An Introduction to Expenditure Analysis ~ an overview of the NASA methodology Teresa Guthrie Centre for Economic Governance and AIDS in Africa OSI Workshop, Istanbul Sept 2006 Presentation based on slides provided by UNAIDS, Resource Tracking and Projections Unit

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 health issue or beneficiary group. National AIDS Spending Assessment

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 Resource Tracking: Purposes

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 NASA Framework for HIV/AIDS

Classifications for Resource Tracking R.T. aims to collect comprehensive data regarding: Sources – who pays Agents – who manages the funds Service Providers – who provides the services Functions – 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.

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 the health issue They are comparable across resource needs and resource tracking – i.e. must be standardised across studies and between countries for comparison purposes. Functions

NASA Functions 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. AIDS programme costs – program management, monitoring, training, upgrading/new buildings etc. Human resources for AIDS – monetary incentives Social mitigation – social/financial support, human rights etc. Community development – institutional development, IGAs, women’s programmes etc. Research – biomedical, social, psychological, behavioural, vaccine etc.

Target Group or Beneficiaries Population of interest addressed with actions included in service functions: People living with HIV and AIDS Most at risk populations Vulnerable groups OVCs Women – reproductive health clinics STI clinic patients Migrants Refugees Blood donors Men who have sex with men (MSMs)

Object of Expenditure Production factors purchased to produce a good or deliver a service, under any determined production function e.g. Health personnel Pharmaceutical products Reagents and materials Administrative Transport

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

Exercise – mapping ‘the response’ Identify your health topic to be examined (or beneficiary group) Identify the broad categories of programmes that are involved in your topic Under each category list the services delivered Identify the beneficiaries of the services

Exercise – determining the purpose What are the gaps in existing information that will be addressed by the research? What is the purpose of the data and report? (eg. to contribute accurate data on an issue, or to highlight areas of corruption, under-spending?) Who will be the key audience of the findings?

Exercise – determining the scope (1) For which year/s will data be collected? Financial years or calendar years (if different in the country)? Focus on budgets i.e public allocations, or on actual expenditure, or both? Quantitative and/or qualitative data – e.g. figures alone (ie. Allocations or actual expenditures) and/or descriptive data, such as analysis of budget processes, procurement systems, challenges, bottlenecks, case studies etc.

Determining the Scope (2) If including expenditure - only public sources, or also external aid (donor funds), and private (business, private health insurances, out-of-pocket expenditure)? Or specific focus on one (or more) key external sources of aid (e.g Global Fund assessment). To what level will the analysis be undertaken – national, provincial and district?

Determining the Scope (3) Will the study include allocations and/or expenditure made to health activities outside of the Ministry of Health e.g in Correctional service? Will the outputs and outcomes measured? Against what? Efficiency analysis? (CBA, CEA, CUA?) Is analysis of the beneficiary groups required? Is analysis of the objects of expenditure required?

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