"Where did the money go? Findings from the National AIDS Spending Assessment Report.“ Authors: Annang Dennis 1, Asante Felix 2, Yeboah Kenneth 3, Epeh Daniel 1, Atuahene Steven 1, El-Adas Angela 1 1 Ghana AIDS Commission, 2 Institute of Statistical, Social and Economic Research, 3 Pricewaterhouse Coppers,

Presentation Outline Background Country Context Overview Objectives Methods Steps Assumptions Results Conclusions and Recommendations

Background - Country Context(2014) General Adult prevalence % ANC Prevalence is 1.6% Total number of PLHIV – 250,232 Adults (15+ years) – 229,009 (92%) Children (0–14 years) – 21,223 (8%) Total new infections - 11,356 Adults (15+ years) – 9,467 (83%) Children (0–14 years) – 1,889 (17%) Total AIDS Deaths – 9,248 Adults (15+ years) – 7,953 (86%) Children (0–14 years) – 1,295 (14%) Northern 0.6% Volta 2.2% Ashanti 2.8% Brong Ahafo 2.6% Western 2.4% Eastern 3.7% Upper West 1.3% Central 1.4% Upper East 1.4% Greater Accra 3.1% Source: National AIDS/STI Control Programme Legend 0.00 – – – – 3.00

Background - Overview Ghana’s HIV response is guided by the NSP 2011 – 2015 and highlights the need to strengthen resource tracking at all levels. The National AIDS Spending Assessment (NASA) is the key tool for this strategy which supports planning, information generation for decision-making and the design of policies aimed at controlling the HIV epidemic The resource tracking process of the NASA maps the financial transactions from their origin (funding source) through to the final destination (beneficiaries receiving goods and services). This is used to assess national commitment and action, which is an important component of the Global AIDS Response Progress Reporting (GARPR)

Background - Objectives Analyse expenditure patterns related to the structure of HIV and AIDS-related services and organisations in Ghana Validate, enter and analyse financial data for national level data Document and share the NASA process and findings with stakeholders Build national level capacity for systematic monitoring of HIV and AIDS financing flows

Method - Steps Planning – identification of stakeholders and classifying them into the following sub types: Financing sources - decides on assigning resources to functions Financing agents - pay for purchase of goods and services Providers of services - responsible for delivering goods or services Beneficiaries - populations that benefit from spending on HIV/AIDS Data Collection – using required NASA data collection forms and tools to collect the financial data from stakeholders Data Processing – grouping financial data into the NASA spending categories with respective beneficiary population using the NASA Resource Tracking System (RTS) software Data Analysis - exporting the RTS outputs to Excel® to produce summary tables and graphs

Methods – Assumptions Financial year – where the external sources’ financial year was NOT equivalent to the calendar year, then adjustments were made to estimate the expenditure within the calendar year 2011, 2012 and 2013 Where funds are pooled and not disaggregated by donors, the expenditure contribution were assumed to be in equal proportions The average interbank annual exchange rate of the US dollar to the cedi was used: 2011: GH¢1.50 to US$1 2012: GH¢1.81 to US$1 2013: GH¢1.96 to US$1

Results - Total Expenditure for (US$)

Results - Spending Priorities for 2011–2013

Conclusion and Recommendation So where did the money go ?

Priority Areas NSP Costing (US $) (A) NASA Findings (US $) (B) Variance (B – A) Variance % Prevention Programmes106,854,07582,764,418(24,089,657)(22.5) Treatment and care components49,888,15585,089,76035,201, OVC and Social Protection and Social Services 8,470,17814,838,9316,368, Programme Management and Administration and HR 18,696,16370,486,42451,790, Enabling Environment20,148,9812,442,133(17,706,848)(87.9) HIV- and AIDS-Related Research39,192,3592,756,487(36,435,872)(93.0) Where did the money go? Ghana 2011 – 2013

NASA expenditure areas and NSP categorization were not well aligned e.g. operational research spending in programme management A more realistic approach should be applied in costing the NSP 2016 – 2020; adopt more accurate projections and unit costs to avoid over and under budgeting Agencies and implementers should be clearer on their specific spending areas and disaggregate as far as possible in reporting. Finally there is a need to improve accuracy of financial data and reporting mechanism to conform to the Three Ones Principle. There is the need for more predictable and increased funding for HIV activities if we are to end AIDS by 2030 Conclusion and Recommendation

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