KZN HIV and AIDS Spending Assessment: Preliminary Findings Presented by Dr F. Ndlovu OFFICE OF THE PREMIER. PROVINCIAL COUNCIL ON AIDS MEETING 25 AUGUST.

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Presentation transcript:

KZN HIV and AIDS Spending Assessment: Preliminary Findings Presented by Dr F. Ndlovu OFFICE OF THE PREMIER. PROVINCIAL COUNCIL ON AIDS MEETING 25 AUGUST 2010

Outline  Methodology  Total HIV and AIDS spending in KZN (public, external & private but business limited)  Sources  Agents  Activities  Providers  Beneficiaries  DOH spending on HIV and AIDS  DOH voted funds for HIV and AIDS  DOH CG for HIV and AIDS

Objectives of NASA in KZN  To identify all the sources of financing for HIV and AIDS and TB in KZN, for the years 2007/08 and 2008/09.  To measure all the public, external and private financial resources allocated/ committed and spent for HIV and AIDS and TB activities in KZN, for the years 2007/08 and 2008/09.  To identify the providers of the HIV and AIDS and TB services in KZN, for the years 2007/08 and 2008/09.  To identify the activities on which the funds were spent, according to the NASA classifications and the PSP priorities, for the years 2007/08 and 2008/09.  To identify the beneficiaries of the spending on HIV and AIDS and TB activities in KZN, for the years 2007/08 and 2008/09.  To make recommendations for the improved targeting of funds and efficiency of spending, according to the provincial priorities.

Methodology  Aimed to include data from all sources, from all agents and from sampled service providers.  All DOH & PPSD & NHLS expenditure by activity and service provider – from BAS records  Verified with small sample of clinics / hospitals / pharmacists / NGOs receiving DOH and /or DSD grants  DOE – provided detailed expenditure of lifeskills CG  DSD – did not provide BAS expenditure, so had to use the audited expenditure amounts from budget documents and split between OVC, HBC, M&E, planning & coord, training, social services – excludes the payments made on grants (national level analysis).

Methodology cont.  Other govt departments were interviewed: agriculture, OP, treasury – they were unable to provide any HIV-specific spending.  Public wellness programme - there was no HIV-specific spending in the study years, they are creating it currently.  External sources – data obtained from EU, GF & donors to DOH only.  Missing all other external partners since they indicated that their expenditure would be obtained from Head Offices.  Missing private medical aid & insurances indicated that their expenditure would be obtained from Head Offices.  Missing: spending of most municipalities, mortuaries & C. Sections.

Methodology cont.  Business sector – only DCC & SABCOAH & McCarthy provided data, many did not respond and some indicated that their Head Offices would have to provide the data.  NGOs: were sampled from 911 database – many were not contactable, and eventually only about 60 provided data.  Research institutions – contacted: MRC, HSRC, HST, HEARD, HIVAN, RHRU, PASCA, McCord Hospt, Nelson Mandela Med.School – only got data from MRC & HEARD.  To be collected at national level – blood safety, condoms (the numbers of condoms distributed were not obtained from HAST so could not be estimated), correctional health services, private medical insurances, businesses & external funders. DRAFT - DO NOT DISSEMINATE.

Methodology cont  Data collection through interviews & expenditure record verification.  Data triangulation to ensure correct actual expenditure.  Also avoided double counting through triangulation & creating transactions.  Data cleaned and captured in Excel.  Exported to NASA RTS where aggregated and matrices produced.  All analysis & graphs generated in excel.

Total Spending on HIV and AIDS in KZN All public, external & some private (business limited)

Total Funding & Sources for HIV and AIDS in KZN DRAFT - DO NOT DISSEMINATE.

Sources of all HIV spending in KZN – further disaggregated 2007/08 & 2008/09

Funding Levels & Sources in the SADC Region and 1 West African Country Source Data: individual Country NASA reports, complied by Guthrie, 2009.

Comparison with Spending in SADC Source Data: individual Country NASA reports, complied by Guthrie, 2009.

Sources of Private HIV and AIDS spending 2007/08

Sources of External HIV and AIDS spending 2007/08

Multilateral AID for HIV and AIDS in KZN 2007/08 & 2008/09

Bilateral AID For HIV and AIDS in KZN 2007/08 & 2008/09

External Foundation AID for HIV and AIDS in KZN 2007/08 & 2008/09

Agents of Spending  The managers of funds – receive and send on to providers.  Decide programmatic spending.  Eg. GF – CCM assumed principal recipient is the agent  But for EU funds, EU is the agent DRAFT - DO NOT DISSEMINATE.

Financing Agents of HIV spending 2007/08 & 2008/09 DRAFT - DO NOT DISSEMINATE.

Public sources by Agents for HIV and AIDS spending 2007/08 & 2008/09 DRAFT - DO NOT DISSEMINATE.

External Sources by Agents for HIV spending in KZN 2007/08 & 2008/09 DRAFT - DO NOT DISSEMINATE.

HIV and AIDS Spending Activities  NASA classifications:  Prevention  Treatment and care  OVCs  Policy, management and coordination  Human Resources  Social services & Protection  Enabling environment  Research  Each have several sub-components

Total KZN HIV and AIDS Spending Activities

Comparison with Activities in SADC

Public Spending Activities

Private Spending Activities

External Spending Activities

Prevention Activities

Treatment Activities DRAFT - DO NOT DISSEMINATE.

