national aids spending assessment conceptual overview

NASA 2008

National AIDS Spending Assessment

Conceptual overviewNASA TRAINING

September 2008

Economic and Financing Division -Resource Tracking and Projections Unit

UNAIDS EXO/EVA

NASA 2008

NASA Methodological introduction

Part I

NASA 2008

1. What is NASA?

2. NASA Objectives

3. NASA Attributes

4. Sources of information

5. NASA and NHA

6. Approximate time: 30 min

Outline

NASA 2008

NASA

?

NASA 2008

English: National AIDS spending Assessment (NASA)

Spanish: Medición de Gasto en SIDA (MEGAS)

French: Évaluation des Flux de Ressources et des Dépenses nationales contre le Sida (EF-REDES)

Portuguese: Medição do Gasto em SIDA (MEGAS)

Acronyms:

NASA 2008

NASA is:

A methodology to measure and track resources of the national responses to HIV. It is used to estimate HIV

expenditure.

Compared with Resource Needs reflects possible financing Gaps

National Aids Spending Assessment

NASA 2008

NASA is not:

A Software.

Resource Needs.

Economic impact.


NASA 2008

Resource Needs Model (RNM)Resources requirements

(Future)

FuturePast

NASA vs. RNM:

National Aids Spending Assessment (NASA)

Resources consumed (Past)

NASA 2008

NASA (I):

NASA does tracks resources of health services, social mitigation, education, labour, justice and other sectors to embody the multi-sectoral response.


Social MitigationHealth

Human Rights

HIV

Labour

Education

NASA 2008

Objectives:


NASA describe the financial flows, actual disbursements and

expenditures for HIV/AIDS by identifying:

who pays and who purchase? (F. Sources & F. Agents)

who benefits? (Beneficiary Populations)

who provides the services? (Providers)

what was provided? (Aids Spending Categories)

$ MoF

NGO

OVC OVC

Clinic

NASA 2008

To describe the AIDS health and non-health financial flows and expenditures according to three dimensions and six vectors:

FINANCING: 1) Sources; 2) Agents

PROVISION: 3) Providers; 4) Production Factors

USE: 5) AIDS Spending categories; 6) Intended Beneficiary Populations

NASA Dimensions and vectors:

NASA 2008

National AIDS Spending Assessments – Resource Tracking

Financing Sources

Financing Agents

Providers

Production Factors

AIDS Spending Categories

Intended Beneficiary Populations

FINANCING:

PROVISION:

USE:

NASA 2008

• Sources (Public, Private, International)– Financing Agents (to decide the use of the funds)

• Providers of services and goods – (e.g. hospitals, ambulatory services, pharmacies,

NAP, MoH, other Ministries, etc.)• Functions: (Health, Health Related, Non-health)• Beneficiary Populations (or beneficiaries; vulnerable

and at-risk epidemiologically defined populations): MSM, CSW, IDU; Accessible groups: military, school children; Recipients of treatment: PLWH, PLWA

• Production Factors (budgetary items): salary of health personnel, non-health personnel, material and equipment, administration, etc.)

Classifications Classifications

NASA 2008

1. Prevention2. Treatment and care3. Orphan and vulnerable children4. Programme management5. Human resources for AIDS6. Social protection7. Enabling environment &

community development8. Research: AIDS related

Categories of Spending

NASA 2008

Objectives:

NASA can also be used for monitoring of global objectives such as the Millennium Development Goals (MDG).

NASA facilitates the finding of real or potential gaps in the nations public policies.

NASA is a tool for policymakers to determine if funds are being spent as intended and in line with national AIDS strategic plans.


NASA 2008

Objectives:

NASA is an information system that tracks the use of financial resources.

NASA is used to monitor HIV services and interventions which change over time.

NASA analyses the activities local governments and of bilateral aid, multilateral programmes and private households as part of the HIV response.


NASA 2008

NASA:

A tool /method to measure and track resources of the

national responses to HIV.

