An overview of the NASA methodology Teresa Guthrie Centre for Economic Governance and AIDS in Africa

Overview of this Presentation UNAIDS’ aim Introduction to resource tracking & NASA Purposes of NASA NASA relationship to NHA NASA methodology Ghana NASA objectives - expectations Anticipated process NASA requirements

UNAIDS Steps (2005/6): 1.Increase the number of countries with NASAs to report Domestic Public expenditure on HIV/AIDS for UNGASS (~60 countries by end 2005) 2.Create/strengthen regional networks to conduct National Spending Assessments (7 regions) 3.Significantly increase the number of NASA country experts (horizontal technical cooperation; capacity / strengthening building) 4.Endorsement by Global Resource Tracking Consortium

Low- and middle-income countries reporting on domestic expenditure for the review of the DoC. March, 2006

To provide indicators of the financial country response to HIV/AIDS or health To support monitoring resource mobilization To obtain information in order to improve decision- making To define priorities regarding the distribution of resources Not an auditing process Resource Tracking: Purposes

National AIDS Spending Assessment NASA is a generic term currently used for all country’s HIV/AIDS resource tracking activities. It provides a framework and tools for undertaking a comprehensive analysis of actual expenditures for HIV/AIDS - which can be applied to any HIV/AIDS activity (health and non-health).

Measurement of Spending –Total Domestic Public (e.g. UNGASS indicator) –Inflows by donors (e.g. GF additionality) –Private – OOPE, business, NGO Usefulness as input in the AIDS planning cycles –Complimentary with the NSP categories –Complimentary with Resource Needs Provides the base data to undertake further analysis: Equity, beneficiary analysis, Efficiency, Bottlenecks, Absorptive capacity, Allocative efficiency, etc. NASA data usefulness

NASA’s contribution Well developed methods and tools – user- friendly, internationally comparable stds Skills transfer and capacity building of NAC, UNAIDS & consultants Contribute to the development of financial information systems for the ongoing monitoring by NAC

Complimentarity to the Resource Needs Model NASA and the RNM use the same classification for HIV/AIDS activities This makes analysis of the financing gap between current expenditure and the projected resource needs more useful for Programme managers

Use of NASA Results: Work in progress aimed at supporting better spending in countries Efficiency:Bottlenecks and absorptive capacity Additionality – GF projects Improved tracking of non-health expenditures: Expanded response Timeliness of data: opportunity to influence policies Allocative effectiveness – funding for the right interventions Equity – funding for the right populations

NASA is not limited to health expenditures for HIV/AIDS, but emphasizes the tracking of non-health expenditure such as social mitigation, education, labour, justice and other sectors’ expenditure related to HIV/AIDS Captures according to categories similar to the NSPs - more useful to NACA NASA Framework for HIV/AIDS

12 The Development of the 3 Approaches for HIV/AIDS Funds Health Systems PHRplus NHA HIV/AIDS Sub- analysis SIDALAC National AIDS Accounts HIV AIDS State AIDS Budget Analysis Idasa - ABUGovtBudgets Adjusted from PHR+ presentation, Feb 04. PHR+. NASAs !

NASA Relationship to NHAs Same accounting procedure Same data produced with more disaggregation of activities/ functions Data for non-health expenditure NASA is compatible and comparable with NHA (HIV sub-analysis), but provides greater detail for NSP usefulness

Coverage of AIDS Resource Tracking NAA Non-health (memorandum items.) Differences on personal services with Public Health implications, e.g. STI. Care and Treatment Prevention and Public Health Non-health NHA-AIDS Personal services Public Health Memorandum Items NASA Care and Treatment Prevention and Public Health Orphan & VC HR (incentives) Social mitigation Community development AIDS related research (not OR)

NASA Spending Categories/ Priorities

NASA Treatment Components

NASA Beneficiaries of Spending

NAAs ~ HIV/AIDS per capita expenditures LAC and selected African countries. PPP-USD$, 2002/3. (Pre-GF) Burkina Faso Ghana Kenya Rwanda Zambia PPP$ 7.79 PPP$ 8.12 PPP$10 PPP$12 PPP$ 15

NASA Classifications R.T. aims to collect comprehensive data regarding: Sources – who pays Agents – who manages the funds Service Providers – who provides the services Functions/activities – what is provided Beneficiaries – who benefits Objects of expenditure – what are the components of expenditure The primary responsibility of the resource tracking team is to ensure that the classification scheme used is made of mutually exclusive and exhaustive categories within each of the classifications.

