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Moscow , 5 June 2007

Europe and CIS. RESPONDING TO HIV/AIDS IN EUROPE AND THE CIS 4th RBEC Community of Practice Meeting. MDG costing experience from Tajikistan & the region. Moscow , 5 June 2007. Jacek Cukrowski MDG Advisor, UNDP RBEC Bratislava Regional Centre. Europe and CIS. 2000 Millennium Summit.

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Moscow , 5 June 2007

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  1. Europe and CIS RESPONDING TO HIV/AIDS IN EUROPE AND THE CIS 4th RBEC Community of Practice Meeting MDG costing experience from Tajikistan & the region Moscow, 5 June 2007 Jacek Cukrowski MDG Advisor, UNDP RBEC Bratislava Regional Centre

  2. Europe and CIS 2000 Millennium Summit • In September 2000 189 heads of states adopted the Millennium Declaration • Human rights, Democracy, Good governance • Peace, Security, Disarmament • Environment protection • Development and poverty eradication • The Millennium Declaration is our key program document • Available atwww.un.org/millennium/declaration/ ares552e.htm

  3. Europe and CIS Millennium Development Goals • MDGs were proposed in the Report of the Secretary-General in September 2001 • “Road map towards the implementation of the United Nations Millennium Declaration” • Available at: www.un.org/documents/ga/ docs/56/a56326.pdf

  4. Europe and CIS Global MDG agenda Goal 1: Halving extreme poverty and hunger Goal 2: Achieving universal primary education Goal 3: Promoting gender equality Goal 4: Reducing under-five mortality Goal 5: Reducing maternal mortality Goal 6: Reversing the spread of HIV/AIDS, malaria and TB Goal 7: Ensuring environmental sustainability Goal 8: Developing a global partnership for development

  5. Europe and CIS MDGs in Europe and the CIS • The report of the Secretary-General has been approved • all the countries-members of UN are committed to MDGs • All CIS/CEE countries adjusted global agenda to national circumstances • participatory process • weak national ownership of national MDGs • national MDG reports developed in most of the countries • unclear reporting requirements

  6. Europe and CIS Regional MDG Report for Europe and the CIS Contents • Introduction • The MDGs and development trends in CEE and CIS • National MDG agendas • Priorities, challenges and opportunities • Conclusions • Annex • A global agenda • Monitoring progress towards nationally adopted goals • Assessing progress

  7. Europe and CIS MDG6: Combat HIV/AIDS, TB, malaria, other diseases • HIV/AIDS relatively low, asymmetric prevalence … but • High growth (incidence) • 270,000 new infections in 2006 EECA representing a twenty-fold increase in less than a decade !* • bringing total number of people living with HIV to approx. 1.7 million ( 20% annual growth – outpacing other issues) • Highly concentrated among youth and vulnerable groups, with extreme social exclusion * Source: AIDS Epidemic update: December 2006, UNAIDS

  8. Europe and CIS MDG6: Target 1 (HIV/AIDS) –national formulations* • “Have halted by 2015 and begun to reverse the spread of HIV/AIDS” (global formulation):Albania, Bosnia and Herzegovina, Croatia, Macedonia, Montenegro, Turkey, Armenia, Azerbaijan, Georgia, Moldova, Russian Federation, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan, Czech Republic • “Prevent the epidemic spread of HIV/AIDS”:Bulgaria, Turkmenistan • “Maintain, by 2007, the incidence of HIV at the level of 2002”:Romania • “Stop the spread of HIV/AIDS including among the most vulnerable groups”:Belarus • “Reduce the rate of spread of HIV/AIDS by 13% (in 2015)”:Ukraine • “Reduce by yearly 10% in the period up to 2015, the number of HIV cases” +”Achieve adequate care and treatment for 50% of HIV patients by 2015”:Latvia • No HIV/AIDS target:Hungary, Poland, Slovakia, Slovenia * Estonia, Malta and Cyprus did not produce National MDG Reports

  9. Europe and CIS MDG needs assessment • An assessment seeks to quantify the resources — when combined with appropriate policies — to meet the goals specified in the national MDG agendas • Objective: Inform the national budget and aid allocations • Two steps • Identifying the policy reforms (key interventions) needed to achieve national targets/goals • Calculating the resources required to meet these targets/goals (MDG costing)

