Overview of Resource Tracking Approaches SIDALAC

1. Satellite Meeting Resource Tracking and Priority Setting.XV International AIDS Conference Bangkok. 13 July, 2004. Overview of Resource Tracking Approaches SIDALAC

2. National HIV/AIDS Accounts • The national health accounts describe the distribution of resources to the institutions, by source of financing, public/private mixture for service provision, the role of the NGO’s, and the international cooperation. • It is the result of applying specifically to HIV/AIDS, the methodology to estimate the national accounts of the health sector. • The categories of services and goods in the health care functions has been adapted to better fit HIV/AIDS programs, services and goods.

3. The national accounts describe the distribution of resources to the institutions, by source of financing, public/private mixture for service provision, the role of the NGO’s, and the international cooperation. Background

4. 1) To analyze the expenditure in order to obtain a comprehensive description of the flow of resources from their origin up to the end users 2) To determine the levels and determinants of expenditure on HIV/AIDS. Objectives of NAA

5. 3) To describe the financial flows identifying: -who pays -who benefits -through what mechanisms(reconstructing transactions from their sources to the end-up users) Objectives of NAA (2)

6. Characteristics of NAA • Comprehensive: An inventory of all resources addressed to HIV/AIDS • Internally consistent: Totals must add-up and be congruent across different tables. • Internationally comparable accounts: The breakdown of tables, the content of categories and the methods of calculation must be harmonized as far as possible. • Compatible with upper-level systems (as National Health Accounts) and social statistics.

7. Methods of the NAA • Estimation of all resources spent by calendar year in all kinds of activities from all sources • Description of sources of funding • Domestic and International • Public, Private • Description of agents or providers of services • Description of use of the resources • Prevention vs. Care; and non-health • Goods and services • Beneficiaries or target groups

8. Data collection • Expenditures estimated from budgets • Estimation of the actual costs of providing services and goods • Classification of expenditures by International Classifications • OECD • Description of flows of financing • Differentiation between budgets and executed expenditures • Differentiation between donor perspective and actual flow into the country for HIV/AIDS activities • Avoid of duplication of expenditures by describing flows

9. Prevention of Sexual Transmission. • Identification of the expenditure explicitly directed to the most vulnerable populations and the highest risk for HIV • MSM • CSW (men and women) • General Population (youngsters, women) • Social marketing of condoms • Inmates • Mobile Populations

10. Categories of Expenditure(examples) • Public Health: Epi Surveillance, IEC • Prevention: Condoms, STI’s Tx, MTCT Prevention, Needles, Blood Banks • Treatment: Hospitalary, Ambulatory • Support Services: Diagnostic Tests, Monitoring of ARV therapy –viral load, CD4+ Cell counts. • Anti-retrovirals • Other drugs: Prophylaxis, Treatment of OI

11. Strengthening/Building Capacities in LAC and West Africa • Projects conducted by in-country consultants as joint efforts with NAPs • GUIDELINES and software (SIFRAS) • Spanish • English • French • Hands-on training of national professionals (e.g. staff of the NACP)

12. Capacity Building • Main results output: • Description of the levels and trends of the expenditures and the financing flows • Main Capacity building outputs: • Training of professionals within each country to continue estimating expenditures with a valid and comparable methodology over time and across countries of the estimates • Creation of networks of experts to provide south-south or Horizontal Technical cooperation in each region • Cross-fertilization between regions of developing countries (e.g. LAC to West Africa)

13. Other relevant topics to consider • Other applications of NAA: • To provide key indicators to monitoring the implementation of strategic plans • To provide comparative analysis of mobilization and distribution of resources to regional forums of technical cooperation and other supranational level organisms. • To accomplish its aims, NAA must made some trade-offs between: • Timeliness: estimates must be available when decisions are to be taken; • Precision: estimates must be as accurate as possible; • Relevance of indicators: useful figures must emerge from estimates; • Policy and Political Sensitivity: estimates must capture the effects of change, maintain or not state policies.

14. EXPENDITURE ON HIV/AIDS IN LAC TOTAL EXPENDITURE (Million USD): US$1,225.3 • Public Sources: US$ 904.6 (73.8%) • Private Sources: US$ 294.3 (24.0%) • External Sources: US$ 26.3 ( 2.1%)

15. Main features of the HIV/AIDS expenditure in LAC, 2000 Average Per capita expenditure: US$2.69 • Lowest: Bolivia US$0.37 • Highest: Uruguay US$5.83 Average Percentage of the Gross National Product (GNP): 0.05% • Lowest: Mexico (0.03%) • Highest: Belize, Brazil, Uruguay (0.1%) Average Percentage of the National Health Expenditure: 1.0% • Lowest: Mexico and Bolivia (0.6%) • Highest: Honduras 5%

16. Main Expenditure Items in LAC • CARE (70% of total Expenditure) • Total Expenditure on Care US$ 800,845,217 • Main Item ARV 65% • Expenditure per capita $1.65 • PREVENTION (27% of Total Expenditure) • Total Expenditure in Prevention and Public Health US$ 309,221,436 • Main Item CONDOMS 58% • Total per capita $0.64 • NON-HEALTH ACTIVITIES (3%) • Total Non-Health Expenditure US$37,582,037 • Main Item TRAINING 72% (e.g. conferences)

17. HIV/AIDS Expenditures by source and by target population. Belize, 2003.