Rosette Kyomuhangi Khiga 20 th July 2012

1. Rosette Kyomuhangi Khiga 20th July 2012

2. SPENDING ON PREVENTION ACTIVITIES IN THE SADC REGION Are The Trends and Priorities Within an Investment Framework?

3. Acknowledgements • UNAIDS Geneva & Regional RTS, and Country Offices • All countries which shared their NASA reports – NACs and research teams • Teresa Guthrie who supported the NASA in many SADC countries • SANAC, UNAIDS-SA and the team that was involved in SA NASA

4. Introduction HIV PREVENTION IN THE SADC REGION The Southern African Development Community (SADC) is the world's most affected region with HIV and AIDS. The combined population of the SADC Member States is about 4% of the world population, yet globally the region accounts for more than 37% of people living with HIV. It is estimated that between 11.7 and 18.8 million people of the region are currently living with HIV (WHO 2010) Over the past 30 years there have been tremendous gains in the global HIV response, but until now there has been only limited systematic effort to match needs with investments. The result is often a mismatch of the two, and valuable resources are stretched inefficiently across many objectives. To achieve an optimal HIV response, countries and their international partners must adopt a more strategic approach to investments.

5. A new investment framework for HIV • Schwartlander et al (2011): • Developed by an international group of experts from UNAIDS, GFATM, Bill & Melinda Gates Foundation, The World Bank, WHO and academic and policy institutions • The framework is based on evidence of what works in HIV prevention, treatment, care and support • Modeling the framework's impact shows that its implementation would avert 12.2 million HIV new infections and 7.4 million AIDS-related deaths between 2011 and 2020 Presentation Name PRESENTATION DATE

6. A new investment framework for HIV-Continued • Key components of the framework include: • Basic programme activities • Key population at higher risk i.e CSW, IDUs & MSMs • Elimination of new HIV infection among the children • Condom promotion & distribution • Voluntary male circumcision • Behaviour change communication • Care treatment and support for people living with HIV • Prioritising the above activities and considering the two indicators below would lead to the desired impact • Critical enablers (Social & programme) • Synergies with development sectors

7. Objectives & Methodology of Study • To compare the prevention spending in those SADC countries that had undertaken NASAs and/or submitted their GAR financial matrix correctly. • To compare with actual spending with the investment framework categories, their costed NSPs, & per capita spending. • Method: We reviewed country NASA reports (CEGAA) and GAR data (courtesy of UNAIDS), and examined the breakdown of the spending on prevention activities. • The reports varied in the coverage years from 2006 to 2010.

8. Limitations • This was a desk study that relied totally on available NASA and GAR data. It did not seek to validate any of the available data. • The data is outdated - the most recent being 2009/10 for South Africa 2010 for some few SADC countries – before the Investment Model was promoted (2011). • Some country data was not well disaggregated between prevention activities and thus may have underestimated spending on specific interventions. • Although the investment framework provides unit costs, that still doesn't say how much, or what proportions of the total should be spent on each priority area

9. SADC HIV Per Capita Spending and Prevalence (2006-2009)

10. Who are the key funders of HIV prevention activities in the SADC region?

11. HIV prevention spending per capita in the region (US$ per person per annum)

12. Is HIV prevention prioritized in the SADC region?

13. What is the most prioritized prevention activity in the region?

14. HIV prevention spending on investment high impact prevention activities

15. Case study: South Africa’s provincial HIV spending-2009/10

16. Case study: South Africa’s provincial HIV prevention spending-2009/10

17. Case study: South Africa- prevention per HIV negative person per capita spending (ZAR) and HIV incidence rates

18. Comparison of (Previous) NSP cost estimates with NASA results-South Africa.

19. Conclusions • The spending on HIV prevention in the SADC region in previous years has not been prioritised, and the chosen prevention activities had not prioritised those thought to be the most impactful within the investment framework. • Treatment spending has taken the bulk of the funding, which is likely to increase as more patients are enrolled on ART. This will also reduce the transmission rates and its preventative potential is acknowledged. • General HIV spending does not appear to match the greatest burden of the disease among the SADC countries • HIV costed NSPs do not match HIV spending patterns. • Eg. In SA, the costed need for HIV prevention was higher than its expenditure

20. Recommendations • In order to reduce the number of persons needing treatment, it is vital that budgets & spending are increased for those key prevention interventions that have been shown to have the greatest impact, whilst not ignoring the critical enablers as are suggested in the Investment Framework (UNAIDS). • Given funding constraints in recent years, the SADC countries need to increase and carefully align their domestic prevention spending according to the most impactful package of interventions. • In order to track the impact of investment framework prioritisation, countries must improve their tracking of HIV expenditure – routine resource tracking! • Provide guidelines for ideal nominal and proportional spending on investment priorities? • A recent comparison of NASA finds and investment framework is recommended for better results

21. Recommendations (2) • The SADC region should attempt to align their HIV expenditure to the National strategic plans & their cost estimates, to avoid wastage or under-spending on national priorities. • Costing of the NSPs need to improve in accuracy so as to avoid over- or under-estimating the resource requirements. • Impact studies are recommended. For instance countries may consider conducting routine resource tracking exercises and match with output indicators to examine the cost-effectiveness of prevention interventions. • Improve financial information systems to enable routine tracking of expenditure linked to outputs – to enhance the quality of available data so as to timeously inform policy decisions and programme implementation.

22. Thank you Rosette Kyomuhangi Khiga Kampala, Uganda rosette@cegaa.org Tel # +256 782 423 085/ 704 818 296 Teresa Gurthrie 5th floor, 30 WaterKant street, Cape Town, South Africa teresa@cegaa.org Tel # +27 82 872 4694 +27 21 425 2852 www.cegaa.org