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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%