  10. Europe and CIS MDG needs assessment – regional experience • Tajikistan, Kyrgyzstan and Moldova* • simple methodology proposed in the framework of the Millennium Project • sectoral approach based on national income accounting • costing under different scenarios • unit cost approach • Tajikistan • detail but resource and time consuming exercise • financing needs for combating HIV/AIDS estimated based on detail model developed for UNAIDS by Futures Group • Kyrgyzstan and Moldova • brief and short analyses * In Uzbekistan MDG needs has been started, and it is going to be based on Computable General Equilibrium (CGE) model (it is to early to discuss the results).

  11. Europe and CIS Key differences • Common objective, but significant differences • Processes • government engagement (ownership), resources allocated for MDG needs assessments, time frame, etc. • Approaches • development of different policy options and assessment of the resources needed • assessment of the resources needed for achieving MDGs assuming that existing sectoral strategies will be implemented • Methods • simple sectoral models (Tajikistan, Kyrgyzstan, Moldova) • complex CGE models (Uzbekistan)

  12. Europe and CIS ExampleMDG6 costing in Tajikistan • Assumptions • Adult prevalence rate • rises to 5.4 by 2010 and remains constant thereafter • Reduction in the cost of palliative therapies • 10-per cent annually • Peer education • for 20 percent of the labour force each year • Unit costs of interventions • based on regional average (in some cases adjusted to Tajikistan’s specifics) • Cost estimates depend on (assumptions) • Pace of epidemic expansion • Price of drug therapies • Range of care and treatment offered

  13. Europe and CIS MDG costing – basic results (1) • Tajikistan: total need until 2015 (food security, gender, education, health, water and sanitation, and the environment): $13.0 billion* • $4.7 billion (14% of GDP) needs to be financed by donors • $3.6 billion for health • financial estimates for combating HIV/AIDS: $0.4 billion • break down of financial estimates for combating HIV/AIDS Per cent of total (million USD) 18.8 76.2 5.0 Source: MDG Needs Assessment, Republican Centre on AIDS Prevention and Control of the MoH, 2005 * About 50% of GDP per annum

  14. Europe and CIS MDG costing – basic results (2) • Kyrgyzstan: total need until 2015 (poverty reduction, gender, education, health, and environmental sustainability): 22% of GDP per annum ($9.0 billion) • $2.4 billion for health (5.9% of GDP) • financial estimates for combating HIV/AIDS: $0.042 billion • Prevention: 92.0% • Care and treatment: 3.2% • Policy, administration and research: 4.8% • Moldova: total need until 2015 (poverty reduction, gender, education, health, and environmental sustainability): 25-27% of GDP per annum • for health (MDG4-MDG6): 5.4%-6.5% of GDP annually • financial estimates for combating HIV/AIDS: 0.1% of GDP annually

  15. Europe and CIS MDG costing – problems • Deriving credible estimates of the resources required to reach the MDGs is not a simple task • numerous risks and uncertainties • lack of statistical data, international benchmarks • numerous assumptions • imperfect methodologies and modelling tools (sectoral models, CGE models) • Key weaknesses of MDG costing • over simplifications (linear trends, constant marginal costs, etc.) • difficulties to cover links between interconnected goals and targets • different approaches -- no singe methodology can be recommended • results highly dependent on assumptions, indicate nothing more than an order of magnitude • Ownership of the results

  16. Europe and CIS Conclusion • The cost estimates are by far not precise and are subject to different internal and external risks • There is no single methodology to be recommended for needs assessment in all the countries • approaches depend on the country needs, timeframes, resources, data availability, etc., • but there are experts in different methodologies that can be employed in other countries, if needed • The results of MDG costing, independently on the methods used, need to be used with caution • should not pretend to nothing more than indicating the scale of the resources needed • MDG costing yield results with reasonable degree of accuracy within 2-3 year time frame • ill advised to make detail estimates over an extended period of time • MDG costing needs to be repeated periodically when new data are available

  17. Europe and CIS Thank you… • Jacek.Cukrowski@undp.org United Nations Development Programme, Europe and the Commonwealth of Independent States, Bratislava Regional Centre • http://europeandcis.undp.org

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