linking nha and nasa a country perspective - rwanda
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Linking NHA and NASA A country perspective - Rwanda. Agnès Binagwaho , MD, Paed Executive Secretary, National AIDS Control Commission. - PowerPoint PPT PresentationTRANSCRIPT
Linking NHA and NASAA country perspective - Rwanda
Agnès Binagwaho, MD, PaedExecutive Secretary, National AIDS Control
Commission
NASA and NHA• National AIDS Spending Assessment (NASA), Generally conducted by NAC (with UNAIDS), to monitor the annual flows of funds used to finance the multisectoral response to HIV/AIDS
• National health accounts (NHA), Generally conducted by MOH (with WHO, USAID), to track expenditures on overall health care with particular attention of health sub accounts as HIV/AIDS
NASA and NHA
General NHA
NASA
Health portion of HIV/AIDS expenditures
Nonhealth portion of HIV/AIDS expenditures
NASA- NHA Crosswalk
Health related
NHA HIV/AIDS subaccount (represents health and health related portions of HIV/AIDS expenditures)
General NHA
NASA
Health portion of HIV/AIDS expenditures
Nonhealth portion of HIV/AIDS expenditures
NASA- NHA Crosswalk
Health related
NHA HIV/AIDS subaccount (represents health and health related portions of HIV/AIDS expenditures)
UNAIDS
NHA-NASA crosswalk
FS.1.1.1.1 Ministry of Finance
FS.1.1.2 Local Authorities
FS.3. Rest of the world
HC.1.1 Inpatient curative care
W Z
HC.1.3.1 Out patient curative care- VCT
Y
HC.6.3.1 VCT Programs
X
FS.1.1 Territorial government: central
FS.1..2 Territorial government: state/provincial
FS.3. International funds
ASC 2.2. Inpatient care W Z
ASC 1.3. VCT( incl. (programmatic and personal)
X Y
NHA HIV/AIDS subaccount
NASA – UNGASS table
UNAIDSImplemented in Rwanda by MOH and CNLS team
Rwanda experience:Both NHA (for health and non-health) and
NASA were carried out in 2007
The teams of NACC and MOH worked together to harmonise the findings of the two exercises in one table only, with some difficulties:
• respondent fatigue given two sets of surveys (one for NASA and one for NHA)
• in some case estimates were conflicting
• inefficient use of human resources (two teams!)
• some gaps and inconsistencies were identified in the harmonization process
Current gaps and inconsistencies for harmonization
• NHA treats all donor funding into one basket called “Rest of the World” while NASA/UNGASS requires distinction for each donor funding
• NHA had a non-health addendum, but not comprehensively addressed (insufficient to fill UNGASS matrix) – e.g. no data on income generating activities
Rwandan Experience
Current gaps and inconsistencies for harmonization
con’t• With a small team of consultants and resources NASA
exercise was only able to identify declared expenditure by funding agents and not to track funding flows down to the implementers to avoid double counting – NHA could do that (the team was bigger and with more resources)
• Expenditure for condoms distribution under NASA is totally attributed to HIV, while NHA makes a distinction with family planning (need to include data from the RH sub-account as well)
Rwandan Experience
Current gaps and inconsistencies for harmonization
con’t
It is very difficult for NACC with a small NASA team to collect data country wide. e.g. from private sector and for out-of pocket expenditure
Rwandan Experience
RecommendationsAt international level
(UNAIDS, WHO, and USAID)• Refine (disaggregate) categories of expenditure for NHA
to allow a better “crosswalk” with NASA (for UNGASS table)
• For NHA, maintain distinction across donors (who finance what for each category) in order to allow UNGASS reporting
• Better one complete exercise from the beginning than two parallel ones with “last minute” harmonization
• Keep all stakeholders at country level informed
Recommendations cont’ At country level
• One exercise only (one questionnaire only): NHA or NASA
• Need to know real expenditure by implementers in country (declared expenditure by donors is not sufficient)
• If using NHA, make sure it includes non-health information as well, it keeps each donor funding separate, and make sure representative from NAC are included into the MOH team
• Make use of existing data collection (e.g. information on expenditure by stakeholders at district level included into the CDLS database) – define “crosswalk” between existing database and NHA/NASA
Lessons learned: AIDS money is a catalyst for
improvements in all sectors.Tool for making the money work:
• With this exercise we had a better tracking of funds
• We are improving our financial reporting • e.i: We gave evidence of 40% PEPFAR money, voted for
Rwanda, missing in country reports
This will lead to better allocation of funds and planning• We are applying the methodology to other sectors
• A better tracking of other sectorial money will assure alignment to EDPRS and our vision 2020
Malaria, HIV/AIDS, and RH in the context of general health expenditures 2006
RH; 6,2%
Other remaining
health; 57,1%
Malaria; 13,9%
HIV/AIDS; 23,5%
2006
Households2%
Public sources
3%
Private companies and others
1%
Donor94%
Financing Sources:Where do HIV/AIDS monies come from?
2002
Donor75%
Households16%Public
8%
Other private1%
Financing Sources:Where do HIV/AIDS monies come from?
Providers:Where do PLHIV spend their money?
2006
Independent pharmacies
19%
Agréé health centers
3%
Public health
centers 23%
Traditional healer 11%
Private clinics
6%
Private hospitals
7%
Public hospitals
23%
Not specified by kind
8%2002
Public health centers
27%Private clinics
6%
Private hospitals
5%
Public hospitals
35%
Independent pharmacies
16%
NGO health centers
7%
NGO hospitals
4%
= RWF 1,020,258,690 ($1,849,166)
=RWF 950,475,493 ($1,722,687)
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