SIDALACSIDALAC

11

Satellite Meeting Resource Tracking and Priority Setting.

XV International AIDS Conference Bangkok. 11 July,

2004.

Methodological Approaches - Utility of National AIDS Accounts

SIDALAC

22

FUNSALUD

SIDALACSIDALAC

To describe the financial flows

identifying:

-who pays

-who benefits

-through what mechanisms

(reconstructing transactions

from their sources to the end-

up users)

Objectives of NAA

33

FUNSALUD

SIDALACSIDALAC

Methods of the NAA Estimation of all resources spent by

calendar year in all kinds of activities from all sources Description of sources of funding

Domestic and InternationalPublic, Private

Description of agents or providers of services

Description of use of the resourcesPrevention vs. Care; and non-health Goods and services

Beneficiaries or target groups

44

FUNSALUD

SIDALACSIDALAC

Data collection Expenditures estimated from budgets Estimation of the actual costs of providing

services and goods Classification of expenditures by

International Classifications OECD

Description of flows of financing Differentiation between budgets and executed

expenditures Differentiation between donor perspective and

actual flow into the country for HIV/AIDS activities Avoid of duplication of expenditures by describing

flows

55

FUNSALUD

SIDALACSIDALAC

Detail by subprograms

Access to ARV

Vertical Prevention

Blood Banks

IDU Prevention

66

FUNSALUD

SIDALACSIDALAC

Identification of the expenditure explicitly directed to the most vulnerable populations and the highest risk for HIV

MSMCSW (men and women)Social marketing of condomsInmates Mobile PopulationsGeneral Population (youngsters,

women)

77

FUNSALUD

SIDALACSIDALAC

Categories of Expenditure(examples)

Public Health: Epi Surveillance, IEC

Prevention: Condoms, STI’s Tx, MTCT

Prevention, Needles, Blood Banks

Treatment: Hospitalary, Ambulatory

Support Services: Diagnostic Tests,

Monitoring of ARV therapy –viral load, CD4+

Cell counts.

Anti-retrovirals

Other drugs: Prophylaxis, Treatment of OI

88

FUNSALUD

SIDALACSIDALAC

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00%

Bolivia

Peru

Honduras

Paraguay

Uruguay

Nicaragua

Dominican R

El Salvador

Chile

Argentina

Costa Rica

Guatemala

Brazil

Panama

México

Q1

Q2

Q3

Q4

Public Expenditures in HIV/AIDS as Percentage of National HIV/AIDS Expenditures in LAC

Regional Average 73.8%

99

FUNSALUD

SIDALACSIDALAC

EXPENDITURE ON HIV/AIDS IN LAC

TOTAL EXPENDITURE (Million USD):

US$1,225.3 Public Sources: US$ 904.6

(73.8%) Private Sources: US$ 294.3

(24.0%) External Sources: US$ 26.3

( 2.1%)

1010

FUNSALUD

SIDALACSIDALAC

Total HIV/AIDS Expenditures LAC and Two West African countries. Adjusted by PPP-USD$, 2002.

0.00 2.00 4.00 6.00 8.00 10.00 12.00

BoliviaGuatemala

MéxicoChile

ParaguayEl Salvador

R DominicanaPerú

Brasil

PanamáNicaraguaCosta Rica

ArgentinaUruguay

Honduras

Q1

Q2

Q3

Q4

Honduras HIV/AIDS Prevalence = 1.79%; Burkina Faso = 4% ; Ghana = 3.4%

African countries provide very limited coverage of ARV.

Burkina FasoGhana

1111

FUNSALUD

SIDALACSIDALAC

Main Expenditure Items in LAC

CARE (70% of total Expenditure) Total Expenditure on Care US$ 800,845,217 Main Item ARV 65% Expenditure per capita $1.65

PREVENTION (27% of Total Expenditure) Total Expenditure in Prevention and Public

Health US$ 309,221,436 Main Item CONDOMS 58% Total per capita $0.64

NON-HEALTH ACTIVITIES (3%) Total Non-Health Expenditure US$37,582,037 Main Item TRAINING 72% (e.g. conferences)

1212

FUNSALUD

SIDALACSIDALAC

FUNSALUD

SIDALACSIDALAC

ONUSIDA

Total HIV/AIDS Expenditures by Functions, Burkina Faso, 2003

Personal Health Care services26%

Equipment 2%

Non-Health or health related expenditures 23%

Administration15%

Prevention and Public Health34%

1313

FUNSALUD

SIDALACSIDALAC

FUNSALUD

SIDALACSIDALAC

ONUSIDA

HIV/AIDS Expenditure by Function -Ghana, 2003

PUBLIC HEALTH AND PREVENTION

39%

PERSONAL HEALTH CARE

SERVICES13%

Non-Health or Health Related

42%

Investment2% Administration

4%

1414

FUNSALUD

SIDALACSIDALAC

HIV/AIDS Expenditures by source and by target population, e.g. Belize, 2003.

Source ► Target Pop'n ▼

Central Gov't

Other Public

Org Private

Non-for-profit Org.

House-holds IDA Ext Private Total

Non Targetted 15.7% 5.2% 5.3% 26.2%Schoolars 0.1% 0.1%Workers 0.0% 0.0%MSM 0.0% 0.0%M&F CSW 21.2% 0.7% 21.9%UDI 0.0% 0.0%MTCT 1.7% 1.7%Blood Banks 0.9% 0.9%Migrants 0.2% 0.2%Uniformed Pop'n 0.1% 0.1%Inmates 0.3% 0.0% 0.3%Pregnant women 1.2% 0.5% 1.8%

Vulnerable children and youth 6.0% 6.0%Health Personnel 2.1% 0.2% 2.2%PLWH 0.4% 1.1% 1.6%PLWA 26.3% 0.0% 0.0% 4.9% 2.4% 3.5% 37.1%

TOTAL 70.0% 0.0% 0.0% 0.0% 10.1% 16.4% 3.5% 100.0%

1515

FUNSALUD

SIDALACSIDALAC

Expenditure in Functions by Source in 13 LAC countries, 2002.

