caribbean hiv conference. aids spending presentation
TRANSCRIPT
Andrew Fearon: [email protected]
Challenges and Opportunities for
Sustainable Actions to Address HIV
among Special Populations in the
Caribbean
National AIDS Spending
Assessments in the Caribbean
Total HIV Expenditure 2002-
2009 Trinidad & Tobago
0
20
40
60
80
100
120
140
2002 2003 2004 2005 2006 2007 2008 2009
TT$m
Presentation Outline
1. BACKGROUND
- Why Track HIV Expenditures
- Why Track HIV Prevention Expenditures on MARPs
- HIV Prevalence in the Caribbean (Gen Pop, MSM, FSW)
2. METHODS
- National AIDS Spending Assessment (NASA)
- National Health Accounts (NHA)
- UNGASS Reporting on National HIV Spending
3. RESULTS
4. DISCUSSION
5. CONCLUSIONS AND RECOMMENDATIONS
Background
Since 2001 there has been an unprecedented level in external financial and technical assistance from mechanisms like the UN Joint Team, PEPFAR, the GF, World Bank and other donors in the region
While this surge in funding is a welcome development, perhaps more critical than the amount invested is how those funds are spent and whether or not they are meeting intended targets i.e. more efficiency and with greater impact – or are they targeted at all?
Tracking HIV expenditures can measure the extent of government / donor commitment over time—towards a sustainable national and regional response
The Global Economic Crisis has forced all partners to do more to meet unmet needs with finite resources.
1. Why Track HIV Expenditures
Three of the largest Anglophone Caribbean countries
(Jamaica, Trinidad and Tobago, and Guyana) report an
HIV prevalence of 20 percent or more among MSM.
(UNAIDS 2008).
For many other countries, it is not clear if MARPs are
the drivers of the Epidemic
Preventing HIV transmission among MARPS benefits
society as a whole because they can serve as a bridge
to spread HIV to the wider population
Why Track HIV Prevention Expenditure
on Most At Risk Populations
Comparing Adult HIV Prevalence
with HIV Prevalence in MSM (2005-2008)
0%
5%
10%
15%
20%
25%
30%
35%
DOR T&T JAM SUR GUY BAH
1.1% 1.5% 1.6%2.4% 2.5% 3%
6%
20%
31.8%
7%
21%
8.2%
Adult HIV Prevalance
MSM Prevalance
Comparing Adult HIV Prevalence
with HIV Prevalence in FSWs (2008-2009)
0%
5%
10%
15%
20%
25%
30%
DOR JAM SUR GUY
1.1% 1.6%2.4% 2.5%3%
9%
21%
27%
Adult HIV Prevalance
SW Prevalance
Methods
Study Methods
Data collected from the (UNAIDS) National AIDS Spending Assessment (NASA), (WHO) National Health Accounts (SHA) and UNGASS Indicator 1 on Four countries in the Caribbean was utilized for this study. Using data collected from this study we conducted the following analysis:
1. Described the trends in HIV expenditures related to GDP
2. Compare contributions of domestic and international financing sources for HIV
3. Compared HIV expenditures on MARPS with overall prevention expenditures.
4. Based on current HIV expenditure on MARPs, discuss utility of expenditure tracking surveys for making resource allocation and mobilization decisions with a view to sustainability for MARPs programming
National AIDS Spending Assessment
(NASA) Developed by UNAIDS to track all financial flows relating to HIV and
AIDS
Designed to give decision makers critical financial information to enable improved decision making on sustained and efficient allocation of resources.
NASA is a globally recognized methodology, linked to the SHA that reveals sources of funds, expenditure by provider, expenditure by activity, expenditure by beneficiary population.
