Tracking HIV/AIDS resources in-country: Institutionalization through capacity building and regional networks

T. Dmytraczenko and S. De, Abt Associates Inc.and PHRplusIn collaboration with José Antonio Izazola, SIDALAC and Teresa Guthrie, Idasa

Points of clarification

What do I mean by institutionalization? Housed in a national institution Periodic

PHRplus experience NHA, HIV/AIDS subanalysis

SIDALAC experience NAA

Overview of process

Principal goal is to produce data that can and will be used by policymakers

Stakeholder buy-in of NHA process is critical

Heavy emphasis on institutionalization Building capacity within the government so that data can be

collected regularly

Closely follows NHA framework

Adapts to the state of the epidemic and country context

Key elements in the the institutionalization process

Determine when to conduct subanalysis Concurrent with implementation of a general NHA

Set up the subanalysis core team Members of the general NHA

Ministry of Health (MoH) Representatives from MoH HIV/AIDS program

and/or multi-sectoral HIV/AIDS committee Lead the process

Key elements in the the institutionalization process (cont.) Consultation with a broader group of

stakeholders Steering Committee

CCM, major donors (such as CDC, UNAIDS), NGOs involved in HIV/AIDS, civil society organizations

Communicate policy concerns to NHA team Give feedback to NHA team on results and findings Facilitate any difficulties NHA team might encounter Assist in interpreting the NHA results and drawing policy

implications

Steering Committee and core team

NHA & HIV/AIDS

subanalysis Core Team

Steering Committee

General country stakeholders

Building capacity

Orientation to methodological approach OECD System of Health Accounts A Guide for Producing NHA in Low- and Middle Income

Countries – WHO, World Bank, USAID Identification of data sources

Review of secondary data Primary data collection as a last resort

PLWHA survey Donor survey, NGO survey, employer survey etc.

Adapted to state of the epidemic

Capacity building (cont.)

Technical support Survey instrument development by core team, approval by

steering committee Training local data collectors Data analysis by core team in consultation with steering

committee Report writing by core team, vetting by steering committee

Formulation of a dissemination strategy Discussion of how to incorporate data collection within

ongoing government information systems

Factors that affect policy use of NHA HIV/AIDS

Maximum Maximum Use In Use In PolicyPolicy

MinimalUse In Policy

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Fact

ors

Fact

ors

Stakeholder involvementStakeholder involvement

Policy linkagesPolicy linkages

Dissemination strategyDissemination strategy

OwnershipOwnership

TimelinessTimeliness

Credibility of reportCredibility of report

““ Cha

n ce”

Cha

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Fact

ors

Fact

ors

Government stabilityGovernment stability

Political opportunityPolitical opportunity

Policy advocatePolicy advocate

““--””

““--””

““+”+”

““+”+”

Regional Networks

Regional networks

SIDALAC National AIDS accounts network 20 countries in Latin America and the Caribbean Aim to start a network in West Africa

PHRplus and partners National Health Accounts networks

Idasa Civil society advocacy networks throughout Africa

that can support resource tracking networks

Regional networks

Creation and maintenance of a forum for exchange by geographical region / sub-region

Electronic, study visits or periodic meeting Bring together teams conducting HIV/AIDS tracking in different

countries Provide south-south and horizontal technical assistance Exchange of lessons learnt

Process and technical On-going technical cooperation and harmonization of

methods Mechanism for capacity building

Challenges in creating and sustaining regional networks

Dependence on external support Launch and sustain networks

Possible to leverage existing efforts May not get desired participants nor optimal skill set

Sufficient financing of new estimates, and secure financial support for medium/long term initiatives (not a once exercise)

Avoid dominance by one country

Challenges (continued)

Mechanism for formal peer-review Willingness to submit estimates for revision by expert sources

Empowering civil society organizations to undertake HIV/AIDS budget monitoring and participate in networks for resource tracking

Political will to use and validate the information National authorities, international agencies / programs

Support the use of the information for advocacy purposes, but keep objectives separate

Challenges (continued)

Capacity-building should occur through the process of resource tracking Expenditure tracking: government entity Budget analysis: civil society organizations

Building national systems to track performance Weak commitment in HIV/AIDS community Purview of broader health system

Is it really?