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Tackling the Decline in HIV Resources: Lessons Learned from HAPSAT

Tackling the Decline in HIV Resources: Lessons Learned from HAPSAT. Itamar Katz, PhD, MPhil Wendy Wong, BS John Osika, MD,MPH,MHMPP,CCST,FFPH December 2011. Abt Associates Inc.

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Tackling the Decline in HIV Resources: Lessons Learned from HAPSAT

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  1. Tackling the Decline in HIV Resources: Lessons Learned from HAPSAT Itamar Katz, PhD, MPhil Wendy Wong, BS John Osika, MD,MPH,MHMPP,CCST,FFPH December 2011 Abt Associates Inc. In collaboration with:IAga 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

  2. Health Systems 20/20 Health Systems 20/20 is the USAID flagship project for strengthening health systems worldwide 55 countries, US$125 million Health Systems 20/20 developed the HIV/AIDS Program Sustainability Analysis Tool (HAPSAT) in 2008

  3. Outline • Decline in financial resources • Sustainability analysis • HAPSAT-Plus • Three lessons learned • Capacity building • Summary

  4. HIV Funding: Donor and Estimated Need Source: UNAIDS and Kaiser Foundation, 2011; Schwartländer, et al, 2011 Figures are rounded

  5. Sustainability Analysis What goals can be achieved with the current and potential capacity of the program?

  6. Sustainability Analysis: Example

  7. HIV/AIDS Program Sustainability Tool (HAPSAT) is … Sustainability study/tool Provides evidence for decision-making and target setting Comprehensive and flexible costing approach

  8. Evolution of HAPSAT • Original HAPSAT: • Gap analysis • Recommendations for efficiency • The “plus” in HAPSAT-Plus: • Recommendations also on prioritization • Based on stakeholder priorities • HAPSAT 2.0 software - simplified, flexible, user-friendly • Knowledge hub for sustainability

  9. HAPSAT 2.0 Workflow Understanding need for HIV services in the country Defining HIV interventions Quantifying unit costs and human resources unit cost of HIV interventions Defining policy scenarios (target setting) Quantifying financial and human resources policy scenarios Gap analysis: Comparing resources required to resources available Resource Mobilizations Efficiency Prioritizing

  10. HAPSAT Experience Prioritization of services HRH solutions Domestic resource mobilization • Benin • Cote d’Ivoire • DR Congo • Ethiopia • Guyana • Haiti • Kenya • Nigeria • Sierra Leone • South Sudan • Vietnam • Zambia

  11. Lesson Learned 1: Efficient Use of Existing Resources • Guyana: • Interim, efficient solution for data flow • Revisiting belief of shortage in health workers • South Sudan: Avoiding costly HIV-prevention facilities

  12. Lesson Learned 2: Integration, Integration, Integration • Extent of integration of HIV services varies by country, yet need to examine: • Integration into the wider health services • Integration into social services • Integration for resource mobilization

  13. Unit Cost of ART

  14. Lesson learned 3: Prioritize and Set Realistic Targets • Need to prioritize interventions

  15. Billboard vs. Radio for HIV Awareness in South Sudan

  16. Lesson Learned 3: Prioritize and Set Realistic Targets • Need to prioritize interventions • Frequently unrealistic targets are formulated: • Commitment to reach international targets • Mobilizing more resources: • Over-ambitious targets to justify more resources • Under-ambitious targets to ensure achieving targets in performance-based mechanisms • Lack of data prevents setting ambitious, yet feasible, targets

  17. Target Setting Reaching universal coverage requires efforts beyond apparent capacity Both are costed for stakeholders to decide on their scale-up

  18. Target Setting in HAPSAT 2.0 Software

  19. Target Setting in HAPSAT 2.0 Software

  20. Capacity Building • Country level: • Engaging implementers in sustainability approach • Training on the HAPSAT 2.0 software • Regional level: Training two regional research institutions

  21. Capacity Building of Regional Institutions • Advantages • Regional capacity building • Increased scalability of HAPSAT • Potential cost reduction • Challenges • Teaching a flexible approach • Ensuring standardization • Building capacity: • Technical • Managerial

