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SIDALACSIDALAC
11
Satellite Meeting Resource Tracking and Priority Setting.
XV International AIDS Conference Bangkok. 13 July,
2004.
Overview of Resource Tracking ApproachesSIDALAC
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National HIV/AIDS Accounts
The national health accounts describe the distribution of resources to the institutions, by source of financing, public/private mixture for service provision, the role of the NGO’s, and the international cooperation.
It is the result of applying specifically to HIV/AIDS, the methodology to estimate the national accounts of the health sector.
The categories of services and goods in the health care functions has been adapted to better fit HIV/AIDS programs, services and goods.
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The national accounts describe the
distribution of resources to the
institutions, by source of financing,
public/private mixture for service
provision, the role of the NGO’s,
and the international cooperation.
Background
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1) To analyze the expenditure in order to obtain a comprehensive description of the flow of resources from their origin up to the end users
2) To determine the levels and determinants of expenditure on HIV/AIDS.
Objectives of NAA
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3) To describe the financial
flows identifying:
-who pays
-who benefits
-through what mechanisms
(reconstructing transactions
from their sources to the end-
up users)
Objectives of NAA (2)
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Characteristics of NAA
Comprehensive: An inventory of all resources addressed to HIV/AIDS
Internally consistent: Totals must add-up and be congruent across different tables.
Internationally comparable accounts: The breakdown of tables, the content of categories and the methods of calculation must be harmonized as far as possible.
Compatible with upper-level systems (as National Health Accounts) and social statistics.
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Methods of the NAA Estimation of all resources spent by
calendar year in all kinds of activities from all sources Description of sources of funding
Domestic and InternationalPublic, Private
Description of agents or providers of services
Description of use of the resourcesPrevention vs. Care; and non-health Goods and services
Beneficiaries or target groups
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Data collection Expenditures estimated from budgets Estimation of the actual costs of providing
services and goods Classification of expenditures by
International Classifications OECD
Description of flows of financing Differentiation between budgets and executed
expenditures Differentiation between donor perspective and
actual flow into the country for HIV/AIDS activities Avoid of duplication of expenditures by describing
flows
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Prevention of Sexual Transmission. Identification of the expenditure
explicitly directed to the most vulnerable populations and the highest risk for HIVMSMCSW (men and women)General Population (youngsters,
women)Social marketing of condomsInmates Mobile Populations
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Categories of Expenditure(examples)
Public Health: Epi Surveillance, IEC
Prevention: Condoms, STI’s Tx, MTCT
Prevention, Needles, Blood Banks
Treatment: Hospitalary, Ambulatory
Support Services: Diagnostic Tests,
Monitoring of ARV therapy –viral load, CD4+
Cell counts.
Anti-retrovirals
Other drugs: Prophylaxis, Treatment of OI
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Strengthening/Building Capacities in LAC and West Africa
Projects conducted by in-country consultants as joint efforts with NAPs
GUIDELINES and software (SIFRAS)Spanish EnglishFrench
Hands-on training of national professionals (e.g. staff of the NACP)
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Capacity Building Main results output:
Description of the levels and trends of the expenditures and the financing flows
Main Capacity building outputs: Training of professionals within each country to
continue estimating expenditures with a valid and comparable methodology over time and across countries of the estimates
Creation of networks of experts to provide south-south or Horizontal Technical cooperation in each region
Cross-fertilization between regions of developing countries (e.g. LAC to West Africa)
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Other relevant topics to consider Other applications of NAA:
To provide key indicators to monitoring the implementation of strategic plans
To provide comparative analysis of mobilization and distribution of resources to regional forums of technical cooperation and other supranational level organisms.
To accomplish its aims, NAA must made some trade-offs between: Timeliness: estimates must be available when decisions
are to be taken; Precision: estimates must be as accurate as possible; Relevance of indicators: useful figures must emerge from
estimates; Policy and Political Sensitivity: estimates must capture the
effects of change, maintain or not state policies.
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EXPENDITURE ON HIV/AIDS IN LAC
TOTAL EXPENDITURE (Million USD):
US$1,225.3 Public Sources: US$ 904.6
(73.8%) Private Sources: US$ 294.3
(24.0%) External Sources: US$ 26.3
( 2.1%)
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Main features of the HIV/AIDS expenditure in LAC, 2000
Average Per capita expenditure: US$2.69 Lowest: Bolivia US$0.37 Highest: Uruguay US$5.83
Average Percentage of the Gross National Product (GNP): 0.05% Lowest: Mexico (0.03%) Highest: Belize, Brazil, Uruguay (0.1%)
Average Percentage of the National Health Expenditure: 1.0% Lowest: Mexico and Bolivia (0.6%) Highest: Honduras 5%
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Main Expenditure Items in LAC
CARE (70% of total Expenditure) Total Expenditure on Care US$ 800,845,217 Main Item ARV 65% Expenditure per capita $1.65
PREVENTION (27% of Total Expenditure) Total Expenditure in Prevention and Public
Health US$ 309,221,436 Main Item CONDOMS 58% Total per capita $0.64
NON-HEALTH ACTIVITIES (3%) Total Non-Health Expenditure US$37,582,037 Main Item TRAINING 72% (e.g. conferences)
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HIV/AIDS Expenditures by source and by target population. Belize, 2003.
Source ► Target Pop'n ▼
Central Gov't
Other Public
Org Private
Non-for-profit Org.
House-holds IDA Ext Private Total
Non Targetted 15.7% 5.2% 5.3% 26.2%Schoolars 0.1% 0.1%Workers 0.0% 0.0%MSM 0.0% 0.0%M&F CSW 21.2% 0.7% 21.9%UDI 0.0% 0.0%MTCT 1.7% 1.7%Blood Banks 0.9% 0.9%Migrants 0.2% 0.2%Uniformed Pop'n 0.1% 0.1%Inmates 0.3% 0.0% 0.3%Pregnant women 1.2% 0.5% 1.8%
Vulnerable children and youth 6.0% 6.0%Health Personnel 2.1% 0.2% 2.2%PLWH 0.4% 1.1% 1.6%PLWA 26.3% 0.0% 0.0% 4.9% 2.4% 3.5% 37.1%
TOTAL 70.0% 0.0% 0.0% 0.0% 10.1% 16.4% 3.5% 100.0%
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