OVC Spending DRAFT - DO NOT DISSEMINATE.

Programme Management etc. DRAFT - DO NOT DISSEMINATE.

Service Providers DRAFT - DO NOT DISSEMINATE.

HIV and AIDS Service Providers – 2007/08 & 2008/09 DRAFT - DO NOT DISSEMINATE.

Beneficiaries of Spending DRAFT - DO NOT DISSEMINATE.

Beneficiaries of Total HIV and AIDS Spending DRAFT - DO NOT DISSEMINATE.

Beneficiaries of HIV and AIDS Services 2007/08 DRAFT - DO NOT DISSEMINATE.

Beneficiaries by Activity (2008/09) DRAFT - DO NOT DISSEMINATE.

MARP Spending MARPS in KZN (2007/08)

OVCs & Vulnerable Groups

Access.Pops. 2007/ /09

DOH HIV and AIDS Spending in KZN

DOH Comprehensive Conditional Grant for HIV and AIDS DRAFT - DO NOT DISSEMINATE.

Total DOH ES & CG for HIV and AIDS (2007/ /10)

DOH Absorption of ES & CG Funds (07/08) DRAFT - DO NOT DISSEMINATE.

DOH Absorption of ES & CG Funds (2008/09) DRAFT - DO NOT DISSEMINATE.

DOH Absorption of ES & CG Funds (2009/10) DRAFT - DO NOT DISSEMINATE.

KZN DOH CG Spending by Activity 2007/08 & 08/09 DRAFT - DO NOT DISSEMINATE.

KZN DOH Spending on ART (2007/09 – 2009/10)

DOH Programme Costs in ART Delivery

Public ART Unit Costs in KZN DRAFT - DO NOT DISSEMINATE.

KZN DOH Voted Funds for HIV and AIDS DRAFT - DO NOT DISSEMINATE.

KZN Total Voted Funds by Activity, 2007/08 & 2008/09 DRAFT - DO NOT DISSEMINATE.

KZN Voted Funds Service Provider (2008/09) DRAFT - DO NOT DISSEMINATE.

KZN District Service Delivery Voted Funds for HIV and AIDS (%) (2007/ /09) DRAFT - DO NOT DISSEMINATE.

KZN Hospitals Voted HIV Spending by Activity (%) 2007/08 & 2008/09 DRAFT - DO NOT DISSEMINATE.

KZN Public Clinics Voted HIV and AIDS Spending (%) DRAFT - DO NOT DISSEMINATE.

KZN DOH Voted Funds to NGOs & Mission Hospitals by Activity 2007/08, 2008/09 DRAFT - DO NOT DISSEMINATE.

KZN DOH CG for HIV and AIDS DRAFT - DO NOT DISSEMINATE.

DOH CG HIV and AIDS Spending Activities DRAFT - DO NOT DISSEMINATE.

KZN DOH CG Service Providers (2007/08) DRAFT - DO NOT DISSEMINATE.

KZN DOH CG Service Providers (2008/09) DRAFT - DO NOT DISSEMINATE.

KZN HAST HIV CG Spending (2007/08 & 2008/09)

DRAFT - DO NOT DISSEMINATE. KZN Hospital HIV CG Spending (2007/08 & 2008/09)

DRAFT - DO NOT DISSEMINATE. KZN Clinic HIV CG Spending (2007/08 & 2008/09)

DRAFT - DO NOT DISSEMINATE. KZN NGO HIV CG Spending (2007/08 & 2008/09)

 Currently the response in KZN is dominated by spending by DOH - Greater inter-sectoral effort required  More funds needed for prevention activities such as BCC, community mobilisation, male circumcision, PMTCT, youth interventions and VCT, and potentially microbicides  Prevention efforts increased for MARPs, while also attempting to address SA’s key modes of transmission  TB prophylaxis roll-out important with greater integration of TB and HIV and AIDS services  Other priority areas: OVC, Social mitigation, Enabling environment, Research – underfunded  Increased implementation of workplace wellness programmes  Additional resources for infrastructural development DRAFT - DO NOT DISSEMINATE. Key Points & Recommendations (1)

Key Points & Recommendations (2)  Voted DOH funds should continue to target other important interventions i.e HBC, BCC,STI prevention and VCT because CG is devoted to ART  If KZN is reducing its ES for HIV and AIDS, then the CG must also cover these important interventions other than ART  More funds needed for HBC, step-down care & palliative care – best provided through NGOs  Greater treatment efficiencies in spending – lower tender drug prices, task shifting, step-down, clinic level delivery  Skilled and professional health workers required at the district level, but require adequate recompense to retain their skills DRAFT - DO NOT DISSEMINATE.

 NGOs & CBOs play important roles and could be strengthened and expanded  DSD & DOH need to increase & standardize stipends to HBC volunteers  Financing and reporting requirements for NPOs need to be harmonized  Greater collaboration between provincial managers and district officials required in budget planning processes  An integrated Performance Budget System would greatly enhance planning, implementation & monitoring  Capacity building in data management, analysis and utilization of data in planning processes needed at district level DRAFT - DO NOT DISSEMINATE. Key Points & Recommendations (3)

Thank you DRAFT - DO NOT DISSEMINATE.