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What can we learn from NHA and HIV spending accounts?. Jose Antonio Izazola. $17.4. 17.5. $17,0. $15.9. $15.6. 15.0. $14,3. $14.4. $12,8. 12.5. $11.4. Signing of Decleration of. 10.0. $8.9. Commitment on HIV/AIDS, UNGASS. US$ billion. $09,9. $8.3. 7.5. HIP+. $6.1. - PowerPoint PPT Presentation
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What can we learn from NHA and HIV spending accounts?
Jose Antonio Izazola
TOTAL annual resources available for AIDS in low and middle income countries, 1996-2009
$15.9
$15.6
$11.4
$8.9
$8.3
$6.1
$5.0
$0.3 $0.5 $0.5$0.9
$1.4 $1.6
$3.2
0.0
2.5
5.0
7.5
10.0
12.5
15.0
17.5
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
US
$ b
illi
on
UN AIDS Gates Foundation
World Bank MAP launch
Signing of Decleration of Commitment on HIV/AIDS, UNGASS
PEPFAR
The Global Fund
$12,8
$09,9
$14,3
$17,0
UNITAID
HIP+
$14.4
$17.4
Resources Available for AIDS from All Sources, 2009
$15.9 billion available in 2009 for HIV in low and middle income countries
0.0
4.0
8.0
12.0
16.0
US
D b
illio
ns
Foundations (4%)
UN and otherMultilateral (4%)
Contribution toGFATM (11%)
Bilateralcontributions (37%)
Domestic-public andprivate- (44%)
Expenditures from international sources as percentage of total HIV spending
Principles:
National Aids Spending AssessmentNational Aids Spending Assessment
NASA is inspired from broader social accounting systems. Its methods rest mainly on principles sustained in the System of Health Accounts (SHA) –
National Health Accounts (NHA).
System of National Accounts
System of Health Accounts & National Health Accounts
National Aids Spending Assessment
National Health Sub Accounts (HIV, Malaria, etc)
NASA:
NASA does tracks resources of health services, social mitigation, education, labour, justice and other sectors to embody the multi-sectoral response.
National Aids Spending Assessment
Social MitigationHealth
Human Rights
HIV
Labour
Education
NASA divergence with NHA:
NASA does not confine itself to health expenditures and the sector boundary overlaps with other sub-accounts (i.e.: Reproductive Health, Education…)
NASA and NHANASA and NHA
General NHA
NASA
Health portion of HIV/AIDS expenditures
Nonhealth portion of HIV/AIDS expenditures
NASA- NHA Crosswalk
Health related
NHA HIV/AIDS subaccount (represents health and health related portions of HIV/AIDS expenditures)
General NHA
NASA
Health portion of HIV/AIDS expenditures
Nonhealth portion of HIV/AIDS expenditures
NASA- NHA Crosswalk
Health related
NHA HIV/AIDS subaccount (represents health and health related portions of HIV/AIDS expenditures)
NASA tracks health and non health related
HIV expenditures
e.g. Malaria, TB, hepatitis, etc
e.g. STI
HIV health related
HIV Spending - Defining BoundariesHIV Spending - Defining Boundaries
NHA
Health Spending
Health Accountants
NASA
HIV spending
NASA resource tracking team
NASA follows the space and time boundaries of national health accounts.
Both NASA and NHA aim to…
• Address critical policy questions (for both national and international stakeholders) i.e.– “what are we getting for the money?”
• What matters is not only how much is invested but…– How funds are invested– Whether or not funds are reaching intended targets
• Serve as advocacy and monitoring tools, supporting evidenced-based policy processes– e.g. informing resource allocation decision-making
• Provide country comparable data
Coordination complies with the UNAIDS “three ones principle”
• For coordination of national HIV/AIDS responses
– ONE agreed HIV/AIDS action framework that provides the basis for coordinating the work of all partners,
– ONE National AIDS coordinating authority, with a broad-based multisectoral mandate, and
– ONE agreed country level monitoring and evaluation system.
