Once the hepatitis programme has been costed and an investment case created, the next step will be to determine what can be implemented within the next budget cycle and to budget for this accordingly.

As part of the budgeting process countries may want to undertake scenario planning which looks at a conservative, a moderate and an aggressive budget scenario so that any of the three could be implemented depending on the resources available. Countries’ ability to scale up may be financially constrained and require a step-wise approach and in this instance prioritisation and target setting is needed.

Factors to consider when prioritising are:

  • Front loading the investment will generally give the best return. So, for example, the more HBV infections that can be prevented now by scaling up vaccine coverage, the more savings will accrue in the long term. To take another example, the more people who are cured of HCV now, the quicker and greater the savings from preventing on-going transmission and end-stage liver disease.
  • In general it may be more cost effective to test everyone as soon as possible because the yield of diagnosis per test will fall as more people are tested and the undiagnosed pool shrinks. This is particularly relevant if people are tested multiple times, for example where there is no register of those tested.
  • Commodities should not always come first; it may be more appropriate to put in place a governance structure
  • The infrastructure needed to support a scaled-up approach to commodities

The decisions made in regards to scale-up and prioritisation for each of the scenarios (conservative, moderate and aggressive) are used as inputs when determining the budget. The costing tool can be used again at this stage but for only the next budget year and using different inputs and assumptions.

Once the scenario and associated budget has been agreed, the government must evaluate the best financing sources for different activities and estimate any remaining gaps.