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 2009PS 04/8

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.

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

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

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

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

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

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

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

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

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

Public Spending Categories (2003-2005)

0

100,000,000

200,000,000

300,000,000

400,000,000

500,000,000

600,000,000

700,000,000

800,000,000

900,000,000

1,000,000,000

2003 2004 2005

Pul

a

FN 8..HIV- and AIDS-Related Research

FN 7..Community Development &Enhanced Environment

FN 6..Social mitigation

FN 5..Human Resources for HIV andAIDS activities

FN 4..Prog.Devmt & HSS strengthening

FN 3..Orphans and Vulnerable Children(OVC)

FN 2..Treatment and care components Total

FN 1..Prevention Programmes

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

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

-

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000

300,000,000

350,000,000

400,000,000

Public funds Internationalfunds

Total

Sources of funds

SZL

HIV and AIDS realatedresearch(Excluding operationalresearch)Enabling Environment and CommunityDevelopment

Social Protection and Social Services(EXCLUDING OVC)

Human Resources' recruitments andRetention Incentive - Human Capital

ProgrammeManagement andadministration strengthening

OVC

Care and Treatments

Prevention

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

-

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

35,000,000

40,000,000

45,000,000

50,000,000

Other sources toNERCHA

GFATM toNERCHA

TOTAL

SOURCES OF FUNDS

SZL

Upgrading and construction ofinfrastructure not elsewhereclassified (n.e.c)

Upgrading laboratoryinfrastructure and new equipment

Serological-surveillance(Serosurveillance)

Monitoring and evaluation

Planning and coordination

Transaction costs

Programme Administration

Swaziland Prevention Spending (SZL, 05/06-06/07)

-

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

70,000,000

2005/ 2006 2006/ 2007

YEAR

SZL

Prevention activities not elsewhere classified (n.e.c.)

Post-exposure prophylaxis (PEP)

Blood safety

Prevention of mother-to-child transmission(PMTCT)

Prevention, diagnosis and treatment of sexuallytransmitted infections (STI) (Improving managementof STI) Public and commercial sector condom provision

Prevention programmes in the workplace

Prevention of HIV transmission aimed at personsliving with HIV (PLHA)

Prevention - Youth out-of-school

Prevention - Youth in school

Risk-reduction for vulnerable and specialpopulations (Programmes for vulnerable and specialpopulations)Voluntary counselling and testing

Community mobilization

Communication for social and behavioral change

Preventio

n

CommMob

l

VCT

CondomsPMTCTBlood Safety

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

-

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

2005/ 2006 2006/ 2007

YEAR

SZL

Social protection services and social servicesnot elsewhere classified (n.e.c)

HIV-specific income generation projects

Social protection through provision of socialservices

Social protection through in-kind benefits

Social protection through monetary benefits

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

-

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

Public Funds International funds Total

SOURCES OF FUNDS

SZL

Enabling environment and communitydevelopment not elsewhere classified(n.e.c)

AIDS-specific programmes focused onwomen

AIDS-specific Institutional Development

Human rights

Advocacy and strategic communication

Beneficiaries of HIV/AIDS Spending(%, 2006)

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

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

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

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)

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

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.

Thank YouTeresa GuthrieCentre for Economic Governance and AIDS in

Africa Email: teresa@cegaa.orgTel: +27-21-425-2852Cell: +27-82-872-4694