Social Return on Investment: A cost-benefit analysis of the HIV Integrated Care and Prevention programs in Cambodia

Abstract

Background: KHANA’s HIV Integrated Care and Prevention (ICP) project provided comprehensive care and support to HIV-affected communities through home and community-based care teams from 2007 to 2011. The aim of this study was to use Social Return on Investment (SROI) methodology to evaluate the social, health, and economic impacts of the ICP project, enabling the calculation of a ratio cost-to-benefit for the community in terms of HIV care, support, and treatment. Methods: The SROI methodology is a social cost-benefit analysis framework that measures and accounts for the values created by a program or series of initiatives. Values were mapped to common outcomes of the project, which were defined by key beneficiaries during a community consultation exercise. Five stages were used to calculate the SROI: establishing scope and identifying key stakeholders, mapping project outcomes, assigning a financial value to project outcomes, establishing project impact, and calculating inputs. Results: A combined five-year investment of approximately US$2,406,000 from the European Commission (EC), plus US$1,957,934 from the World Food Programme (WFP) and community inputs, generated total benefits worth US$10,894,835, after adjusting for the discount rate and Purchasing Power Parity (PPP). Monetized outcome values ranged from $30, avoided cost of informal school fees paid by orphans and vulnerable children (OVC), to $1,200, avoided burden of debt and asset loss caused by health costs prior to diagnosis. Beneficiaries gaining the most outcome value were people living with HIV (PLHIV), OVC, and their families (food security outcome 51% of total value, PLHIV 32%, and OVC 9%). The Return on Investment (ROI) was 1:2—every $1 invested in the ICP generated a return of approximately $2 worth of social, health, and economic value. Conclusions: The ICP program yielded substantial impacts in food security, wellbeing, improved health, and improved productive capacity, which enabled greater economic returns for the households. Results of this study have been used to inform project management, implementing partners, and policy-makers to further explore areas of benefit for PLHIV, OVC, and their families.