Projecting the impact of AIDS on the education system

1. Projecting the impact of AIDS on the education system Sub-regional seminar on HIV/AIDS education, Mombasa, Kenya 12 November, 2002 Accelerating the education sector response to HIV/AIDS in Africa Kamal Desai, PCD, Imperial College, London

2. Overview of this talk • Introduction • Population-level effects of HIV/AIDS • Impacts of HIV/AIDS on education systems • Need for projection models • Situational analysis of HIV/AIDS on the population – example • Education sector analysis of HIV/AIDS – example • Next steps -- refining estimates and sensitivity analysis

3. Introduction Population level effects of HIV/AIDS: • Decline in fertility rates (20% decline TFR) • Decline in life expectancy at birth (up to 15 years) • Slower population growth • Mother-to-child transmission (30-40%) • Rise in numbers of orphans • Shifting paradigms of new HIV infections • . . .

4. Introduction (2) Decline in life expectancy at birth for 5 eastern/southern African countries (source: UNAIDS 2001)

5. Introduction (3) The Impact of HIV/AIDS on Education : • Supply: in terms of numbers of teachers and the capacity to train them • Demand: in terms of numbers and characteristics of the school-age population

6. Introduction (4) Need for models: • Enhance understanding - to understand complex systems by exploring the impact of assumptions which have to be made explicit • Estimate the impact of HIV/AIDS on education (teachers and pupils) - predicting the probable present/future impacts of HIV/AIDS (especially in absence of field studies or other data collection) • Identify data requirements -- for sensible planning in face of HIV/AIDS • Impact of interventions - exploring their potential effectiveness • Assist planners to mitigate impact of HIV/AIDS • Powerful advocacy tools

7. Introduction (5) Would like to estimate: • For country population – absolute numbers of infecteds, HIV prevalence, incident cases by age/sex, AIDS cases, infants born with HIV • For education sector – HIV prevalence in teachers, AIDS-related attrition, absenteeism, required recruitment, school-aged children orphaned by AIDS

8. Situational Analysis of HIV/AIDS on populations • based on SPECTRUM model (USAID, Futures Group) • assumes UN Pop Div medium variant demographic assumptions (TFR, country-specific life tables) • HIV/AIDS epidemiological assumption (vertical transmission, life expectancy, fertility)

9. Situational Analysis (2) – country A • Population of 11 million • Annual growth rate 2.5% • Life expectancy at birth 41 years • TFR = 6.0 births per female • Adult HIV prevalence (ages 15-49) – 20% in 2001

10. Sentinel surveillance sites in Zambia

11. HIV prevalence in Zambia sentinel sites

12. Population of country A in presence and absence of HIV/AIDS (age groups and for 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

13. The absolute number infected with HIV and prevalence of HIV by sex • 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

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

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

16. Education sector analysis of HIV/AIDS • Projections based on Ed-Sida model • Developed by Dfid, IIEP, World Bank, PCD • Previously employed in Burkina-Faso, Benin, Togo, Niger, Nigeria, The Gambia, Ghana, Guinea, Senegal, Zambia

17. Demographic ‘relational’ lifetables Data requirements (I provide) • Country-specific mortality rates not due to AIDS • Mortality rates due to AIDS • Age and sex stratified HIV prevalence and incidence

18. Data requirements (you provide) • Total annual teacher numbers (by age and sex) • Annual number of new teachers recruited (by age / sex) • Total attrition rate • Primary school-age population (past and projected) • GER (past and projected EFA target) • Pupil-teacher ratio (past and projected EFA target)

19. Data for Country A (UNESCO, UN Pop Div) • Current number of teachers in active service-37000 in 2002 • Current annual teacher recruitment-3600 new teachers in 2002 • Age and sex of newly recruited teachers to 2015-95% are of ages 20-29; 50% are women • Attrition rate of teachers not due to AIDS or other mortality-1.0% • HIV prevalence --19.5% in adult population (ages 15-49) • School-aged population (ages 6-14)-2.68 million in 2000, rising to 3.62 million in 2015. • Target gross enrolment rate-81.7% in 2002, rising to 95% in 2015. • Target pupil teacher ratio-60:1 in 2002, declining to 45:1 in 2015.

20. Introduction (5) Would like to estimate: • For country population – absolute numbers of infecteds, HIV prevalence, incident cases by age/sex, AIDS cases, infants born with HIV • For education sector – HIV prevalence in teachers, AIDS-related attrition, absenteeism, required recruitment, school-aged children orphaned by AIDS

21. 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.

22. Teacher attrition due to AIDS mortality and other causes • 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%).

23. Teacher absenteeism due to AIDS under medium, low and high rates of HIV infection • 840 teacher-years of absenteeism will be incurred in 2002 alone. • This figure will grow to 1720 teacher-years lost through absenteeism in 2015

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

25. Numbers of AIDS orphans (maternal, paternal and dual) of ages 6-14 and this number as a percentage of the total primary school aged population • 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.

26. Future Steps • Collect required data from MoE to refine projections in line with EFA targets • Examine robustness of conclusions under range of assumptions / scenarios (sensitivity analysis) • Estimate financial impacts of HIV/AIDS (optional) • Use of projections for advocacy / planning / policy formulation

27. Economic costs for Zambia The major projected financial impact to 2010 associated with HIV/AIDS on educational supply occurs at the level of: • teacher training ($15,045,000; 61%), • absenteeism ($8,097,000; 33%) • teacher funerals ($1,450,000; 6%) Combined the figures imply a total projected cost of $24,592,000. Orphans ($280,000,000).