Teresa Guthrie

M.PH (Health Economics)

HIV modelling for in-country ownership solutions – generation of evidence

IAS Conference, Washington DC, 19-20 July 2012

RationaleThe Centre for Economic Governance and AIDS in Africa

(CEGAA) believes that:

• Governments require information to improve their estimates of need & resource requirements, their

allocative decisions, to ensure efficient expenditure on effective programmes, and to promote transparency,

accountability and good governance.

• Civil society needs to generate evidence on quality of services, spending & hold govt accountable.

• With this evidence governments can take leadership and full ownership of the national response to

HIV/AIDS and TB.

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Modelling & Collecting Data in the Fiscal Cycle

Assessment of Resource Need – costing analysis.Impact modelling & CEA

Fin.Gap AnalysisResource Mobilisation

Budget AllocationsInvestment Framework?

Execution of budget –Fin.Info systems for Expenditure Tracking.Absorption of budget/committed?

Proportion DP aid spent in country?

Systems forreporting:Public, Private& DPs

DP alignment

DP long-term commtmts

Budget Monitoring

Revenue & tax watch

Analysis of Process

Finance channels

Intended Spending

Auditing (financial)

Systems-Accountability

Output analysis – interim indicators.

Achievement of budget Objectives? Quality?

Auditing (internal performance)

Community Social Auditing

Outcome analysis – long-term indicators.Impact assessment

Clinical Trials

Cohort studies

Life years saved

Quality of lif

e

Reduced prevalence rates

Cost Effectiveness

(CEA/CBA/CUA)

All Levels:

National

Provincial

District

Modelling HIV

Epidemiological Trends,

Population Projections,

Scenario Building

Examples of Modelling Data

Costings & Resource Mobilisation Options:

•2031 Estimates of Impact & Costs of various scenarios – SA & Thailand•SA-ART cost estimates (BU&HERO) – modelled & costed increased CD4 eligibility & impact•South Africa created new National Strategic Plan (NSP) for HIV, TB and STIs (2012/13 - 2015/16) – costs estimated by the costing team

SA New Adult (15-49yrs) HIV infections (’93–’31)

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SA Adult (15-49yrs) HIV Prevalence (2000–31)

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SA - Total HIV/AIDS Resources Required by Scenario 2009 –2031 (ZAR billions)

NB. These estimations include all sectors and all sources of funding

SA Expanded NSP – Total Costs and their Distribution (ZAR millions)

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South Africa’s new NSP cost est.2016: R32b (US$4b)

2012: R18.6b (US$2.3b)

Examples of Modelling DataExpenditure Tracking, Alignment & Gap Analysis:• NASA in ESA• South African National AIDS Council (SANAC)

commissioned the National AIDS Spending Assessment (NASA) (2007/08 - 2009/10).

• Compared the estimated cost of SA NSP (new & old) implementation with estimated current and future available funds, and measured the potential funding gap.

• Considered various scenarios for funding options.

Sources of Funding in ESA

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Spending Alignment with Country Priorities

Looking backwards to previous SA NSP costing & NASA (09/10)

Alignment of All SA Partners?

Is SA spending efficiently on ART? (ZAR, 2009/10)

14NB. GP also spent PEPFAR funds on public ART, not included above

DRAFT - DO NOT DISSEMINATE.

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Is SA spending on the best prevention interventions? (%, 2009/10)

Are we targetting the right Beneficiaries? (2006-2009)

DRAFT - DO NOT DISSEMINATE.

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Projected funding availability – gap??

Forward projected available funding vs NSP costs (2012)

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Anticipated gap/surplus by intervention

Modelling Funding Scenarios

Findings – Funding Options4. Mixed Scenario – 20% private, 20% increase in external, 22% public increase

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Best Funding Scenario?

5. Alternative (Innovative?) Domestic Financing Options

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Conclusions i.

• Sound objective evidence - modelling, costs, spending, quality of services, impact – all increase the govt’s ability to lead the response and inform policy choices.

• Research agenda should be aligned to national priorities, not pushed by development partners’ agendas.

• Aid dependency, and its unpredicatbility, short-cycles & lumpiness seriously hinders the country’s ability to future project available funding, plan, and manage the response.

• Improved public accountability & transparency re budgets, spending, outputs & outcomes – improve financial systems!

• Improved transparency of development partners’ commitments, disbursements and actual

spending, so as to measure alignment,

prioritisation & gaps

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Conclusions ii.

• Need to model alternative domestic funding sources & mechanisms, such as a national health insurance, financial transaction tax, a currency conversion levy or an additional AIDS tax on individuals and businesses – to give greater power to governments in taking the leadership role.

• Far greater commitment and transparency from the business sector, the private health insurance industry and the development partners in terms of predictable, aligned and accountable spending on HIV/AIDS.

• Build capacity of civil society to monitor govt budgets & spending• Building local capacity & systems – govt and service providers –

real local ownership & investing in their

longer-term systems strengthening before

funding programme implementation.

Thank youTeresa Guthrie

Centre for Economic Governance and AIDS in Africa

teresa@cegaa.org

www.cegaa.org