Can point to greater efficiencies in resource utilization – Visualize Resource Gaps
Tracking trends in expenditure in HIV & AIDS performance can be benchmarked against the priorities and objectives as outlined in the NSP and facilitate a better understanding of needs and identify gaps in programs
11
NASA Methodology
Financing Source Financing Agent Provider
AIDS Spending
Categories (ASCs)
ASC1
Production
Factors1
Beneficiary
Populations1
ASC2
Production
Factors2
Beneficiary
Populations2
Results Trinidad & Tobago
2002-2009
Results: Trinidad and Tobago 2002-2009
0
10
20
30
40
50
60
2002 2003 2004 2005 2006 2007 2008 2009
TT
$m
Expenditure by Priority Area
Prevention
Treatment
A & HR
S & R
Programme Mgmt
Results: Trinidad and Tobago
2002-2009
0
2
4
6
8
10
12
14
16
18
20
2002 2003 2004 2005 2006 2007 2008 2009
TT$m
Prevention Expenditure
General Population
MARP
PMTCT and VCT
Results: Trinidad and Tobago
2002-2009
0%
10%
20%
30%
40%
50%
60%
70%
2002 2003 2004 2005 2006 2007 2008 2009
HIV Expenditure Targeting Beneficiary Populations 2002-20009
PLWHA
MARP
General Population
Results: Trinidad and Tobago
2002-2009
$0
$5
$10
$15
$20
$25
2002 2003 2004 2005 2006 2007 2008 2009
TT
$
Sources of Funding for Prevention 2002-2009Health
NACC
Other Gov't
International
Private
Results: Caribbean
HIV Expenditure % Share of GDP and
Total HIV Expenditure USD. 2008 2009 2010
0.00%
0.20%
0.40%
0.60%
0.80%
1.00%
1.20%
A B C D
2008
2009
2010
-
0.01
0.01
0.02
0.02
0.03
A B C D
2008
2009
2010
Total HIV Expenditure per
Capita USD 2008 2009 2010
-
5.00
10.00
15.00
20.00
25.00
30.00
35.00
A B C D
2008
2009
2010
HIV Expenditure by Priority
Country A 2008 2009
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Prevention Treatment OVC Programme Managment
Human Resources
Social Protection
Enabling Enviroment
Research
2008
2009
HIV Expenditure by Priority
Country B 2008 2009
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Prevention Treatment OVC Programme Managment
Human Resources
Social Protection
Enabling Enviroment
Research
2008
2009
HIV Expenditure by Priority
Country C 2009 2010
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
Prevention Treatment OVC Programme Managment
Human Resources
Social Protection
Enabling Enviroment
Research
2009
2010
HIV Expenditure by Priority
Country D 2008
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
Prevention Treatment OVC Programme Managment
Human Resources
Social Protection
Enabling Enviroment
Research
2008
2008
Percentage Share HIV
Expenditure Prevention: Sex
Workers 2008 2009 2010
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
A B C D
2008
2009
2010
Percentage Share HIV
Expenditure Prevention: MSM
2008 2009 2010
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
A B C D
2008
2009
2010
Percentage Share HIV
Expenditure Prevention: Drug
Users 2008 2009 2010
0
0.005
0.01
0.015
0.02
0.025
0.03
0.035
A B C D
2008
2009
2010
Percentage Share HIV
Expenditure Prevention: General
Population 2008 2009 2010
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
A B C D
2008
2009
2010
Percentage Share HIV
Expenditure Stigma &
Discrimination 2008 2009 2010
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
A B C D
2009
2009
2010
Percentage Share HIV
Expenditure Civil Societies 2008
2009 2010
0%
5%
10%
15%
20%
25%
30%
35%
40%
A B C D
2008
2009
2010
Measurement Challenges
Inaccessibility and unavailability of expenditure data
Unavailability and limited recognition of the need for
expenditure to be disaggregated by activity and by
beneficiary population.
Lack of financial coordination between funding agents -
donors and governments – varying
budgeting, accounting and financial reporting
Donors financial plans are not harmonised with Country
National HIV Strategic Plans
Not all National Strategic Plans are costed –
comparison of expenditure against the budgets..
31
Measurement Challenges
Lack of an Agenda. Expenditure analysis is seen as a
donor led activity with limited country buy-in
Piecemeal implementation reduces the value of the
expenditure analysis for decision making
Challenges
Lack of Institutionalisation of expenditure tracking – UNGASS Indicator 1 findings: Little emphasis on data collection
Confusion between Budgets and Expenditure
Confusion between Objectives and Activities
Technical Capacity – emphasis on data production, not translation into policy
Lack of transfer of capacity to local staff
Lack of Dissemination of expenditure reports
Lack of understanding between Expenditure Analysis and Auditing
Recommendations
Governance –
expenditure assessments should be
incorporated into the strategic planning
cycle,
International agencies should promote
capacity building in financial policy making,
CSO need to ensure that financial
commitments are maintained by
Governments and Donors
Recommendations
Human Resources– Commitment to Learn by doing
Support by external consultants should focus on capacity building rather than data collection.
Training in financial capacity building –government, international and CSO sector
Financial Information Develop systems that can link financial
information to activity based budgeting
Integrate expenditure analysis into the country planning and budgeting process
Recommendations For
Sustainability Align external support to national Strategic Plans
which are costed.
Recognise where the funding is currently flowing from and where it is flowing to.
Identify current challenges in funding
Recognise what funding (Technical Support as well as cash transfer) the government already provide
Examine areas that can gradually be incorporated into government annual plans and commitments
Develop a domestic sustainable funding strategy
Conclusions
Expenditure on HIV prevention programs for MSM and CSW is very low relative to overall prevention expenditure—despite the proportion of HIV transmission attributed to sex between men.
The evidence, both on the magnitude of the issue and the effectiveness of MSM interventions, demands that countries increase resource allocations for MSM programming.
Government policymakers and program planners will require more evidence of the cost-effectiveness of MSM interventions so that they understand the value of investing in programs for most-at-risk groups—this needs to be part of future research agendas
Post Script – International
Agencies Commitment PANCAP Caribbean Based Resource Mapping Project
Resource Mapping in the British Overseas Territories
World Bank. The Global Strategic Action Plan for the Promotion of National Health Accounts
UNAIDS. The National AIDS Spending Assessment
OECD, World Bank, WHO and USAID. Where is the money and what are we doing with it? Creating an Evidence Base for Better Health Financing and Greater Accountability