

930

-34

35-3

940

-44

45-4

950

-54

55-5

9

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

age-group

Inc

ide

nt

ca

se

s (

tho

us

an

ds

)

males females

1985 2000 2015

Annual number of infants contracting HIV due to mother-to-child Annual number of infants contracting HIV due to mother-to-child transmission and this number as a percentage of all births transmission and this number as a percentage of all births

0

5

10

15

20

25

30

35

40

1980 1985 1990 1995 2000 2005 2010 2015

Year

Nu

mb

er

of

infa

nts

bo

rn w

ith

HIV

(th

ou

sa

nd

s)

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

18.00%

20.00%

Pe

rce

nta

ge

(%

)

absolute number of infants born with HIV

percentage of newborns who are HIV positive

In 2002 there were 29 300 infants (6.8% of all births in the year) who were born HIV positive or who contracted HIV through breast feeding, a figure which will rise to 34 300 (6.8%) of infants born, in 2015

Education sector analysis of Education sector analysis of HIV/AIDSHIV/AIDS

Projections based on Ed-Sida modelProjections based on Ed-Sida model Developed by Dfid, IIEP, World Bank, PCDDeveloped by Dfid, IIEP, World Bank, PCD Previously employed in Burkina-Faso, Benin, Togo, Niger, Nigeria, The Previously employed in Burkina-Faso, Benin, Togo, Niger, Nigeria, The

Gambia, Ghana, Guinea, Senegal, ZambiaGambia, Ghana, Guinea, Senegal, Zambia

Model flows

HIV negative teachers

Recruitment x HIV prevalence

Recruitment x (1- HIV prevalence)

HIV incidence (may be teacher-specific)

retirement

retirement

mortality*

mortality*

*affected by HIV/AIDS

HIV positive teachers

Data requirements (I provide)Data requirements (I provide)

Country-specific mortality rates not due to AIDSCountry-specific mortality rates not due to AIDS

Mortality rates due to AIDS Mortality rates due to AIDS Age and sex stratified HIV prevalence and Age and sex stratified HIV prevalence and

incidenceincidence

Demographic ‘relational’ lifetables

Data requirements (you provide)Data requirements (you provide)

Total annual teacher numbers (by age and sex)Total annual teacher numbers (by age and sex) Annual number of new teachers recruited (by age / Annual number of new teachers recruited (by age /

sex)sex) Total attrition rateTotal attrition rate Primary school-age population (past and Primary school-age population (past and

projected)projected) GER (past and projected EFA target)GER (past and projected EFA target) Pupil-teacher ratio (past and projected EFA target)Pupil-teacher ratio (past and projected EFA target)

Data for Country A Data for Country A (UNESCO, UN Pop Div)(UNESCO, UN Pop Div)

1.1. Current number of teachers in active service-37000 in 2002Current number of teachers in active service-37000 in 20022.2. Current annual teacher recruitment-3600 new teachers in Current annual teacher recruitment-3600 new teachers in

200220023.3. Age and sex of newly recruited teachers to 2015-95% are of Age and sex of newly recruited teachers to 2015-95% are of

ages 20-29; 50% are womenages 20-29; 50% are women4.4. Attrition rate of teachers not due to AIDS or other mortality-Attrition rate of teachers not due to AIDS or other mortality-

1.0%1.0%5.5. HIV prevalence --19.5% in adult population (ages 15-49)HIV prevalence --19.5% in adult population (ages 15-49)6.6. School-aged population (ages 6-14)-2.68 million in 2000, School-aged population (ages 6-14)-2.68 million in 2000,

rising to 3.62 million in 2015.rising to 3.62 million in 2015.7.7. Target gross enrolment rate-81.7% in 2002, rising to 95% in Target gross enrolment rate-81.7% in 2002, rising to 95% in

2015.2015.8.8. Target pupil teacher ratio-60:1 in 2002, declining to 45:1 in Target pupil teacher ratio-60:1 in 2002, declining to 45:1 in

20152015..

