Spending assessment for political decision making in HIV/AIDS: Experience & Opportunities

1. Spending assessment for political decision making in HIV/AIDS: Experience & Opportunities Presenter Teresa Guthrie Centre for Economic Governance and AIDS in Africa (CEGAA) September, 2008 UNAIDS

2. Overview of Presentation • Introduction • NASA global findings • Opportunities for evidence-based political decision making

3. INTRODUCTION: Resource Tracking Using NASA • As the international response to AIDS continues to scale-up, it is increasingly important to accurately track in detail: • how funds are spent at the national level and • where the funds originate. • The data helps national-level decision-makers monitor the scope and effectiveness of their programs • When aggregated across multiple countries, the data helps the international community evaluate the status of the global response 11.3

4. KEY FINDINGS OF NASAs Examples from the regions

5. SOURCES OF FUNDS

6. HIV Financing Sources Ukraine and Russian Federation, 2006

7. Composition of HIV international sources – Swaziland (05/06 & 06/07)

8. 400,000,000 350,000,000 300,000,000 International 250,000,000 funds 200,000,000 Public Funds Emalangenn 150,000,000 100,000,000 50,000,000 - 2005/2006 2006/2007 239,520,821 220,816,750 International funds 32,835,809 136,915,968 Public Funds Year Sources of HIV/AIDS Funds in Swaziland

9. Ukraine and Russian FederationInternational Share, 2006

10. FINANCING AGENTS

11. Financing Agents in Moz

12. AIDS SPENDING CATEGORIES

13. Ukraine HIV Spending Priorities 2005 Prevention Care and Treatment Orphans and Vulnerable Children 1% 15% 3% 19% Program Management and Administration Strengthening 0% Incentives for Human Resources Social Protection and Social 20% Services excluding Orphans and Vulnerable Children Enabling Environment and 39% 3% Community Development Research excluding operations research which is included under

14. EECA Countries* - Reported HIV Spending by Intervention

15. Prevention and Treatment and Care spending, Mexico 1995 - 2005 Source: Resource Needs for an Expanded Response to AIDS in Low and Middle Income Countries. UNAIDS, 2005. Table 1.

16. AIDS Categories in Botswana

17. Treatment Activities – by Source - Swaziland

18. Changing Priorities - Swaziland

21. SERVICE PROVIDERS

22. Care & Treatment Prevention HIV Service Providers Expenditure by Intervention, 2004-2006, Moz

23. BENEFICIARY ANALYSIS

24. Beneficiaries in Zambia

25. MEASURING PROGRESS TOWARDS NATIONAL PRIORITIES

26. Comparison of Costed NSP with NASA Spending - Swazi

27. NSP Priorities vs Actual Spending - Zambia

28. RESOURCE GAP ANALYSIS ~ Comparison of Estimated Resource Needs (RNE) with Actual Expenditure (NASA)

29. Draft

30. Share of different programmatic areas in expenditures and resource needs in 2006 in selected SSA countries Draft

31. Comparison of Total financial resources needed and total Expenditures, Cambodia 2004 $19,638.8 $19,676.8 $20,000.0 $10,000.0 $0.0 (domestic public and international sources)

32. Comparison between Estimated Needs (RNM) and Expenditures (NASA), Cambodia 2004. Selected interventions (Thousand USD) ‘000 USD $3,000 $2,500 $2,000 $1,500 $1,000 $500 $0 STI IDU MSM ART CSW PMTCT Workplace Youth in School Mass Media Blood safety Treatment OI Palliative Care Estimated Needs Expenditures (domestic public and international sources)

33. Opportunities for Informing Evidence-Based Decision-Making

34. Opportunities for evidence-based political decisions • adequacy of funding – public & external • Public commitments-meeting national/international commitments ~ long-term sustainability • Comparison to costed NSP estimates of required resources – funding gap analysis • Centralised funding and spending with low funds for the sub-national level • Data not disaggregated according to national and sub-national levels • Discrepancies between allocations and actual expenditures ~ measurement of absorptive capacity, leakages, transaction costs

35. Opportunities for evidence-based political decisions (2) • ALLOCATIVE DECISIONS – PRIORITIES • Meeting national priorities (aligned to NSP?) • Balance between programmes ~ unsustainability of treatment costs without adequate prevention interventions ~ allocative efficiency • Equity in allocations ~ between geographical areas, providers, beneficiaries & according to need • EFFICIENCY OF SPENDING • Provides varying unit costs for interventions, allows comparison of technical efficiency • Identifies poor absorption capacity ~ allows for exploration of factors: bottlenecks, dumping etc.

36. Opportunities for evidence-based political decisions (3) • Coordination, Harmonisation and Alignment • Alignment of the actual HIV/AIDS spending to NSP – public and external • Agent analysis shows who determines use of funds • Identifies poor harmonisation – duplicative financing & reporting, high transaction costs • Institutionalization of NASA • Within the Monitoring and Evaluation (M&E) framework • Using standardised financial information/ reporting mechanisms

37. Opportunities for evidence-based political decisions (4) • Enhanced Transparency, Accountability & Economic Governance • Increased pressure (& desire) for mutual accountability by all players • Promotes a (legal) framework to ensure all partners report through a national resource tracking system • Link framework to the National Resource Mobilisation and Management Strategy • Using the framework to harmonise standards of costing among different partners • Ensures transparent procurement systems & best pricing within and between countries & regions

38. Opportunities for evidence-based political decisions (5) • Standardization & Comparability • Ensures standard classification of spending & activities within & between countries & regions • Provides comprehensive list of possible interventions • Resource needs estimates • Classification standardised with NASA • Package of interventions • Future requirements (funding gap) by programmes • Comparison of TFRR & TE

39. Thank You • Teresa Guthrie • Centre for Economic Governance and AIDS in Africa • Email:teresa@cegaa.org