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Tackling the Decline in HIV Resources: Lessons Learned from HIV/AIDS Program Sustainability

Analysis Tool (HAPSAT) Itamar Katz1, Wendy Wong1, Douglas Glandon1, Brima Kargbo2, Regina Ombam3, Shanti Singh4, John Osika1

Abt Associates Inc.  In collaboration with:I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health

1 Abt Associates, Health Systems 20/20, International Health Division, Bethesda, United States2 National AIDS Secretariat, Freetown, Sierra Leone3 National AIDS Control Council, Nairobi, Kenya4 National AIDS Programme Secretariat, Georgetown, Guyana

Background

Heavy dependence on donor funding Expansion of HIV services beyond the levels

that can be sustained

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HAPSAT: HIV/AIDS Program Sustainability Analysis Tool

Sustainability of HIV programs in limited-resource settings: What should be prioritized? What efficiency measures should be applied? How should additional resources be mobilized?

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Objectives of the presentation

In relation to prioritization and resource mobilization: HAPSAT framework Interests of policy makers of HIV responses

Examples from Guyana, Kenya, Sierra Leone and South Sudan (conducted in additional 10 countries)

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Prioritization

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Effectiveness of interventions: mainly for medical interventions

Capacity (versus universal access)

Cost

Contextual issues

Prioritization

South Sudan: HIV awareness through radio vs. billboards

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Cost per exposure Context Priority

Radio ads and talkshow

s US$ 0.003

Major information source for South

SudaneseHigh

Billboards US$ 0.05

Low literacy levels limits its use,

potentially useful in urban areas

Low

Prioritization among MARPs

South Sudan: Scaling up CSW outreach rather than constructing costly prevention centers

Sierra Leone: Under the program leadership and support from UNAIDS, Global Fund and USAID (the latter through HAPSAT) Inclusion of MSM in the national strategic plan

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Resource mobilization strategies

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Increased govt. budgetary allocations to HIV/AIDS interventions

Earmarked taxation for HIV/AIDS Concessionary loans for HIV/AIDS programs Debt conversion (known also debt2health) Risk-pooling schemes (e.g. insurance) and special

social assistance programs covering HIV/AIDS services

Fundraising (special/endowment HIV/AIDS funds)

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Resource mobilization: Financing Kenya’s National HIV Response 2008/09 vs. 2012/13

2008/09$687 million

2012/13$1,003 million

13%

87%

Insurance Premiums

Innovative Financing

Increased Gov-ernment Budget

27%

73%

Country Donor

Lessons learned

Understanding the reality Need for prioritization

Need for diverse funding sources Resource mobilization

Need for sustainability plans Sierra Leone: Govt. pledges to replace Global

Fund financing once ends Guyana: Preparing for PEPFAR gradual pull out

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Email:hapsat@abtassoc.comitamar_katz@abtassoc.com

Visit:www.hs2020.org/hapsat: Country reports, the HAPSAT tool and document on target setting

For more information…

Thank you