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An overview of the NASA methodology

An overview of the NASA methodology. Teresa Guthrie Centre for Economic Governance and AIDS in Africa. Overview of this Presentation. UNAIDS’ aim Introduction to resource tracking & NASA Purposes of NASA NASA relationship to NHA NASA methodology Ghana NASA objectives - expectations

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An overview of the NASA methodology

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  1. An overview of the NASA methodology Teresa Guthrie Centre for Economic Governance and AIDS in Africa

  2. Overview of this Presentation • UNAIDS’ aim • Introduction to resource tracking & NASA • Purposes of NASA • NASA relationship to NHA • NASA methodology • Ghana NASA objectives - expectations • Anticipated process • NASA requirements

  3. Low- and middle-income countries reporting on domestic expenditure for the review of the DoC. March, 2006

  4. Resource Tracking: Purposes • To provide indicators of the financial country response to HIV/AIDS or health • To support monitoring resource mobilization • To obtain information in order to improve decision- making • To define priorities regarding the distribution of resources • Not an auditing process

  5. National AIDS Spending Assessment NASA is a generic term currently used for all country’s HIV/AIDS resource tracking activities. It provides a framework and tools for undertaking a comprehensive analysis of actual expenditures for HIV/AIDS - which can be applied to any HIV/AIDS activity (health and non-health).

  6. NASA data usefulness • Measurement of Spending • Total Domestic Public (e.g. UNGASS indicator) • Inflows by donors (e.g. GF additionality) • Private – OOPE, business, NGO • Usefulness as input in the AIDS planning cycles • Complimentary with the NSP categories • Complimentary with Resource Needs • Provides the base data to undertake further analysis: Equity, beneficiary analysis, Efficiency, Bottlenecks, Absorptive capacity, Allocative efficiency, etc.

  7. NASA’s contribution • Well developed methods and tools – user-friendly, internationally comparable stds • Skills transfer and capacity building of NAC, UNAIDS & consultants • Contribute to the development of financial information systems for the ongoing monitoring by NAC

  8. Complimentarity to the Resource Needs Model • NASA and the RNM use the same classification for HIV/AIDS activities • This makes analysis of the financing gap between current expenditure and the projected resource needs more useful for Programme managers

  9. Use of NASA Results: Work in progress aimed at supporting better spending in countries • Efficiency: Bottlenecks and absorptive capacity • Additionality – GF projects • Improved tracking of non-health expenditures: Expanded response • Timeliness of data: opportunity to influence policies • Allocative effectiveness – funding for the right interventions • Equity – funding for the right populations

  10. NASA Framework for HIV/AIDS NASA is not limited to health expenditures for HIV/AIDS, but emphasizes the tracking of non-health expenditure such as social mitigation, education, labour, justice and other sectors’ expenditure related to HIV/AIDS Captures according to categories similar to the NSPs - more useful to NACA

  11. HIV AIDS Health Systems PHRplus SIDALAC NHA HIV/AIDS Sub-analysis National AIDS Accounts Govt Budgets State AIDS Budget Analysis Idasa - ABU The Development of the 3 Approaches for HIV/AIDS Funds NASAs ! Adjusted from PHR+ presentation, Feb 04. PHR+.

  12. NASA Relationship to NHAs • Same accounting procedure • Same data produced with more disaggregation of activities/ functions • Data for non-health expenditure • NASA is compatible and comparable with NHA (HIV sub-analysis), but provides greater detail for NSP usefulness

  13. NASA NHA-AIDS NAA Care and Treatment Care and Treatment Personal services Prevention and Public Health Public Health Prevention and Public Health • Orphan & VC • HR (incentives) • Social mitigation • Community development • AIDS related research (not OR) Non-health Memorandum Items Non-health (memorandum items.) Differences on personal services with Public Health implications, e.g. STI. Coverage of AIDS Resource Tracking

  14. NASA Spending Categories/ Priorities

  15. NASA Treatment Components

  16. NASA Beneficiaries of Spending

  17. PPP$ 15 Zambia Ghana PPP$12 Burkina Faso PPP$10 Kenya PPP$ 8.12 Rwanda PPP$ 7.79 Honduras Uruguay Argentina Q4 Haiti Costa Rica Nicaragua Panamá Q3 Brasil Perú R Dominicana Q2 El Salvador Paraguay Chile México Q1 Guatemala Bolivia 0.00 2.00 4.00 6.00 8.00 10.00 12.00 NAAs ~ HIV/AIDS per capita expenditures LAC and selected African countries. PPP-USD$, 2002/3. (Pre-GF)

  18. NASA Classifications R.T. aims to collect comprehensive data regarding: • Sources – who pays • Agents – who manages the funds • Service Providers – who provides the services • Functions/activities – what is provided • Beneficiaries – who benefits • Objects of expenditure – what are the components of expenditure The primary responsibility of the resource tracking team is to ensure that the classification scheme used is made of mutually exclusive and exhaustive categories within each of the classifications.