• It is used to estimate HIV expenditure•National

•Regional


NASA 2008

Use of NASA results Support in-country policy and decision making process,

specifically for AIDS Provide indicators on the financing of AIDS

Annual estimates of Financing Sources and Functions

Comparison – Financial Gaps: resources available

(PAST) and (FUTURE) resource needs

Monitoring of Declaration of Commitment (e.g. UNGASS) International Comparability Utilization of data for country defined purposes by AIDS

program managers/policy and decision makers

NASA 2008

Results and cross-tabulation system

This methodology is based on double entry tables –matrices- – Represent the origin and the destination of

resources– Help to avoid doubling counting of expenditures.

A NASA report typically includes matrices, summary tables, auxiliary tables and synthetic indicators to facilitate the situation analysis and exposition to selected audiences.

NASA 2008

Matrix

NASA uses double entry tables or Matrix to cross information on its vectors and dimensions.


NASA 2008

• Comprehensive: An inventory of all resources addressed to

HIV/AIDS

• Internally consistent: Totals must add-up and be congruent

across different variable dimensions and tables.

• Internationally comparable accounts: The breakdown of

tables, the content of categories and the methods of

calculation must be harmonized (e.g. use of compatible

classifications)

• Compatible with upper-level or aggregated systems

– NHA and SNA. Systems developed during the last 30 years.

Mainly OECD based. Producers guide for NHA: WHO

Characteristics of NASACharacteristics of NASA

NASA 2008

One of the most important characteristics of a classification scheme is assuring that the categories are mutually exclusive and exhaustive.

Using standardized classifications for Resource Tracking allows both international comparisons and comparisons at country level in time trends.

The classifications scheme must answer to politically relevant questions in order to help monitoring the national strategic action plans.

Characteristics of NASACharacteristics of NASA

NASA 2008

Sources of InformationSources of Information

Sources of information (1): -Records of external funding of the public sector- Budget execution reports from each entity-Budget execution reports from entities executing HIV/AIDS programs -Budget execution reports from medical care programs -Reports of services contracted for HIV/AIDS patients-Budget execution reports from the largest organizations in each main type of provider / service function-Reports on resources channeled towards HIV/AIDS non for- profit organizations by external agencies or by government sources

NASA 2008

Sources of InformationSources of InformationSources of information (2): -Reports on services provided and claims for HIV/AIDS coverage from private insurance and private social insurance-Business survey by type of productive branch- Households surveys: out-of- pocket expenditures -HIV/AIDS service provider survey-· Pharmaceutical sector: importation and expenditures on condoms, anti-retroviral medication and other medical supplies related to prevention and treatment-Secondary source: Home health expenditure surveys-Interviews with people living with HIV/AIDS-Providers Surveys

NASA 2008

P1

Source 1 Source 2

Agent 1

P2 P4P3

Agent 2 Agent 3

ASCi ASCi ASCi ASCi ASCi ASCi ASCiASCi

P5 P6

NASA – Resource Tracking

NASA: we analyze data “Bottom up” & “Top down”

NASA 2008

NASA & National Health Accounts:

Is NASA overlapping with NHA?

No, because the methodologies are complementary, as the peruse different

objectives….

NASA 2008

Objective:

NHA are designed to capture the full range of information contained in these resource flows and to reflect the main functions of health care financing: resource mobilization and allocation, pooling and insurance, purchasing of care, and the distribution of benefits. NHA enable stakeholders to identify policy concerns and to simulate the impact of solutions to the problems monitored.

NHA address four basic sets of questions:

I) where do resources come from II) where do they goIII) what kinds of services and goods do they purchase and IV) whom do they benefit?

National Health Accounts (NHA)

NASA 2008

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…)


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 2008

NASA Methodological Introduction

Part 2

NASA TRAINING

15 - 19 September 2008

Zagreb, Croatia

NASA 2008

• Resource Tracking & Transactions

• NASA Dimensions & Vectors

• What do we understand by “expenditures”?

• Budget and Budget Execution

• Donors: Pledge, Commitments, Disbursements

• Accrual method

• Stocks, purchases and actual spending

• Approximate time: 45 min

Note: Ask questions at any time.

Outline

NASA 2008

Resource Tracking &Transactions

Resource tracking is based on a methodology to reconstruct all the financial transactions related to the National Response to HIV and AIDS epidemic.

A transaction is a transfer of resources between different economic agents.

It follows the money from sources to mobilization to provision and factor tracking to consumption (final use).

