Tracking Expenditure for HIV and AIDS in Africa ~ Cross-Country Comparisons Guthrie, T., Kioko, U. Inaugural Conference of the African Health Economics and Policy Association Accra - Ghana, 10th - 12th March 2009 PS 04/8
Objectives • Determine the total flows of financing and expenditures for HIV/AIDS, from all international and public (domestic) sources of financing • To identify the flow of expenditures by sources, agent, providers of services activities, and target population • To make recommendations for improved efficiency and prioritization of HIV and AIDS spending, and for improved financial information systems.
Methodology • Review of UNGASS Indicator 1 for SSA countries (Source: UNAIDS Global Report 2008 Annex2) • Review of Country NASA Reports for further detail: Ghana, Botswana, Zambia, Swaziland • National AIDS Spending Assessment is an approach to comprehensively measure: • All spending for HIV/AIDS • From all sources, through agents, providers, activities to beneficiaries • From a multi-sectoral perspective • According to interventions reflected in the NSPs • Allows countries to monitor their own progress towards the national and international commitments. • Acknowledgements to UNAIDS, the NACs and NASA team members for access to their data
SSA Low Income Countries HIV Prevalence (%) and Spending per Capita on HIV/AIDS (2006, in current US$)
Per Capita HIV/AIDS Spending (current US$) & HIV Prevalence (%) in Middle Income SSA Countries (2006)
Using Detailed NASA data From Botswana, Zambia, Swaziland, Ghana
Swaziland Prevention Spending (SZL, 05/06-06/07) Blood Safety PMTCT Condoms VCT CommMobl Prevention
To what Degree Does HIV/AIDS Spending Contribute to General health systems strengthening?
Botswana HIV Spending that may Contribute to general HSS (9.83% of THAE)
HIV/AIDS Spending on HSS & General Health: Zambia 2007, 15% of THAE Swaziland, 11% of THAE
Recommendations • Need for more sustainable predictable financing for HIV/AIDS and health • Need for increasing public agents ie. Control of funds ~ through common funds, DBS, IHPs. • LNGOs playing important role in delivery of HIV/AIDS services ~ need to be supported through efficient funding mechanisms • Treatment requiring increasing share of financing, prevention and other interventions requiring increasing, especially mitigation and social protection activities
Recommendations cont. • Increase public funds for enabling environment esp. Promotion and protection of human rights • Improve output indicators to enable beneficiary incidence analysis • Increase funds for MARPs and vulnerable groups • Increase HSS funding and mechanisms (eg.IHPs) and increase allocations to HIV/AIDS activities that contribute to general HSS (eg. Blood safety, laboratories, upgrading facilities)
Recommendations cont. • Increasing alignment with NSPs, but some donors still have own agenda, own systems ~ need harmonisation • Increase absorptive capacity: • Reduce donor ‘dumping’ of funds at the end of the financial year • Improve predictability of donor commitments, over longer period • Increase speed of disbursements, reduce tedious systems, while improving public accountability systems • Improve public programmatic and human resource capacity to deliver services
Recommendations cont. • Improve public financial reporting & information systems • Routine resource tracking ~ institutionalise NASA in M&E systems • Harmonise to 1 national system for reporting on commitments, disbursements & spending • Civil society play greater role in monitoring public spending & in sharing their own spending activities • Critical to have good financial monitoring systems in place before implementing IHPs etc.
Thank You • Teresa Guthrie • Centre for Economic Governance and AIDS in Africa • Email:email@example.com • Tel: +27-21-425-2852 • Cell: +27-82-872-4694