guthrie, t., kioko, u., chitama, d., asante, f., chitsomia, a., madadume, b. inaugural conference of...
TRANSCRIPT
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)
2005 2006 -
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
35,000,000
InternationalPublic
Lesotho (prelim) ~ Financing Sources for HIV/AIDS (M, 2005/06 & 2006/07)
2005/06 2006/070
50000000
100000000
150000000
200000000
250000000
300000000
InternationalPublic
Alignment with National Priorities
Swaziland ~ Comparison of Costed NSP with NASA Spending (SZL, 2006/07)
Zambia ~ NSP Costed Priorities vs Actual Spending (%, 2006)
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0% 45.0% 50.0% Percentage
I. Intensifying Prevention
II. Expanding Treatment, Care and Support
III. Mitigating the Socio-economic impact of HIV and AIDS
IV. Strengthening the Decentralized Response and mainstreaming HIV and AIDS
V. Improving the monitoring of the multisectoral Response
VI. Integrating Advocacy and Coordination of the Multi-sectoral
Response
Theme
Actual expenditure NASF Priorities
Botswana ~ NSP Priorities Compared to Actual Spending (%, 2005/06)
13.6
49.4
14.4
22.2
0.5
10
54
7
17
0
0.0 10.0 20.0 30.0 40.0 50.0 60.0
Prevention
Care & Support (inclARVs)
Mgmt of NationalResponse
Psychosocial &Economic Impact
Strengthen Legal &Ethical Enviro.
NS
F G
oal
s
%NSF %
Actual Spending %
Ghana ~ Costed APOW vs Actual Spending (US$, 2006)
Po
licy,
Ad
vo..
.
Co
ord
. &
M..
.
Miti
ga
ting
t..
.
Pre
ven
tion
...
Tre
atm
en
t, .
..
Re
sea
rch
, S
...
Mo
bili
zatio
n..
.0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
Costed APOWAct.ExpenditureU
S$
Lesotho ~ Spending Compared to Costed NSP Priorities (%, 2006/07)
Mgmt, Coord, Support
Prevention Treatment & Care Impact Mitigation0
5
10
15
20
25
30
35
40
45
50
Costed NSPAct.Spending
Botswana ~ Spending on HIV/AIDS by Source (%, 2005)
Public sector Internat.Orgs Total Pula0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
FN 8. Research
FN 7. Community Develmt & Environment
FN 6. Social mitigation
FN 5. Human Resources Incen-tives
FN 4. Prog.Devmt & HSS strengthening
FN 3. OVCs
FN 2.Treatment and care
FN 1..Prevention Programmes
Swaziland ~ Effects of Reducing External Aid (SZL, 2005/06-2006/07)
-
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
300,000,000
350,000,000
400,000,000
2005/ 2006 2006/ 2007
YEAR
SZL
HIV and AIDS realatedresearch(Excluding operational research)
Enabling Environment and CommunityDevelopment
Social Protection and Social Services(EXCLUDING OVC)
Human Resources' recruitments andRetention Incentive - Human Capital
ProgrammeManagement andadministration strengthening
OVC
Care and Treatments
Prevention
Swaziland ~ Reducing Treatment (Nutrition Supplements) Spending (SZL, 2005/06-2007/08)
-
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
60,000,000
70,000,000
80,000,000
90,000,000
2005/ 2006 2006/ 2007
YEAR
SZ
L
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
Zambia – absorption rates improving (US$, 2005 & 2006)
2005 2006 -
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
AllocationsActual Spending
Av.72%
Av.88%
Factors Limiting Absorptive Capacity
Limited human resources & skills at all stages of project conceptualisation, implementation & monitoring
High rate of turn-over and deaths of staff Preferential use of funding (according to source) Governmental ceilings for development / social
sector spending – frozen posts Delayed disbursements (some funding
mechanisms worse than others) Complexity of reporting and accounting
requirements and other conditionalities – absorb staff time
Govt procurement systems very slow Short project cycles and disbursement cycles
Summary of Findings Evidence of improving public contribution to
total spending on HIV/AIDS Some decreases in external sources (Swaziland
& Lesotho) Treatment (specifically ART) requiring
increasing 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 players
Promote 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