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National AIDS Spending Assessment Conceptual overview

National AIDS Spending Assessment Conceptual overview. NASA TRAINING September 2008 Economic and Financing Division - Resource Tracking and Projections Unit UNAIDS EXO/EVA. Part I. NASA Methodological introduction. Outline. What is NASA? NASA Objectives NASA Attributes

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National AIDS Spending Assessment Conceptual overview

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  1. National AIDS Spending AssessmentConceptual overview NASA TRAINING September 2008 Economic and Financing Division - Resource Tracking and Projections Unit UNAIDS EXO/EVA

  2. Part I NASA Methodological introduction

  3. Outline • What is NASA? • NASA Objectives • NASA Attributes • Sources of information • NASA and NHA • Approximate time: 30 min

  4. NASA ?

  5. Acronyms: 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)

  6. National Aids Spending Assessment 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

  7. National Aids Spending Assessment NASA is not: • A Software. • Resource Needs. • Economic impact.

  8. Past Future NASA vs. RNM: National Aids Spending Assessment (NASA) Resources consumed (Past) Resource Needs Model (RNM) Resources requirements (Future)

  9. National Aids Spending Assessment Social Mitigation Health HIV Education Labour Human Rights NASA (I): NASA does tracks resources of health services, social mitigation, education, labour, justice and other sectors to embody the multi-sectoral response.

  10. National Aids Spending Assessment $ MoF Clinic OVC OVC NGO 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) Objectives:

  11. To describe the AIDS health and non-health financial flows and expenditures according to three dimensions and six vectors:FINANCING:1) Sources; 2) AgentsPROVISION:3) Providers; 4) Production FactorsUSE:5) AIDS Spending categories; 6) Intended Beneficiary Populations NASA Dimensions and vectors:

  12. National AIDS Spending Assessments – Resource Tracking Financing Sources Financing Agents Providers Production Factors AIDS Spending Categories Intended Beneficiary Populations FINANCING: PROVISION: USE:

  13. Classifications • 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.)

  14. Categories of Spending • Prevention • Treatment and care • Orphan and vulnerable children • Programme management • Human resources for AIDS • Social protection • Enabling environment & community development • Research: AIDS related

  15. National Aids Spending Assessment 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.

  16. National Aids Spending Assessment 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. • - NASAanalyses the activities local governments and of bilateral aid, multilateral programmes and private households as part of the HIV response.

  17. National Aids Spending Assessment NASA: • - A tool /method to measure and track resources of the national responses to HIV. • It is used to estimate HIV expenditure • National • Regional

  18. 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

  19. 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.

  20. National Aids Spending Assessment Matrix NASA uses double entry tables or Matrix to cross information on its vectors and dimensions.

  21. Characteristics of NASA • 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

  22. Characteristics of NASA • 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 internationalcomparisons 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.

  23. Sources of Information • - Sources of information (1): • Records of external funding of the public sector • Budgetexecution 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

  24. Sources of Information • - Sources 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

  25. Source 1 Source 2 Agent 1 Agent 2 Agent 3 P1 P2 P3 P4 P5 P6 ASCi ASCi ASCi ASCi ASCi ASCi ASCi ASCi NASA – Resource Tracking -NASA: we analyze data “Bottom up” & “Top down”

  26. NASA & National Health Accounts: Is NASA overlapping with NHA? No, because the methodologies are complementary, as the peruse different objectives….

  27. National Health Accounts (NHA) 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 go • III) what kinds of services and goods do they purchase and • IV) whom do they benefit?

  28. National Aids Spending Assessment 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…)

  29. NASA Methodological IntroductionPart 2 NASA TRAINING 15 - 19 September 2008 Zagreb, Croatia

  30. Outline • 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.

  31. 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).

  32. Tracking the Transaction 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.

  33. $M F Hospital MoH NASA (I): Source (Ministry of Finance) Agent (Ministry of Health) Beneficiary Population Provider Aids Spending Categories (Hospital)

  34. To describe the AIDS health and non-health financial flows and expenditures according to three dimensions and six vectors:FINANCING:1) Sources; 2) AgentsPROVISION:3) Providers; 4) Production FactorsUSE:5) AIDS Spending categories; 6) Intended Beneficiary Populations NASA Dimensions and vectors:

  35. Consumption Flow Financial Flow F. Source F. Agent Provider Activities or ASC ASC1 ASC2 ASC3 BP1 Bp3 PF1 PF3 Production Factors2 Beneficiary Populations2 Financial and Expenditure Flows:Transactions

  36. National Aids Spending Assessment Triaxiality • Capturing value: a triaxial information approach • Three dimensions (axes) sought : * Financing * Provision * Final use • Agents : * Financing intermediaries ) transact * Providers ) «from » * Beneficiaries ) « to »

  37. T account Revenues Expenditures 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 expenditures Proof of purchase, bills, charges, debits, invoices, statements

  38. Triangulation Gathering, compiling and cross checking information from three sources Provision Citizen Provider Financing Consumption Three party transactions Pooling Purchaser

  39. The agents’ triangulation Purchasers Providers = Financing Sources & Financing Agents Providers & Production Factors Financing Provision Factors of production Sources = = Consumption Commodities Beneficiaries Aids Spending Categories & Beneficiary Populations

  40. F. Source F. Agent Provider ASC = Financing Provision ASC1 ASC3 BP1 PF3 ASC2 BP3 PF1 = = Consumption Production Factors2 Beneficiary Populations2 Financial and Expenditure Flows &Agent’s Triangulation Example: ($ 10 -VCT) $ 10 $ 10 ∑ PFi: $ 10 ∑Activities or ASC: $ 10 ∑ BPi: $ 10

  41. HIV Spending - HIV expenditures: Good and services delivered to a Beneficiary Population. • Antiretroviral therapy BP.1 People living with HIV BP.5 General Population • Social Change Communication • Good and Services: • AIDS Spending Categories • Beneficiary Population

  42. Actual Expenditure + MoH -Is not an ASC = Not captured by NASA - (It is captured once it is delivered to patients) -Antiretroviral in a warehouse in the MoH…

  43. Actual Expenditure -PS.1.1.1 - Public general hospitals -PS.1.2.1 - Public outpatient care centres -ARV delivered, tests done... …should be reflected in a NASA -ASC.2.3 Antiretroviral therapy -ASC.2.1.05 Specific HIV-related laboratory monitoring -ASC.1.03 - Voluntary counselling and testing -ASC.1.17 PMTCT

  44. Budget vs. Actual Spending -Resources allocated, resources committed, resource needs… • -… are usually not equal to Budget executed, or actual expenditures… UNAIDS/G.PIROZZI • …NASA tracks actual expenditures on the HIV Response.

  45. Budget vs. Budget Executed -Execution ratio = Budget executed / Budget

  46. Budget, Budget Executed & HIV expenditures -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).

  47. Donors - 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

  48. + MoH Donors - Disbursements Source Agent resources available for the recipient of the funds (not necessarily spent) Provider

  49. + MoH Donors - Actual Spending Source Agent Provider Actual Spending: Good and Services delivered to a Beneficiary Population Beneficiary Population

  50. 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)

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