Introduction (5)Introduction (5)

Would like to estimate:Would like to estimate:

For country population – absolute numbers of For country population – absolute numbers of infecteds, HIV prevalence, incident cases by infecteds, HIV prevalence, incident cases by age/sex, AIDS cases, infants born with HIVage/sex, AIDS cases, infants born with HIV

For education sector – HIV prevalence in For education sector – HIV prevalence in teachers, AIDS-related attrition, absenteeism, teachers, AIDS-related attrition, absenteeism, required recruitment, school-aged children required recruitment, school-aged children orphaned by AIDSorphaned by AIDS

Projection of the number of teachers

0

20000

40000

60000

80000

100000

120000

1995 2000 2005 2010 2015Year

Projected number ofteachers

Number of teacherswith HIV

Number of teacherswithout HIV

Absolute number ofteachers (data)

Number of teachers inabsence of HIV/AIDS

The total teaching population will have to rise to 75 500 teachers by 2015 in order to achieve a pupil-teacher ratio of 45:1, and to meet 95% gross enrolment rates.

For 2002, 8400 teachers are estimated HIV positive (prevalence of 22.6% in teachers). By 2015, the number of teachers infected with HIV will grow to 17 000 (22.75%) of teachers.

Teacher attrition due to AIDS mortality and other causesTeacher attrition due to AIDS mortality and other causes

0

1000

2000

3000

4000

5000

6000

Year

No

. o

f te

ach

ers

Attrition -- other causes

Attrition due to AIDS

• In 2002 the total annual attrition in the teaching population was 1 900 teachers (all causes), while attrition due to AIDS deaths is 820 (43%).• These figures will grow to 3 500 total annual attrition in 2015, of which 1600 are due to AIDS mortality (46%).

Teacher absenteeism due to AIDS under medium, low and high rates of Teacher absenteeism due to AIDS under medium, low and high rates of HIV infectionHIV infection

0

500

1000

1500

2000

2500

3000

1995 2000 2005 2010 2015

year

teac

her

-yea

rs

medium scenario

low scenario

high scenario

• 840 teacher-years of absenteeism will be incurred in 2002 alone.

• This figure will grow to 1720 teacher-years lost through absenteeism in 2015

Required annual teacher recruitment to meet EFA targets Required annual teacher recruitment to meet EFA targets under medium, low and high rates of HIV infection in teachers under medium, low and high rates of HIV infection in teachers

0

2000

4000

6000

8000

10000

12000

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Year

Nu

mb

er

Total recruitment - medium scenario

low scenario

high scenario

Recruitment to replace AIDS deaths -- medium

low scenario

high scenario

• The total annual recruitment will have to have an annual increase of 6.5% in order to reach 8300 new recruits in 2015, from 3600 in 2002, in order to achieve a 45:1 pupil teacher ratio

• 17% of total annual recruitment is required to replace teacher attritions due to HIV/AIDS

Numbers of AIDS orphans (maternal, paternal and dual) Numbers of AIDS orphans (maternal, paternal and dual) of ages 6-14 and this number as a percentage of the total of ages 6-14 and this number as a percentage of the total

primary school aged populationprimary school aged population

0

200000

400000

600000

800000

1000000

1200000

1400000

1990 1995 2000 2005 2010 2015Year

Nu

mb

er

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

Per

cent

Numbers of AIDS orphans

percentage of school-aged population who are orphans

• 990 000 children of primary school age (6-14 years) in 2002. who have lost one or both parents to AIDS. This qualifies as 36% of all children in this age group.• 1.28 million children orphaned due to AIDS in 2015 (36%)of all school age children.

Future StepsFuture Steps

Collect required data from MoE to refine Collect required data from MoE to refine projections in line with EFA targetsprojections in line with EFA targets

Examine robustness of conclusions under Examine robustness of conclusions under range of assumptions / scenarios (sensitivity range of assumptions / scenarios (sensitivity analysis)analysis)

Estimate financial impacts of HIV/AIDS Estimate financial impacts of HIV/AIDS (optional)(optional)

Use of projections for advocacy / planning / Use of projections for advocacy / planning / policy formulationpolicy formulation

Economic costs for ZambiaEconomic costs for ZambiaThe major projected financial impact to 2010 associated with The major projected financial impact to 2010 associated with

HIV/AIDS on educational supply occurs at the level of:HIV/AIDS on educational supply occurs at the level of:

teacher training ($15,045,000; 61%),teacher training ($15,045,000; 61%), absenteeism ($8,097,000; 33%) absenteeism ($8,097,000; 33%) teacher funerals ($1,450,000; 6%)teacher funerals ($1,450,000; 6%)

Combined the figures imply a total projected cost of Combined the figures imply a total projected cost of $24,592,000. $24,592,000.

Orphans ($280,000,000).Orphans ($280,000,000).