(Ministry of Finance)
(Ministry of Health)
$ M F
Clinic
MoH
(Ambulatory Center)
NASA: resource tracking
Source
Agent
Provider
Beneficiary Population
Aids Spending Categories
Financing Source Financing Agent Provider
ASC1
Production Factors1
Beneficiary Populations1
ASC2
Production Factors2
Beneficiary Populations2
Financial Flow
Consumption Flow
Financial and Expenditure FlowsFinancial and Expenditure Flows
The agents’ triangulationThe agents’ triangulation
Fina
ncin
g
Fina
ncin
g Provision
Provision
ConsumptionConsumption
====
==
Fina
ncin
g So
urce
s
Fina
ncin
g So
urce
s
& F
inan
cing
Age
nts
& F
inan
cing
Age
nts P
roviders &
Providers &
Production Factors
Production Factors
Aids Spending Categories & Beneficiary PopulationsAids Spending Categories & Beneficiary Populations
MoH
NACP
Central Lab
Public Hospitals
Blood Safety
SEIC
Min. of Defense
Military Hospital
Min. of Interior
Police Hospital
Min of Education
Public Schools
Minf of Social
DevelopmentINAU
Social Security SS Hospital
Private HospitalsMin of
Labour
INDA
Out of pocket
Households
Central Govt Revenue
Multilateral Funds
Corporations
NGOs
Prisons
Local Givt.Local Govt Revenue
Financing AgtentsProvider of Services
Pharmacies
NGOs
Local AIDS Authority
Financing Sources
International NGOs
Bilateral Funds
National HIV Response and financing and consumption flows
MoH
NACP
Central Lab
Public Hospitals
Blood Safety
Central Govt. Revenue
I.M.MLocal Covt. Revenue
Financing AgentsProviders of
ServicesFinancing Sources
Financing Source Financing Agent Provider
AIDS Spending Categories (ASC)
ASC1
Production Factors1Beneficiary
Populations1
ASC2
Production Factors2Beneficiary
Populations2
Financing Source Financing Agent Provider
AIDS Spending Categories (ASC)
ASC1
Production Factors1
Beneficiary Populations1
ASC2
Production Factors2Beneficiary
Populations2
National HIV Response and financing and consumption flows
Planned vs. executed - Nepal 2007
NAP and NASA (US $ '000)
21,294
7,037
466 418
8,346
2,976
5,110
1,2151,626
-269960
-
5,000
10,000
15,000
20,000
25,000
Prevention Treatment, Careand Support
Advocacy, Policy,Legal reform
Leadership andmanagement
Strategic info, M& E
Finance andresource mob
NAP NASA 2007
Top spenders – Last year reported
Total HIV spending GR 2010, last year reported - Top 15 Globally
0
100
200
300
400
500
600
700
800
900
Russia
n Fed
erat
ion 2
008
Kenya
200
9
Brazil
200
8
Nigeria
200
8
China
2009
Botsw
ana
2008
Ugand
a 20
08
Argen
tina
2008
Mex
ico 2
009
Thaila
nd 2
009
Moz
ambiq
ue 2
008
India
200
9
Rwanda
200
8
Colom
bia 2
009
Mala
wi 200
9
Mill
ion
s
Last year reported
US
D InternationalPublic
Top spenders per capita – Last year reported
Total HIV spending per capita GR 2010, last year reported - Top 15 Globally
0
20
40
60
80
100
120
140
160
180
200
Botsw
ana
2008
Swazila
nd 2
007
Leso
tho
2008
Kenya
200
9
Rwanda
200
8
Ugand
a 20
08
Gabon
200
9
Moz
ambiq
ue 2
008
Mala
wi 200
9
Cuba
2009
El Salv
ador
200
8
Argen
tina
2008
Belize
200
9
Russia
n Fed
erat
ion 2
008
Chile
2008
Last year reported
US
D International per capitaPublic per capita
Funding sources by income level, Last year reported
(n = 29) (n = 25) (n = 15)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Low income Lower middle income Upper middle income
International
Public
Sources of Financing for HIV/AIDS
Total HIV and AIDS Expenditure, Senegal 2007-2008Total HIV and AIDS Expenditure, Senegal 2007-2008
0
5
10
15
20
25
30
35
2007 2008
US
$ m
illi
on
PRIVATE
PUBLIC
INTERNATIONAL
International HIV and AIDS Expenditure, Senegal International HIV and AIDS Expenditure, Senegal 2007-20082007-2008
Bilateral, 10,223,460
GFATM, 7,640,509
Foundations and international NGOs,
531,441 UN agencies,
741,153
Other multilateral, 230,264
Profiles of Spending by Beneficiaries in Sierra Leone 2007Profiles of Spending by Beneficiaries in Sierra Leone 2007
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Public Funds Bilateral Funds Multilateral
Funds
Other populations
Non-targeted
interventions
General population
Children and Youth in
school
Orphans and vulnerable
children (OVC)
MARP's
PLWHA
Providers of Services (PS) NASA - Nepal 2007
Spending by ProvidersMinistry of
Health (including.
