SIDALAC 1 Satellite Meeting Resource Tracking and Priority Setting. XV International AIDS Conference Bangkok. 13 July, Overview of Resource Tracking Approaches SIDALAC

FUNSALUD SIDALAC 2 National HIV/AIDS Accounts The national health accounts describe the distribution of resources to the institutions, by source of financing, public/private mixture for service provision, the role of the NGO’s, and the international cooperation. It is the result of applying specifically to HIV/AIDS, the methodology to estimate the national accounts of the health sector. The categories of services and goods in the health care functions has been adapted to better fit HIV/AIDS programs, services and goods.

FUNSALUD SIDALAC 3 The national accounts describe the distribution of resources to the institutions, by source of financing, public/private mixture for service provision, the role of the NGO’s, and the international cooperation. Background

FUNSALUD SIDALAC 4 1) To analyze the expenditure in order to obtain a comprehensive description of the flow of resources from their origin up to the end users 2) To determine the levels and determinants of expenditure on HIV/AIDS. Objectives of NAA

FUNSALUD SIDALAC 5 3) 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 (2)

FUNSALUD SIDALAC 6 Characteristics of NAA Comprehensive: An inventory of all resources addressed to HIV/AIDS Internally consistent: Totals must add- up and be congruent across different tables. Internationally comparable accounts: The breakdown of tables, the content of categories and the methods of calculation must be harmonized as far as possible. Compatible with upper-level systems (as National Health Accounts) and social statistics.

FUNSALUD SIDALAC 7 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 International Public, Private  Description of agents or providers of services  Description of use of the resources Prevention vs. Care; and non-health Goods and services  Beneficiaries or target groups

FUNSALUD SIDALAC 8 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

FUNSALUD SIDALAC 9 Prevention of Sexual Transmission. Identification of the expenditure explicitly directed to the most vulnerable populations and the highest risk for HIV MSM CSW (men and women) General Population (youngsters, women) Social marketing of condoms Inmates Mobile Populations

FUNSALUD SIDALAC 10 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

FUNSALUD SIDALAC 11 Strengthening/Building Capacities in LAC and West Africa Projects conducted by in-country consultants as joint efforts with NAPs GUIDELINES and software (SIFRAS) Spanish English French Hands-on training of national professionals (e.g. staff of the NACP)

FUNSALUD SIDALAC 12 Capacity Building Main results output: Description of the levels and trends of the expenditures and the financing flows Main Capacity building outputs: Training of professionals within each country to continue estimating expenditures with a valid and comparable methodology over time and across countries of the estimates Creation of networks of experts to provide south-south or Horizontal Technical cooperation in each region Cross-fertilization between regions of developing countries (e.g. LAC to West Africa)

FUNSALUD SIDALAC 13 Other relevant topics to consider Other applications of NAA: To provide key indicators to monitoring the implementation of strategic plans To provide comparative analysis of mobilization and distribution of resources to regional forums of technical cooperation and other supranational level organisms. To accomplish its aims, NAA must made some trade-offs between: Timeliness: estimates must be available when decisions are to be taken; Precision: estimates must be as accurate as possible; Relevance of indicators: useful figures must emerge from estimates; Policy and Political Sensitivity: estimates must capture the effects of change, maintain or not state policies.

FUNSALUD SIDALAC 14 EXPENDITURE ON HIV/AIDS IN LAC TOTAL EXPENDITURE (Million USD): US$1,225.3 Public Sources: US$ (73.8%) Private Sources:US$ (24.0%) External Sources:US$ 26.3 ( 2.1%)

FUNSALUD SIDALAC 15 Main features of the HIV/AIDS expenditure in LAC, 2000 Average Per capita expenditure: US$2.69 Lowest: Bolivia US$0.37 Highest: Uruguay US$5.83 Average Percentage of the Gross National Product (GNP): 0.05% Lowest: Mexico (0.03%) Highest: Belize, Brazil, Uruguay (0.1%) Average Percentage of the National Health Expenditure: 1.0% Lowest: Mexico and Bolivia (0.6%) Highest: Honduras 5%

FUNSALUD SIDALAC 16 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)

FUNSALUD SIDALAC 17 HIV/AIDS Expenditures by source and by target population. Belize, 2003.