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Tracking Expenditure for HIV and AIDS in Africa ~ Cross-Country Comparisons

Tracking Expenditure for HIV and AIDS in Africa ~ Cross-Country Comparisons. Guthrie, T., Kioko, U. Inaugural Conference of the African Health Economics and Policy Association Accra - Ghana, 10th - 12th March 2009 PS 04/8. Objectives.

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Tracking Expenditure for HIV and AIDS in Africa ~ Cross-Country Comparisons

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  1. Tracking Expenditure for HIV and AIDS in Africa ~ Cross-Country Comparisons Guthrie, T., Kioko, U. Inaugural Conference of the African Health Economics and Policy Association Accra - Ghana, 10th - 12th March 2009 PS 04/8

  2. Objectives • Determine the total flows of financing and expenditures for HIV/AIDS, from all international and public (domestic) sources of financing • To identify the flow of expenditures by sources, agent, providers of services activities, and target population • To make recommendations for improved efficiency and prioritization of HIV and AIDS spending, and for improved financial information systems.

  3. Methodology • Review of UNGASS Indicator 1 for SSA countries (Source: UNAIDS Global Report 2008 Annex2) • Review of Country NASA Reports for further detail: Ghana, Botswana, Zambia, Swaziland • National AIDS Spending Assessment is an approach to comprehensively measure: • All spending for HIV/AIDS • From all sources, through agents, providers, activities to beneficiaries • From a multi-sectoral perspective • According to interventions reflected in the NSPs • Allows countries to monitor their own progress towards the national and international commitments. • Acknowledgements to UNAIDS, the NACs and NASA team members for access to their data

  4. Comparison of UNGASS Indicator1 - Sources of Financing for HIV/AIDS

  5. Comparison of UNGASS Indicator1 - Sources of Financing for HIV/AIDS

  6. SSA Low Income Countries HIV Prevalence (%) and Spending per Capita on HIV/AIDS (2006, in current US$)

  7. Per Capita HIV/AIDS Spending (current US$) & HIV Prevalence (%) in Middle Income SSA Countries (2006)

  8. Using Detailed NASA data From Botswana, Zambia, Swaziland, Ghana

  9. Levels & Sources of Financing (US$m, 2006)

  10. Agents of HIV/AIDS Spending (US$m, 2006)

  11. Providers of HIV/AIDS Services (US$m, 2006)

  12. AIDS Spending Activities ~ Priorities (US$m, 2006)

  13. Botswana ~ Public Trends (Pula, 2003-2005)

  14. Swaziland ~ HIV/AIDS Priorities by Source of Funds (SZL, 2006)

  15. Swaziland ~ funds for Programme Management by NERCHA (SZL, 2006)

  16. Swaziland Prevention Spending (SZL, 05/06-06/07) Blood Safety PMTCT Condoms VCT CommMobl Prevention

  17. Swaziland ~ Social Protection spending (SZL, 05/06-06/07)

  18. Swazi~ environment and community development spending (SZL, 2006/07)

  19. Beneficiaries of HIV/AIDS Spending(%, 2006)

  20. To what Degree Does HIV/AIDS Spending Contribute to General health systems strengthening?

  21. Botswana HIV Spending that may Contribute to general HSS (9.83% of THAE)

  22. HIV/AIDS Spending on HSS & General Health: Zambia 2007, 15% of THAE Swaziland, 11% of THAE

  23. Recommendations • Need for more sustainable predictable financing for HIV/AIDS and health • Need for increasing public agents ie. Control of funds ~ through common funds, DBS, IHPs. • LNGOs playing important role in delivery of HIV/AIDS services ~ need to be supported through efficient funding mechanisms • Treatment requiring increasing share of financing, prevention and other interventions requiring increasing, especially mitigation and social protection activities

  24. Recommendations cont. • Increase public funds for enabling environment esp. Promotion and protection of human rights • Improve output indicators to enable beneficiary incidence analysis • Increase funds for MARPs and vulnerable groups • Increase HSS funding and mechanisms (eg.IHPs) and increase allocations to HIV/AIDS activities that contribute to general HSS (eg. Blood safety, laboratories, upgrading facilities)

  25. Recommendations cont. • Increasing alignment with NSPs, but some donors still have own agenda, own systems ~ need harmonisation • Increase absorptive capacity: • Reduce donor ‘dumping’ of funds at the end of the financial year • Improve predictability of donor commitments, over longer period • Increase speed of disbursements, reduce tedious systems, while improving public accountability systems • Improve public programmatic and human resource capacity to deliver services

  26. Recommendations cont. • Improve public financial reporting & information systems • Routine resource tracking ~ institutionalise NASA in M&E systems • Harmonise to 1 national system for reporting on commitments, disbursements & spending • Civil society play greater role in monitoring public spending & in sharing their own spending activities • Critical to have good financial monitoring systems in place before implementing IHPs etc.

  27. Thank You • Teresa Guthrie • Centre for Economic Governance and AIDS in Africa • Email:teresa@cegaa.org • Tel: +27-21-425-2852 • Cell: +27-82-872-4694

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