NASA 2008

Transaction: the basic unit of the financial flow, that describes the transit of resources from a source to an agent, who purchases from a provider one or more ASC benefiting beneficiary populations, specified or not, and produced consuming production factor.

Tracking the TransactionTracking the Transaction

NASA 2008

(Ministry of Finance)

(Ministry of Health)

$ M F

Hospital

MoH

(Hospital)

NASA (I):

Source

Agent

ProviderBeneficiary Population

Aids Spending Categories

NASA 2008

To describe the AIDS health and non-health financial flows and expenditures according to three dimensions and six vectors:

FINANCING: 1) Sources; 2) Agents

PROVISION: 3) Providers; 4) Production Factors

USE: 5) AIDS Spending categories; 6) Intended Beneficiary Populations

NASA Dimensions and vectors:

NASA 2008

Financial Flow

Consumption Flow

Financial and Expenditure Flows:Transactions

Provider

Production Factors2

ASC1

F. Source

Activities or ASC

Beneficiary Populations2

F. Agent

ASC2

ASC3

PF1

BP1

PF3

Bp3

NASA 2008

Triaxiality

• Capturing value: a triaxial information approach

• Three dimensions (axes) sought : * Financing

* Provision

* Final use

• Agents : * Financing intermediaries ) transact

* Providers ) «from »

* Beneficiaries ) « to »


NASA 2008

T account T account

All the revenues in one side and all the expenditures on the other side, produce a balance and reduce error

Information systems and book keeping on expendituresProof of purchase, bills, charges, debits, invoices, statements

Revenues Expenditures

NASA 2008

TriangulationTriangulationGathering, compiling and cross checking information Gathering, compiling and cross checking information

from three sourcesfrom three sources

Provision

Con

sum

ption F

inanci

ng

Citizen

PoolingPurchaser

Provider

Three party transactions

NASA 2008

The agents’ triangulation

Fina

ncin

g

Fina

ncin

g Provision

Provision

ConsumptionConsumption

====

==Fi

nanc

ing

Sour

ces

Fina

ncin

g So

urce

s

& F

inan

cing

Age

nts

& F

inan

cing

Age

nts

Providers &

Providers &

Production Factors

Production Factors

Aids Spending Categories & Beneficiary PopulationsAids Spending Categories & Beneficiary Populations

Sources

Purchasers Providers

Factors of production

Commodities Beneficiaries

NASA 2008

∑ Activities or ASC: $ 10

Financial and Expenditure Flows & Agent’s Triangulation

Provider

Production Factors2

ASC1

F. Source

ASC

Beneficiary Populations2

F. Agent

ASC2

ASC3

PF1

BP1

PF3

BP3

$ 10 $ 10

Example: ($ 10 -VCT)

∑ PFi: $ 10

Fina

ncin

Fina

ncin

gg

Provisio

Provisio

nn

ConsumptiConsumptionon

====

==

∑ BPi: $ 10

NASA 2008

HIV SpendingHIV Spending

HIV expenditures: Good and services delivered to a Beneficiary Population.

Beneficiary Population

Antiretroviral therapy BP.1 People living with HIV

Good and Services:

AIDS Spending Categories

Social Change Communication

BP.5 General Population

NASA 2008

Antiretroviral in a warehouse in the MoH…

+ MoH

Actual Expenditure

Is not an ASC = Not captured by NASA

(It is captured once it is delivered to patients)

NASA 2008

ASC.2.3 Antiretroviral therapy ASC.2.1.05 Specific HIV-related laboratory monitoringASC.1.03 - Voluntary counselling and testing ASC.1.17 PMTCT

PS.1.1.1 - Public general hospitalsPS.1.2.1 - Public outpatient care centres

Actual Expenditure

ARV delivered, tests done...

…should be reflected in a NASA

NASA 2008

UN

AID

S/G

.PIR

OZ

ZI

Resources allocated, resources committed, resource needs…

… are usually not equal to Budget executed, or actual expenditures…

• …NASA tracks actual expenditures on the HIV Response.

