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April 19, 2023 UNAIDS

Spending assessment for Spending assessment for political decision making in political decision making in

HIV/AIDS: HIV/AIDS: Experience & OpportunitiesExperience & Opportunities

PresenterTeresa Guthrie

Centre for Economic Governance and AIDS in

Africa (CEGAA)

Septe

mber,

2

00

8

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1. Introduction2. NASA global findings3. Opportunities for evidence-based

political decision making

Overview of Presentation

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INTRODUCTION: Resource Tracking Using NASA

11.3

• As the international response to AIDS continues to scale-up, it is increasingly important to accurately track in detail:

• how funds are spent at the national level and

• where the funds originate.

• The data helps national-level decision-makers monitor the scope and effectiveness of their

programs

• When aggregated across multiple countries, the data helps the international community evaluate the status of the global response

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KEY FINDINGS OF NASAsExamples from the regions

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SOURCES OF FUNDS

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HIV Financing Sources Ukraine and Russian Federation, 2006

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Composition of HIV international sources – Swaziland (05/06 & 06/07)

-

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000

300,000,000

Years

Em

ala

ngen

International not-for-profitorganizations and foundations

Multilateral Agencies servicingearmarked grants 

Direct bilateral contributions

International not-for-profitorganizations andfoundations

21,308,130 47,318,039

MultilateralAgenciesservicingearmarked grants 

205,340,217 153,449,193

Direct bilateralcontributions

12,872,474 20,049,518

2005/2006 2006/2007

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Sources of HIV/AIDS Funds in Swaziland

 

-

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000

300,000,000

350,000,000

400,000,000

Year

Em

alan

gen

n

Internationalfunds

Public Funds

International funds 239,520,821 220,816,750

Public Funds 32,835,809 136,915,968

2005/2006 2006/2007

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Ukraine and Russian FederationInternational Share, 2006

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FINANCING AGENTS

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Financing Agents in Moz

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AIDS SPENDING CATEGORIES

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Ukraine HIV Spending Priorities 2005

19%

39%3%

20%

0%

3% 15% 1%

Prevention

Care and Treatment

Orphans and Vulnerable Children

Program Management andAdministration Strengthening

Incentives for Human Resources

Social Protection and SocialServices excluding Orphans andVulnerable ChildrenEnabling Environment andCommunity Development

Research excluding operationsresearch which is included under

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EECA Countries* - Reported HIV Spending by Intervention

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Source: Resource Needs for an Expanded Response to AIDS in Low and Middle Income Countries. UNAIDS, 2005. Table 1.

2001 2003 2005

0

5

10

15

20

25

Programs for sex workers and their clients Programs for MSM

Prevention of mother-to-child transmission Blood safety

Prevention and Treatment and Care spending, Mexico 1995 -

2005

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AIDS Categories in Botswana

Proportional Spending Priorities 2005

0%

20%

40%

60%

80%

100%

Public sector Internat.Orgs

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

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Treatment Activities – by Source - Swaziland

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Changing Priorities - Swaziland

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NA

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SERVICE PROVIDERS

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HIV Service Providers Expenditure by Intervention, 2004-2006, Moz

Care & Treatment

Prevention

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BENEFICIARY ANALYSIS

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Beneficiaries in Zambia

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MEASURING PROGRESS TOWARDS NATIONAL PRIORITIES

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Comparison of Costed NSP with NASA Spending - Swazi

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NSP Priorities vs Actual Spending - Zambia

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SA RESOURCE GAP ANALYSIS ~

Comparison of Estimated Resource Needs (RNE) with Actual

Expenditure (NASA)

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Draft

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Draft

Share of different programmatic areas in expenditures and resource needs in

2006 in selected SSA countries

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(domestic public and international sources)

Comparison of Total financial resources needed and total Expenditures, Cambodia 2004

$19,638.8 $19,676.8

$0.0

$10,000.0

$20,000.0

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Comparison between Estimated Needs (RNM) and Expenditures (NASA), Cambodia 2004.

Selected interventions (Thousand USD)

Estimated Needs Expenditures

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

CSW

MSM IDU

Yout

h in

Sch

ool

Wor

kpla

ce STI

PMTC

TMas

s Med

iaBl

ood

safe

tyPa

lliat

ive

Care

Trea

tmen

t OI

ART

‘000 USD

(domestic public and international sources)

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Informing Evidence-Based Decision-Making

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Opportunities for evidence-based political decisions

• ADEQUACY OF FUNDING – PUBLIC & EXTERNAL– Public commitments-meeting national/international

commitments ~ long-term sustainability– Comparison to costed NSP estimates of required

resources – funding gap analysis– Centralised funding and spending with low funds

for the sub-national level– Data not disaggregated according to national and

sub-national levels– Discrepancies between allocations and actual

expenditures ~ measurement of absorptive capacity, leakages, transaction costs

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Opportunities for evidence-based political decisions (2)

• ALLOCATIVE DECISIONS – PRIORITIES– Meeting national priorities (aligned to NSP?)– Balance between programmes ~ unsustainability

of treatment costs without adequate prevention interventions ~ allocative efficiency

– Equity in allocations ~ between geographical areas, providers, beneficiaries & according to need

• EFFICIENCY OF SPENDING– Provides varying unit costs for interventions,

allows comparison of technical efficiency– Identifies poor absorption capacity ~ allows for

exploration of factors: bottlenecks, dumping etc.

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Opportunities for evidence-based

political decisions (3)• COORDINATION, HARMONISATION AND ALIGNMENT

– Alignment of the actual HIV/AIDS spending to NSP – public and external

– Agent analysis shows who determines use of funds– Identifies poor harmonisation – duplicative financing &

reporting, high transaction costs• INSTITUTIONALIZATION OF NASA

– Within the Monitoring and Evaluation (M&E) framework– Using standardised financial information/ reporting

mechanisms

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Opportunities for evidence-based

political decisions (4)• ENHANCED TRANSPARENCY, ACCOUNTABILITY

& ECONOMIC GOVERNANCE – Increased pressure (& desire) for mutual

accountability by all players– Promotes a (legal) framework to ensure all

partners report through a national resource tracking system

– Link framework to the National Resource Mobilisation and Management Strategy

– Using the framework to harmonise standards of costing among different partners

– Ensures transparent procurement systems & best pricing within and between countries & regions

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Opportunities for evidence-based political decisions (5)

• STANDARDIZATION & COMPARABILITY

– Ensures standard classification of spending & activities within & between countries & regions• Provides comprehensive list of possible

interventions

– Resource needs estimates• Classification standardised with NASA• Package of interventions• Future requirements (funding gap) by

programmes• Comparison of TFRR & TE

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SA Thank You

Teresa GuthrieCentre for Economic Governance and AIDS in

Africa Email: teresa@cegaa.org