Assessment Along 3 Dimensions 3 dimensions and 6 vectors Financing: –(1) Sources –(2) Agents Provision: –(3) Providers –(4) Production factors Consumption –(5) Activities –(6) Beneficiary groups

Financing Provision Consumption Sources Purchasers Providers Factors of production Commodities Beneficiaries Triangulation

Entity which generates the funds and makes the decision for assigning resources to functions, or agents e.g. Ministries of Finance/ Treasury  Global Fund  World Bank Financial Source

Intermediary flow in the context of health financing. If a financial agent assigns resources to confront AIDS, for NASA purposes, becomes a financial source as well e.g. Ministry of Health, National AIDS Commission Financial Agent

Entity responsible for delivering goods or services in response to HIV/AIDS or health e.g. Blood bank  Ambulatory care center (OPD)  Hospital Provider

All the interventions, services and activities undertaken/ provided in response to HIV/AIDS. They are comparable across resource needs and resource tracking – i.e. must be standardised across studies and between countries for comparison purposes. Activities/ Spending Categories

NASA Spending Categories for HIV/AIDS Classified for eight HIV/AIDS programmatic areas Prevention - Mass media, condoms, HRPs etc. Treatment & care – ARVs, OI Rx, palliative care etc. Orphans and vulnerable children – education, family support, nutrition etc. Programme development & strengthening health care systems for HIV/AIDS – program management, monitoring, training, upgrading/new buildings etc. Human resources for HIV/AIDS activities – monetary incentives Social mitigation – social/financial support, human rights etc. Community development and enhanced environment – institutional development, IGAs, women’s programmes etc. Research – biomedical, social, psychological, behavioural, vaccine…

Target Group or Beneficiaries Population of interest addressed by / benefiting from the activities: People living with HIV and AIDS Most at risk populations Vulnerable groups –OVCs –Migrants –Refugees –Men who have sex with men (MSMs) Accessible populations –STI clinic patients –Women – reproductive health clinics –Police, military, truckers, sailors –Children at school General populations

Object of Expenditure Production factors purchased to produce a good or deliver a service, under any determined production function e.g. Current expenditure –Wages/ salaries/ non-wage income –Pharmaceutical products (ARVs, other drugs) –Reagents, materials, supplies –Condoms –Services Transport Training of staff Consultant services Administrative Capital –Buildings, equipment, vehicles, capital transfers

Is the basic unit of the financial flow, that describes the transit of resources from a source to a provider, who purchases objects of expenses to develop one or more functions benefiting target groups, specified or not. Tracking the Transaction

Flow of resources from origin to end users: reconstruction of transactions AC Source Provider Functions B Objects of Expenditure Target Groups Non Specific

Sources of Data for NASA Top-down: from sources of funds eg donor reports, commitment reports, government budgets etc. Bottom-up: service provides’ expenditure records, facility level records, governmental dept. expenditure accounts. Missing data: costing techniques are used to estimate actual expenditure

Production Factors Flow of resources from origin to users: reconstruction of transactions (“Top Down”) Financing Agents Providers of services Functions (Health or non-Health) Beneficiaries - Specific Target Groups - Or unspecified Sources Financing Provision Use

Reconstruction of transactions (“Bottom Up”) to reconcile with flows from sources (ceiling) Production Factors Financing Agents Providers of services Functions (Health or non-Health) Beneficiaries Financial Sources Financing Provision Use

Challenge of estimating information not easily accessible There are several components for which the information is not easily accessible –e.g. unlikely to be reported and leave “administrative trail” Example: Treatment of Opportunistic Infections in public settings –Part of the hospital budget –Need to use costing tools to provide the best possible estimations

Costing Techniques for Estimations Internationally accepted costing methods and standards used to retrogressively measure past actual expenditure Ingredient and step-down costing is used for direct and shared expenditure for HIV/AIDS Shared costs are allocated on the most appropriate utilization factor Donated goods and in-kind servicies are valued at their valve in the year of consumption Capital goods costs are annualised and adjusted for inflation (where appropriate)

NASA process/ timeframe Planning & training – week 1 Key stakeholder meeting – end of week 1 Identification of key sources of data & appointment setting – 1-5days Obtaining permissions, letters of access – 2/3weeks Data collection (interviews, site visits) – 4-5weeks Data capturing in the software – ongoing. 2weeks. Data analysis – 1/2 weeks Draft 1 of report – 1/2 weeks Validation meeting – prelim findings to stakeholders Editing and improving report – 1 week Finalisation of report

NASA Team Requirements Permissions – letters to key sources of data – especially Moh, MoE, MoLG (SS), district level services Comprehensive database of all sources, agents, providers in Ghana Assistance with sample selection & site visit preps Secondary data (refer to list) Access to expenditure records et al – electronic and hard copies GAC & UNAIDS representatives, ISSER team Data capturers (?) Transportation & accommodation for site visits Printing of docs etc.

Thank you! Teresa Guthrie Centre for Economic Governance and AIDS in Africa