Percentage of the total expenditureSOURCE

(% of the Total)Care

(75.2%)PREV.(18.2%)

ADMN.(4.6%)

INVEST(0.2%)

NON-HEALTH

(1.8%)

PUBLIC(83.6%) 70.3 8.0 4.5 0.1 0.7

PRIVATE(14.8%) 4.6 9.7 0.1 0.1 0.3

INTERNATIONAL

( 1.6%)0.3 0.5 0.0 0.0 0.8

Total expenditure = USD$ 588,550,000

1616

FUNSALUD

SIDALACSIDALAC

Expenditure in Functions by Source in two West African countries, 2003.

Percentage of the total expenditureSOURCE

(% of the Total)CARE

(17.9%)PREV.(36.7%)

ADMIN.(9.2%)

INVEST.(1.9%)

NON-HEALTH(33.3%)

PUBLIC(33.3%) 5.2 13.2 2.9 0.0 12.0

PRIVATE(10.8%) 6.8 4.0 0.0 0.0 0.0

INTERNATIONAL

( 55.9%)6.9 19.5 6.3 1.9 21.3

Total expenditure = USD$ 51,858,000

1717

FUNSALUD

SIDALACSIDALAC

Per capita public and private expenditure in HIV/AIDS, 2002. USD$

R2 = 0.3447

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50

Public US$ per capita

Priv

ate

US

$ p

er c

ap

ita

GUY

URU

ARG

MEX

CHICSR

PAN

BEL

ELS

COLBOLVEN

PAR

NIC

GH03GH

BF03

1818

FUNSALUD

SIDALACSIDALAC

Expenditure per PLWHA versus GDP per capita (US$) in thirteen selected LAC countries, 2001

R 2 = 0,4808

0

500

1.000

1.500

2.000

2.500

3.000

0 1.000 2.000 3.000 4.000 5.000 6.000 7.000 8.000 GNP per cápita US$

Exp

end

itu

res

per

PL

WH

A

US

D$

GUY

URU

ARG MEX

CHI CSR

PAN BEL

ELS

COL HON BOL

SIDALACSIDALAC

1919

Country examples of the utility of

NAA

2020

FUNSALUD

SIDALACSIDALAC

Expenditure in Prevention and Care. BRAZIL 1997-2000

(million $USD)A saving in care; an increase in prevention

45 42 68157

248352

812

415

0

200

400

600

800

1000

1997 1998 1999 2000

YEAR

US

D$

Prevention Treatment and care

2121

FUNSALUD

SIDALACSIDALAC

HIV/AIDS Expenditures in prevention and care. MEXICO 1995-2002. (Million USD$)Sharper increase in care; moderate increase for prevention.

30

49

34

50

36

82

41

82

44

114

42

128

43

155

0

20

40

60

80

100

120

140

160

1995 1996 1997 1998 1999 2000 2001 2002

Prevention Care

2222

FUNSALUD

SIDALACSIDALAC

Preventive expenditure on MSM and the percentage of AIDS cases among MSMLack of correlation between epidemiogical information and expenditure in the population at highest risk

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Argen

tina

Bolivia

Brazil

Chile

Costa

Rica

Domini

can

R

El Salv

ador

Guate

mala

Mex

ico

Panam

a

Parag

uay

Peru

Urugu

ay

Preventive Expenditure on MSM AIDS Cases among MSM

%

2323

FUNSALUD

SIDALACSIDALAC

HIV/AIDS Expenditures in Local Currency. Ghana, 2002-2003Additionality of GFATM

0

20,000

40,000

60,000

80,000

100,000

Min

istr

y of

Hea

lth

Oth

er C

entr

al G

over

nmen

t

NG

O’s

Hou

seho

lds

(OO

PE

)

Mul

tilat

eral

s(I

nclu

ding

GF

AT

M)

Bila

tera

ls

Inte

rnat

iona

lN

GO

s

2002

2003PUBLIC PRIVATE INTERNATIONAL

CE

DIS

2424

FUNSALUD

SIDALACSIDALAC

Resources according to source of information

NAA

Level of expenditure

according to NAA

2525

FUNSALUD

SIDALACSIDALAC

Resources according to source of information

NSP

Costing of National Strategic

Plan

2626

FUNSALUD

SIDALACSIDALAC

Comparison between level of Resources according to source of information: NAA and NSP

NAA

NSP

2727

FUNSALUD

SIDALACSIDALAC

Comparison of results from NAA and from NSP

Non essential expenditure

NEEDS OF NEW RESOURCES

Irreducible exp.

NAA

NSP=

Eliminate expenditure

Add to NSP

2828

FUNSALUD

SIDALACSIDALAC

CHALLENGES Need of capacity building /capacity

strengthening Continue with capacity building in countries

already involved in resource tracking and initiate process in other countries/regions

Instead of experts producing hardly-repeatable case studies, promote country officials conduct their own estimates;

Transformation into a continuous information system instead of cross-sectional estimates

Need of sufficient financial resources to conduct projects and training in developing countries

SIDALACSIDALAC

2929

http://www.sidalac.org.mx