Tracking HIV/AIDS resources in-country: Institutionalization through capacity building and regional networks T. Dmytraczenko and S. De, Abt Associates Inc.and PHRplus In collaboration with José Antonio Izazola, SIDALAC and Teresa Guthrie, Idasa

Points of clarification What do I mean by institutionalization? Housed in a national institution Periodic PHRplus experience NHA, HIV/AIDS subanalysis SIDALAC experience NAA

Overview of process Principal goal is to produce data that can and will be used by policymakers Stakeholder buy-in of NHA process is critical Heavy emphasis on institutionalization Building capacity within the government so that data can be collected regularly Closely follows NHA framework Adapts to the state of the epidemic and country context

Key elements in the the institutionalization process Determine when to conduct subanalysis Concurrent with implementation of a general NHA Set up the subanalysis core team Members of the general NHA Ministry of Health (MoH) Representatives from MoH HIV/AIDS program and/or multi-sectoral HIV/AIDS committee Lead the process

Key elements in the the institutionalization process (cont.) Consultation with a broader group of stakeholders Steering Committee CCM, major donors (such as CDC, UNAIDS), NGOs involved in HIV/AIDS, civil society organizations Communicate policy concerns to NHA team Give feedback to NHA team on results and findings Facilitate any difficulties NHA team might encounter Assist in interpreting the NHA results and drawing policy implications

Steering Committee and core team NHA & HIV/AIDS subanalysis Core Team Steering Committee General country stakeholders

Building capacity Orientation to methodological approach OECD System of Health Accounts A Guide for Producing NHA in Low- and Middle Income Countries – WHO, World Bank, USAID Identification of data sources Review of secondary data Primary data collection as a last resort PLWHA survey Donor survey, NGO survey, employer survey etc. Adapted to state of the epidemic

Capacity building (cont.) Technical support Survey instrument development by core team, approval by steering committee Training local data collectors Data analysis by core team in consultation with steering committee Report writing by core team, vetting by steering committee Formulation of a dissemination strategy Discussion of how to incorporate data collection within ongoing government information systems

Factors that affect policy use of NHA HIV/AIDS Maximum Use In Policy Minimal Use In Policy “Controllable”Factors Stakeholder involvement Policy linkages Dissemination strategy Ownership Timeliness Credibility of report “Chance”Factors Government stability Political opportunity Policy advocate “-”“-”“-”“-” “-”“-”“-”“-” “+”“+”

Regional Networks

Regional networks SIDALAC National AIDS accounts network 20 countries in Latin America and the Caribbean Aim to start a network in West Africa PHRplus and partners National Health Accounts networks Idasa Civil society advocacy networks throughout Africa that can support resource tracking networks

Regional networks Creation and maintenance of a forum for exchange by geographical region / sub-region Electronic, study visits or periodic meeting Bring together teams conducting HIV/AIDS tracking in different countries Provide south-south and horizontal technical assistance Exchange of lessons learnt Process and technical On-going technical cooperation and harmonization of methods Mechanism for capacity building

Challenges in creating and sustaining regional networks Dependence on external support Launch and sustain networks Possible to leverage existing efforts May not get desired participants nor optimal skill set Sufficient financing of new estimates, and secure financial support for medium/long term initiatives (not a once exercise) Avoid dominance by one country

Challenges (continued) Mechanism for formal peer-review Willingness to submit estimates for revision by expert sources Empowering civil society organizations to undertake HIV/AIDS budget monitoring and participate in networks for resource tracking Political will to use and validate the information National authorities, international agencies / programs Support the use of the information for advocacy purposes, but keep objectives separate

Challenges (continued) Capacity-building should occur through the process of resource tracking Expenditure tracking: government entity Budget analysis: civil society organizations Building national systems to track performance Weak commitment in HIV/AIDS community Purview of broader health system Is it really?