NAPs/NACPs) , 2,247,182 , 13%
Other Ministry, 5,785 , 0%
Hospitals, 82,151 , 0%
Multilateral agencies ,
430,696 , 2%
NGO, INGOs, CBO, 14,895,801
, 85%
Beneficiaries Population - Nepal 2007
Expenditure by BPUS $ 17,661,653
BP.02 Most at risk populations
30%
BP.05 Non-targeted
interventions27%
BP.99 Specific targeted
populations not elsewhere
classified (n.e.c.) 3%
BP.01 People living with HIV (regardless of
having a medical/clinical
diagnosis of AIDS)12%
BP.03 Other key and accessible
populations19%
BP.04 General population
9%
Allocation of resources by programmatic area by type of epidemic
(n = 41) (n = 30) (n = 20)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
C G L
Research
Enabling Environment
Social Protection and Social Services excludingOrphans and Vulnerable ChildrenHuman resources
Program Management and AdministrationStrengthening Orphans and Vulnerable Children
Care and Treatment
Prevention
Allocation of resources by programmatic area by Funding Source, Sub-Saharan Africa last year available USD
0
500
1,000
1,500
2,000
2,500
Public International
Mill
ion
s
Research
Enabling Environment
Social Protection and Social Services excludingOrphans and Vulnerable ChildrenHuman resources
Program Management and AdministrationStrengtheningOrphans and Vulnerable Children
Care and Treatment
Prevention
MARPS Funding sources by UNAIDS regions, Last year reported
(n = 3)
(n = 11)
(n = 1)
(n = 11)
(n = 3) (n = 1)
(n = 1)
(n = 11)
(n = 11) (n = 21)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Car
ibbe
an
Cen
tral
and
Sou
thA
mer
ica
Eas
t Asi
a
Eas
tern
Eur
ope
and
Cen
tral
Asi
a
Mid
dle
Eas
t and
Nor
th A
fric
a
Nor
th A
mer
ica
Oce
ania
Sou
th a
nd S
outh
-E
ast A
sia
Sub
-Sah
aran
Afr
ica
Wes
tern
and
Cen
tral
Eur
ope
InternationalPublic
HIV spending by broad category and detailed prevention distribution. Botswana 2007. Million USD. Public and International funds.
$- $20 $40 $60 $80 $100 $120 $140 $160
Prevention
Care and Treatment
Other
Millions
HIV spending by broad category and detailed prevention distribution. Botswana, 2007. (Million USD)
Prevention activities not elsewhere classified
1%
Communication for social and
behavioral change
3% Community mobilization
16%
VCT1%
Workplace activities
10%
Blood safety11%
Youth in school4%
PMTCT53%
Youth out-of-school
1%
Spending in programs specifically directed to the populations Spending in programs specifically directed to the populations most at risk for HIV as a percentage of total preventionmost at risk for HIV as a percentage of total prevention
8.0%
1.8% 0.5%
2.8%
3.3%
0.1%
8.6%
4.7%
0.0%
0%
5%
10%
15%
20%
25%
Low Concentrated Generalized
Type of Epidemic
Harm reduction programsand IDUs
Programs for men havingsex with men
Programs for sex workersand their clients
A health system comprises all organizations, institutions and
resources devoted to producing actions whose primary intent is to
improve health.
Most national health systems include public, private, traditional and
informal sectors. The four essential functions of a health system
have been defined as service provision, resource generation,
financing and stewardship.