  22. HAPSAT Take-aways • Targets need to be realistic • Resource mobilization strategy needs to be aligned to targets • Participatory approach promotes country ownership • Helps policymakers to think through sustainability issues

  23. Country-level Results • Kenya: Developing an innovative financing mechanism • South Sudan: Avoiding expensive ineffective prevention activities • Guyana: Changing thinking on shortage of health workers

  24. hapsat@abtassoc.com www.healthsystems2020.org/hapsat Thank youFor more information…

  25. HAPSAT-Plus Process

  26. Stakeholder Engagement

  27. Stakeholder Engagement • Stakeholder Engagement Workshop: Identification of sustainability issues and prioritization by stakeholders • Results to Action Workshop: Validating the findings, taking forward approved recommendations, creating action plans

  28. Stakeholder Process in Sierra Leone • Stakeholders’ priority: Need to train M&E officers • HAPSAT team’s solution: Need to strengthen data quality, supervision  m-health supportive supervision • Stakeholders’ decision: Excel-based supportive supervision

  29. Stakeholder Process in Guyana • Stakeholders’ priority: Lack of HRH • HAPSAT team solution: Quantifying HRH need • Stakeholders’ decision: HRH need for HIV services is small • Establish appointment system • Review number of HIV counselors

  30. Stakeholder Process in Guyana, cont.: Sample Action Plan from Results to Action Workshop Expanding Clinic Opening Hours to Better Utilize HRH

  31. Efficiency: Billboard vs. radio for HIV awareness in Southern Sudan

  32. Comparison of HAPSAT and HAPSAT-Plus Scopes • Original HAPSAT: • Assessing current funding resources • Assessing current financial and human resources required to maintain and scale-up HIV services  Gap analysis • Resource generation/innovative financing (optional) • The plus in HAPSAT-Plus: • Customized analysis according to stakeholder priorities • Simplified, flexible, user-friendly software with: • Triangulation of costing • Target setting for multiple scenarios

  33. Development of HAPSAT: 2008 • HAPSAT: HIV/AIDS Programs Sustainability Analysis Tool • In 2007/08 Health Systems 20/20 developed the Excel-based HAPSAT to estimate gaps between countries available human and financial resources, and what is needed to implement HIV programs at the national level • Donor support for HIV programs was still ramping up • Priority was scale-up across the board from donors to countries to programs

  34. Development of HAPSAT-Plus: 2010 • Priority is sustainability, particularly at country and program levels • HAPSAT has been adapted to address concerns of current context and key players • In 2010, paradigm changed significantly and donor support is referred to as constant but likely to fall soon

  35. Sustainability: Decentralization of HIV treatment services in Kenya

  36. HAPSAT-Plus Tool • Purpose • Program sustainability analysis of financial and human resources • Key Features • Setting programmatic targets of clinical and non-clinical HIV activities based on different scale-up scenarios and costing them • Enhanced bottom-up and top-down costing of non-clinical HIV activities • Comparison of different policy scenarios • Customized to obtain data from Spectrum and from UNAIDS’s Mode of Transmission studies • Harmonized with PEPFAR and Global Fund categorization of HIV services  Can be downloaded for free from: www.hs2020.org/hapsat 36

  37. HAPSAT-Plus • Gap analysis: • Assessing current funding resources • Assessing current financial and human resources required to maintain and scale-up HIV services • Planning resource generation/innovative financing (optional) • Customized analysis according to stakeholder priorities Tools: • Flexible, user-friendly software for quantifying the financial and human resources required for a set of policy scenarios • Protocol for the approach

  38. Resource mobilization: Levy tax in Kenya

  39. Health Systems Strengthening: FTE of Medical Doctors Required for pre-ART & ART • Calculating FTE medical doctors required for delivering pre-ART and ART • Three patients per hour (18 per day) • 44 working weeks per year • ART patients visits on average 6 times a year • Visits evenly distributed during the working hours Need to integrate of ART clinics with less than 600 pre-ART and ART patients

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