Tracking of Resources for HIV/AIDS in Africa ~ civil society monitoring

1. Tracking of Resources for HIV/AIDS in Africa ~ civil society monitoring Teresa Guthrie AIDS Budget Unit Idasa OSI Seminar, Istanbul. February 2006.

2. Independent public interest organisation promoting sustainable democracy in South Africa and elsewhere OBJECTIVESof the AIDS BUDGET UNIT 1. Analyse government budget from an HIV/AIDS perspective 2. Produce recommendations for policy-makers on allocations and effective funding mechanisms for transferring money for HIV/AIDS interventions 3. Build capacity in Parliament and civil society to participate in the budget process on HIV/AIDS issues OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

3. Are we meeting international commitments and obligations? • Budgets are a clear indication of a state’s commitment. • Abuja Commitments – 15% of total annual budget to health. “We also pledge to make available the necessary resources for the improvement of the comprehensive multi-sectoral response, and that an appropriate and adequate portion of this amount is put at the disposal of the National Commissions/Councils for the fight against HIV/AIDS, Tuberculosis and Other Related Infectious Diseases.” • UNGASS Commitments. • Rights obligations in international covenants. • Also critical to track donor funds/ foreign aid. • And who determines the limits on social spending i.e. the fiscal space? OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

4. Why budgets analysis? • Fundamental tool in implementation of public policy • sets out the allocation of public resources. • More telling indicator of the priority accorded to fighting HIV/AIDS than policy or legislation • National budget is key to sustainability of any government programme Informed budgets and funding mechanisms for HIV/AIDS therefore enhance ability of governments to plan and implement HIV/AIDS interventions effectively. OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

5. Why track resources for HIV/AIDS? • HIV/AIDS greatest challenge to developing countries, undermining development advances • Increasing resources targeted at HIV/AIDS – limited tracking, monitoring, nor impact assessment • Budget tracking provides insight into the government’s committed allocations • Resource tracking identifies and measures: • All sources of funds – public, private and external • Providers of services (recipients of funds, public & private) • Actual expenditure on all services • Beneficiaries and outputs

6. Uses of Resource Tracking • Identification of what resources are available, so as to ascertain the resource gap • Mobilizing more resources to fill gaps • Informs policy decisions • Advocacy + evidence = power! OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

7. Existing Efforts of Tracking Resources for HIV/AIDS • OECD data base and NIDI Resource Flows Project • Budget analysis studies • National Health Accounts (WHO NHAs) – sub-analysis on HIV/AIDS • National AIDS Accounts (Stand alone NAAs) • UNAIDS - National AIDS Spending Assessments (NASAs) OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

8. Phase 1: South Africa Kenya Namibia Mozambique African countries supported by Idasa to undertake HIV and Aids Resource Tracking • Phase 2: • South Africa • Kenya • Tanzania • Malawi • Zambia • Ethiopia Work with ActionAid – support to CSOs in:Ghana, Zimbabwe, Nigeria, Swaziland, Lesotho. OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

9. ABU’s approach • Exploratory visits to potential countries, extensive meetings, key stakeholder meetings • Establish partnership with key NGO/research institute in each country • Establish Research Teams and Reference Groups incorporating CSOs, PLWHAs, MoF, MoH, NACs. • Capacity building: • Initial and secondary training workshops • Budget analysis and National Aids Spending Assessment (NASA) (principal investigator and govt. representative). • Development of a common terms of reference and workplan. OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

10. ABU’s approach cont. • Research Methodology: • Primarily budget analysis using national and regional budget documents, departmental reports, expenditure reports, NAC’s records. • Expenditure analysis using NASA methods (some costing). • Output and impact assessment. • Face-to-face and telephonic interviews with key officials and stakeholders. • Ongoing support to researchers • Technical support visits (drawing from skills within partners). • Intermediate workshops to share prelim findings; joint problem solving. • Close peer review of draft reports by team. • Formal internal & external review process. OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

11. Effective Advocacy Outcomes of Phase 1 • Kenyan seminar engaged govt, MPs, CSOs and CRT working well together – greater impact of findings • LA counties used information in the International Human Rights Court • Mexico findings in media pressurised govt to increase federal HIV/AIDS programme by 200 million pesos, primarily for prevention interventions (70% increase) • UNAIDS Global Consortium on Resource Tracking • Inclusion of HIV/AIDS budget tracking in SADC workplan • Joint CSO Monitoring Forum to monitor roll-out of ARV programme in South Africa • Assisting UNAIDS in supporting NASAs in Africa. • Kenyan and Ethiopian CRTs created the evidence for their country UNGASS reports (due 2006). OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

12. Challenges/ limitations of the budget studies • General Budget challenges: • Inaccessibility and unavailability of data (for budgets generally and HIV/AIDS specifically) • Previously centralised governments – access difficult & general lack of CSO participation. • Little disaggregation in budget documents. • Recorded budget allocations are rarely the actual expenditure & audited figures not easily available. • Varying budgetary and accounting systems – undermines comparability between countries. OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

13. Challenges cont. • Issues specific to HIV and Aids: • Lack of HIV/AIDS specific line-item in formal budget documents. • Lack of standardized classifications and definitions. • Global interest in donor allocations to HIV and Aids (mostly not indicated on budget) • Countries lack central database of donor funds. • Desk review alone of formal budget documents is insufficient to obtain adequate data – estimates of expenditure required. OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

14. Challenges cont. • Methodological issues: • Budget allocation analysis insufficient – need expenditure estimates, and output analysis. • Limited analysis of the services provided (nothing on target groups). • Demand not only for budget allocations, but to also identify outputs and assess the impact of expenditure. • No district level analysis – but demanded by NGOs. OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

15. Challenges cont. • Co-ordinating and supporting the research: • Identifying interested countries and NGOs with potential capacity and ability to sustain the work. • Identifying all the political issues, key players, forming relationships, getting buy-in. Supporting the establishment of RTs and RGs. • Ensuring full ownership in-country. • Maintaining contact, providing support from afar, ensuring accuracy and relevance of work. • Ensuring relevance and impact of research. In-country dissemination strategies. Full involvement and ownership by advocacy groups. OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

16. Gaps in all the existing information • Local government expenditure • Databases of external sources (at international and national levels) • Limited disaggregation by function (service provided) • Limited: indirect /out-patient / HBC expenditure • Limited household expenditure (different methods) • Limited disaggregation by gender • Limited analysis of expenditure on non-health HIV/AIDS activities • Outputs and outcomes – assessment of goods and services production level, not only resource consumption level • Challenge – standardizing classifications and definitions – to ensure cross-country comparison

17. Conclusion • Attention on improving economic governance, accountability, transparency, challenging the size of the pie – HIV/AIDS provides a spearhead! • Increasing efforts by governments and civil society to track the resources flowing to HIV/AIDS and their utilization • Financial management and reporting systems are poor, and formal budget figures are insufficient to give the whole picture, therefore investigative research required! • The money is where the power is! OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

18. Thank you! • For more information contact: • Teresa Guthrie • Regional Coordinator • AIDS Budget Unit • Idasa • Email: teresa@idasact.org.za • Web: www.idasa.org.za/bis • Tel: (+27) 21 467 5600 • Cell: +82-872-4694 OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.

19. OSI Seminar ~ Monitoring for Health. Istanbul, Feb 2006.