Health Systems
HIV/AIDS Spending on HSS & General Health:
Zambia 2007, 15% of THAE Swaziland, 11% of THAE
The categories included as HSS or for general health spending were:• Blood safety• Safe medical injections• Universal precautions• Opportunistic infection (OI) prophylaxis• Specific HIV-related laboratory monitoring• Opportunistic infections' (OI) treatment (??)• Patient transport and emergency rescue• OVC Basic health care• Monitoring and evaluation• Operations research• Drug supply systems• Information technology• Upgrading and construction of infrastructure• Upgrading laboratory infrastructure and new equipment• Construction of new health centres• Upgrading and construction of infrastructure n.e.c• Home-based care• Human Resources and Training• Research, • Capacity strengthening
34
Health System Spending 2006
1.22 Universal precautions 118,231
2.01.05 Laboratory monitoring 759,507
4.04 Operations research 205,420
4.08 Information technology 77,993
4.10 Upgrading laboratory infrastructure 1,858,515
5.05 Training 4,170,419
8.01 Biomedical research 27,912
Other
Total USD 21,364,523
Mozambique, National AIDS Spending Assessment, 2006
020
4060
8010
0%
of
Tot
al E
xpen
ditu
res
Low Lower middle Upper middle High nonOECD High OECD
Number of Countries: Low (17), Lower middle (19), Upper middle (14), High nonOECD (2), High OECD (3)
Total Expenditures per capita by income level and type of expenditures, 2006
Health System Strengthening Health
Non Health
0 20 40 60 80 100% of Total Expenditures
Western and Central Europe
Sub-Saharan Africa
South & South East Asia
Oceania
MENA
Latin America
Eastern Europe & Central Asia
East Asia
Caribbean
Number of countiries: Sub-Saharan Africa(17), Latin America(12), Eastern Europe & Central Asia(10),South & South East Asia(5), Caribbean(4), East Asia(2), MENA(3), Oceania (1), Western and Central Europe(1)
Total Expenditures by region and type of expenditures, 2006
Health System Strengthening Health
Non Health
1.18 Blood safety 5,468,810
1.20 Safe medical injections 1,123,027
1.21 Male Circumsicion 1,356
1.22 Universal precautions 625,010
2.01.02 Opportunistic infection (OI) prophylaxis 1,132,522
2.01.05 Specific HIV laboratory monitoring 7,947,858
2.01.06 Dental care 139,716
2.01.07 Psychological treatment and support services 2,742,365
2.01.08 Palliative care 18,749,251
2.01.09 Home-based care 26,416,981
2.02.1 Opportunistic infection (OI) treatment 9,215,228
3.02 OVC Basic health care 5,754,995
4.03 Monitoring and evaluation 12,373,568
4.04 Operations research 2,892,772
4.07 Drug supply systems 9,831,338
4.08 Information technology 1,314,477
4.10 Upgrading laboratory infrastructure 14,387,863
4.11 Construction of new health centres 8,335,027
5.05 Training 11,457,021
8.01 Biomedical research 113,912
8.02 Clinical research 185,706
8.03 Epidemiological research 259,651
8.04 Social science research 72,633
HSS or general health spending SSA, 2006
0 20 40 60 80 100% of Total Expenditures
Western and Central Europe
Sub-Saharan Africa
South & South East Asia
Oceania
MENA
Latin America
Eastern Europe & Central Asia
East Asia
Caribbean
Number of countiries: Sub-Saharan Africa(17), Latin America(12), Eastern Europe & Central Asia(10),South & South East Asia(5), Caribbean(4), East Asia(2), MENA(3), Oceania (1), Western and Central Europe(1)
Total Expenditures by region and type of expenditures, 2006
Health System Strengthening Health
Non Health
1. Improved financial information system for quality and accuracy of data
2. Improving implementers reporting and alignment as well as harmonisation of classification
3. Institutionalising NASA as a part of national M&E system
4. National capacity and EDPs role questioned
Use of NASA/policy implications
5. Useful in assessing the expenditures and getting a broad picture of resource availability in the reporting period.
6. Used extensively in reports at country and global level. Highlighting resource gaps
7. Referred during Global Fund Proposal development.
Use of NASA//policy implications
Thank you very much!
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