ARE HIV ALLOCATIONS BEING ALIGNED TO NATIONAL PRIORITIES: Tracking Expenditure in Southern Africa Guthrie, T., Kioko, U., Chitama, D., Asante, F., Chitsomia, A., Madadume, B. Inaugural Conference of the African Health Economics and Policy Association Accra - Ghana, 10th - 12th March 2009 PL 05/1
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Guthrie, T., Kioko, U., Chitama, D., Asante, F., Chitsomia , A., Madadume , B.
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ARE HIV ALLOCATIONS BEING ALIGNED TO NATIONAL PRIORITIES:
Tracking Expenditure in Southern Africa
Guthrie, T., Kioko, U., Chitama, D., Asante, F., Chitsomia, A., Madadume, B.
Inaugural Conference of the African Health Economics and Policy Association Accra - Ghana, 10th - 12th March 2009
PL 05/1
Objectives To compare levels of spending, both domestic
and international, for HIV/AIDS in 4 SADC countries: Botswana, Swaziland, Zambia, Lesotho -> Ghana (non-SADC comparison)
To consider the adequacy and alignment of the funds for the attainment of their National Strategic Plans (NSPs).
To measure the absorption of these funds according to the different funding mechanisms.
To compare unit costs for key interventions (where output data was available )
Methodology Comparison of NASA Reports from the 4
countries National AIDS Spending Assessment is an
approach to comprehensively measure:All spending for HIV/AIDSFrom all sources, through agents, providers,
activities to beneficiariesFrom a multi-sectoral perspectiveAccording to interventions reflected in the NSPsAllows countries to monitor their own progress
towards the national and international commitments. Acknowledgements to the NACs and NASA
team members for their data
Levels and Sources of Financing Increasing amounts of spending on
HIV/AIDS Increasing public allocations, as well as
international Average contributions (in 4 countries): International 58.8%. Public 41.2%. Removing Botswana: International 71.6%. Public 28.4%.
Levels & Sources of Funding for HIV/AIDS (US$mill, 2006)
Botswana Swaziland Zambia Ghana -
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
Internat. Contribution
Public contribution
US$
Per Capita HIV/AIDS Spending & HIV Prevalence (US$, %, 2006)
Botswana Swaziland Zambia Ghana
$136.98
$51.51
$17.62 $1.38
24.1
26.017.0
3.4
Per capita spending (US$, 2006) HIV prevalence rate (%, 2006)
Increasing Public Allocations: Botswana ~ Total Spending on HIV/AIDS (PulaMill, 2003-2005)
2003 2004 20050
200,000,000
400,000,000
600,000,000
800,000,000
1,000,000,000
1,200,000,000
International FundsPublic funds
Swaziland ~ Sources of HIV/AIDS Financing (SZLmill, 2005/06-2006/07)
2005/06 2006/070
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
300,000,000
350,000,000
400,000,000
InternationalPublic
Zambia ~ Sources of HIV/AIDS Financing (US$, 2005&2006)
2005 20060
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
Int'l NGO Bilaterals Multilaterals Public
Ghana – Sources of HIV/AIDS Financing (US$mill, 2005-2006)
Care and treatment services not elsewhereclassified (n.e.c.)
Opportunistic infections’ (OI) treatment
Home-based care
Palliative care
Psychological treatment and supportservices
Specific HIV-related laboratory monitoring
Nutritional support associated to ARVtherapy
Antiretroviral therapy not-desegregated byage or line of treatment
Adult antiretroviral therapy not-desegregated by line of treatment
Pediatric antiretroviral therapy not-desegregated by line of treatment
Opportunistic infection (OI) prophylaxis
Absorptive Capacity
Dimensions of Absorptive Capacity Program Management Procurement and Supply Chain Financial management Governance & oversight Performance and measurement
This focus is on the financial aspects
Financial Absorptive Capacity Ability of implementing agencies to utilise funds
in the planned time period and for the purposes intended
Rate and manner by which funds received are turned into physical resources of materials, equipment, infrastructure, and personnel
Encompasses financial flow: from commitment
through transfer or disbursement to procurement or expenditure
amounts Prevention not receiving notably increased
allocations Other interventions (mitigation, enabling
environment, research) receiving relatively little
Findings cont.Comparing the costed NSP priorities with the actual spending: NSPs generally poorly costed and may not have been
accepted in country NASA captured more than was included in the NSP costing Improving costings and use of NASA will better provide
estimates of funding gaps by intervention There are improvements ito donor alignment with national
priorities (according to the Paris Declaration) Eg. Increasing allocations through common funds for
HIV/AIDS, managed by the NACs However, there are some notable exceptions Parallel systems of financial management remain
Findings cont. Comparison of unit costs of key interventions within
the SADC region has been difficult due to poor or non-comparable out-put indicators.
The funding mechanism appears to influence the degree of absorption of funds, among many other factors
Often poor absorption due to delays in disbursement systems, and ‘dumping’ by donors
Measuring the absorption of funds proved difficult because the NASA approach initially did not collect the allocations/ commitments / disbursements – only the actual spending so the rate could not be calculated.
Only in Zambia....
NASA Provides Data for Evidence-based Allocative Decisions
Adequacy of funding – public & external
Allocative decisions – priorities
Efficiency of spending & absorption rates/ challenges
Coordination, Harmonisation and Alignment Enhanced Transparency, Accountability & Economic
Governance
Standardization & Comparability Need for institutionalization of resource tracking in
routine M&E systems:
Routine Resource Tracking would….Increase pressure (& desire) for mutual
accountability by all playersPromote a framework to ensure all partners
report through a national resource tracking system
Link framework to the National Resource Mobilisation and Management Strategy
Contribute to harmonised standards of reporting and costing among different partners
Ensure transparent procurement systems & best pricing within and between countries & regions
Thank YouTeresa GuthrieCentre for Economic Governance and AIDS in Africa Email: [email protected]: +27-21-425-2852Cell: +27-82-872-4694