Budget vs. Actual Spending Budget vs. Actual Spending

NASA 2008

Execution ratio = Budget executed / Budget

Interventions by type 2007 - Budget 2007 - Executed %

I Prevention 6.400.000 6.010.456 94%

II Treatment and Care 2.010.850 1.786.532 89%

III Other 1.987.000 1.237.890 62%

Total - USD 10.397.850 9.034.878 87%

Budget vs. Budget Executed Budget vs. Budget Executed

NASA 2008

Budgets usually have important differences with Budget execution…

Budget execution does not reflects total HIV expenditure: some expenditures are not HIV Budgeted (i.e.: Human resources in OI, STI, ARV, etc, and some drugs are not reflected in HIV budgets since they are not HIV specific).

Budget, Budget Executed & HIV expendituresBudget, Budget Executed & HIV expenditures

NASA 2008

Donors - SourcesDonors - Sources

Terminology…

Pledge: a promise to give resources.

Commitment: contract on resources to give.

Disbursement: resources available for the recipient of the funds.

Budget: An itemized summary of estimated or intended expenditures for a given period along with proposals for financing them

NASA 2008

Source

Agent

Provider

DonorsDonors - DisbursementsDisbursements

+ MoH

resources available for the recipient of the funds

(not necessarily spent)

NASA 2008

Source

Agent

Provider

DonorsDonors - Actual SpendingActual Spending

Actual Spending: Good and Services delivered to a Beneficiary Population Beneficiary

Population

+ MoH

NASA 2008

Donors Donors

Usually:Only Budget figures available

Sometimes:No data availability in budget nor in actual

expenditures

Solution: Get data from recipients of the funds (Agents and Providers)

NASA 2008

Stocks Vs. Actual SpendingStocks Vs. Actual Spending

+ MoH

2007 2008

Ministry of Health ARV Acquisitions / Warehouse

USD 500,000 USD 300,000

NASA 2008

+ MoH

2007 2008

USD 500,000 USD 300,000

USD 400,000 USD 400,000

MoH ARV Acquisitions

(Stock)

ARV Spending

=

ARV delivered

NASA 2008

Accrual Method Accrual Method Accrual Method: Accounting method that records revenues and expenses when they are incurred, regardless of when cash is exchanged. Income and expenses are recorded as they occur, regardless of whether or not cash has actually changed hands.

(Accrual accounting is opposed to cash basis accounting. Cash Method: Income is recorded when it's received, and expenses are reported when they're actually paid, whenever cash has actually changed hands.)

UNGASS Indicator No. 1 and NASA: Accrual Method.

Resource trackers will encounter a variety of accounting practices in their data sources, some accrual and others cash. Their job is to convert everything to an accrual basis, to the extent possible.

NASA 2008

Accrual Method Accrual Method

E.g.: A patient receives a consultation on a private Clinic on December 2007, but pays for the consultation on January 2008:

2007 2008

Clinic

Accrual Method: The outpatient services must be accounted for 2007.

NASA 2008

Accrual Method ExerciseAccrual Method Exercise

E.g.: An NGO receives condoms from a Donor valuated in USD 100,000 by the end of 2007. The NGO distributes 10% of the condoms in 2007 and the rest in 2008.

For the Donor the USD 100,000 is a 2007 disbursement

For the NGO the USD 100,000 is a 2007 donation…

…How to account it in NASA and UNGASS indicator NO. 1?

NASA 2008

Accrual Method ExerciseAccrual Method Exercise

Accrual Method: 10 % of the condoms should be accounted for the NGO and the Donor as 2007 expenditures, and the other 90% as 2008 expenditures.

NASA: USD 10,000 are a 2007 expenditure and USD 90,000 are a 2008 expenditure.

NASA 2008

Accrual Method Accrual Method

2007 2008

USD 100,000

Don

or

disb

urse

men

t

2007 2008

NG

O c

ondo

m

Dis

trib

utio

n

USD 10,000 USD 90,000

NASA 2008

1. Follow Accrual method as possible

2. Pledge, Commitments, Disbursements are not actual spending

3. Actual spending are good and services delivered to a population

4. Budget figures do not represent expenditures. Budget executed!.

5. Some HIV expenditures are not reflected in HIV budgets.

Recap:

NASA 2008

?

Thank You…

national aids spending assessment conceptual overview

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