  19. Assessment Along 3 Dimensions • 3 dimensions and 6 vectors • Financing: • (1) Sources • (2) Agents • Provision: • (3) Providers • (4) Production factors • Consumption • (5) Activities • (6) Beneficiary groups

  20. Triangulation Purchasers Providers Provision Financing Factors of production Sources Beneficiaries Consumption Commodities

  21. Financial Source Entity which generates the funds and makes the decision for assigning resources to functions, or agents e.g. Ministries of Finance/Treasury - Global Fund - World Bank

  22. Financial Agent Intermediary flow in the context of health financing. If a financial agent assigns resources to confront AIDS, for NASA purposes, becomes a financial source as well e.g. Ministry of Health, National AIDS Commission

  23. Provider Entity responsible for delivering goods or services in response to HIV/AIDS or health e.g. Blood bank - Ambulatory care center (OPD) - Hospital

  24. Activities/ Spending Categories All the interventions, services and activities undertaken/ provided in response to HIV/AIDS. They are comparable acrossresource needs and resource tracking – i.e. must be standardised across studies and between countries for comparison purposes.

  25. NASA Spending Categories for HIV/AIDS Classified for eight HIV/AIDS programmatic areas • Prevention - Mass media, condoms, HRPs etc. • Treatment & care – ARVs, OI Rx, palliative care etc. • Orphans and vulnerable children – education, family support, nutrition etc. • Programme development & strengthening health care systems for HIV/AIDS – program management, monitoring, training, upgrading/new buildings etc. • Human resources for HIV/AIDS activities – monetary incentives • Social mitigation – social/financial support, human rights etc. • Community developmentand enhanced environment – institutional development, IGAs, women’s programmes etc. • Research – biomedical, social, psychological, behavioural, vaccine…

  26. Target Group or Beneficiaries Population of interest addressed by / benefiting from the activities: • People living with HIV and AIDS • Most at risk populations • Vulnerable groups • OVCs • Migrants • Refugees • Men who have sex with men (MSMs) • Accessible populations • STI clinic patients • Women – reproductive health clinics • Police, military, truckers, sailors • Children at school • General populations

  27. Object of Expenditure Production factors purchased to produce a good or deliver a service, under any determined production function e.g. Current expenditure • Wages/ salaries/ non-wage income • Pharmaceutical products (ARVs, other drugs) • Reagents, materials, supplies • Condoms • Services • Transport • Training of staff • Consultant services • Administrative • Capital • Buildings, equipment, vehicles, capital transfers

  28. Tracking the Transaction Is the basic unit of the financial flow, that describes the transit of resources from a source to a provider, who purchases objects of expenses to develop one or more functions benefiting target groups, specified or not.

  29. Source Provider Functions A C B Objects of Expenditure Target Groups Flow of resources from origin to end users: reconstruction of transactions Non Specific

  30. Sources of Data for NASA • Top-down: from sources of funds eg donor reports, commitment reports, government budgets etc. • Bottom-up: service provides’ expenditure records, facility level records, governmental dept. expenditure accounts. • Missing data: costing techniques are used to estimate actual expenditure

  31. Financing Agents Providers of services Sources Functions (Health or non-Health) Beneficiaries - Specific Target Groups - Or unspecified Production Factors Flow of resources from origin to users: reconstruction of transactions (“Top Down”) Financing Use Provision

  32. Financing Agents Financial Sources Functions (Health or non-Health) Providers of services Beneficiaries Production Factors Reconstruction of transactions (“Bottom Up”) to reconcile with flows from sources (ceiling) Financing Use Provision

  33. Challenge of estimating information not easily accessible • There are several components for which the information is not easily accessible • e.g. unlikely to be reported and leave “administrative trail” • Example: Treatment of Opportunistic Infections in public settings • Part of the hospital budget • Need to use costing tools to provide the best possible estimations

  34. Costing Techniques for Estimations • Internationally accepted costing methods and standards used to retrogressively measure past actual expenditure • Ingredient and step-down costing is used for direct and shared expenditure for HIV/AIDS • Shared costs are allocated on the most appropriate utilization factor • Donated goods and in-kind servicies are valued at their valve in the year of consumption • Capital goods costs are annualised and adjusted for inflation (where appropriate)

  35. NASA process/ timeframe • Planning & training – week 1 • Key stakeholder meeting – end of week 1 • Identification of key sources of data & appointment setting – 1-5days • Obtaining permissions, letters of access – 2/3weeks • Data collection (interviews, site visits) – 4-5weeks • Data capturing in the software – ongoing. 2weeks. • Data analysis – 1/2 weeks • Draft 1 of report – 1/2 weeks • Validation meeting – prelim findings to stakeholders • Editing and improving report – 1 week • Finalisation of report

  36. NASA Team Requirements • Permissions – letters to key sources of data – especially Moh, MoE, MoLG (SS), district level services • Comprehensive database of all sources, agents, providers in Ghana • Assistance with sample selection & site visit preps • Secondary data (refer to list) • Access to expenditure records et al – electronic and hard copies • GAC & UNAIDS representatives, ISSER team • Data capturers (?) • Transportation & accommodation for site visits • Printing of docs etc.

  37. Thank you!Teresa GuthrieCentre for Economic Governance and AIDS in Africa teresa@cegaa.org

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