The impact of AIDS on government service delivery: the case of the Zambia Wildlife Authority

Background: The loss of working-aged adults to HIV/AIDS has been shown to increase the costs of labor to the private sector in Africa. There is little corresponding evidence for the public sector. This study evaluated the impact of AIDS on the costs and service delivery capacity of a government agency, the Zambia Wildlife Authority (ZAWA). Methods: Data were collected on workforce characteristics, mortality, costs, and number of days spent on patrol between 2003 and 2005 by 76 current patrol officers (reference subjects) and 11 patrol officers who died of AIDS or suspected AIDS (index subjects). The impact of AIDS on service delivery capacity and labor costs and the net benefits of providing treatment were estimated. Results: Reference subjects averaged 197.4 patrol days per year. After adjustment index subjects patrolled 68% less in their last year of service (P < 0.0001), 51% less in their second to last year (P < 0.0001), and 37% less in their third to last year (P < 0.0001). For each employee who died, ZAWA lost an additional 111 person-days for management, funeral attendance, vacancy and staff replacement. Each death also cost ZAWA the equivalent of 3.3 years' annual compensation for care, benefits, recruitment, and training. In 2005, AIDS reduced service delivery capacity by 6.0% and increased labor costs by 9.3%. Conclusion: Impacts on this government agency are substantially larger than observed in the private sector. AIDS is constraining ZAWA's ability to protect Zambia's parks. At a cost of US $500/patient/year, antiretroviral therapy (ART) would result in service improvements and net budgetary savings to ZAWA. (c) 2007 Lippincott Williams & Wilkins.