1. Linking NHA and NASA A country perspective - Rwanda Agnès Binagwaho, MD, Paed Executive Secretary, National AIDS Control Commission

2. NASA and NHA National AIDS Spending Assessment (NASA), Generally conducted by NAC (with UNAIDS), to monitor the annual flows of funds used to finance the multisectoral response to HIV/AIDS National health accounts (NHA), Generally conducted by MOH (with WHO, USAID), to track expenditures on overall health care with particular attention of health sub accounts as HIV/AIDS

3. NASA and NHA UNAIDS

4. NHA-NASA crosswalk FS.1.1.1.1 Ministry of Finance FS.1.1.2 Local Authorities FS.3. Rest of the world HC.1.1 Inpatient curative care WZ HC.1.3.1 Out patient curative care- VCT Y HC.6.3.1 VCT Programs X FS.1.1 Territorial government: central FS.1..2 Territorial government: state/provincial FS.3. International funds ASC 2.2. Inpatient care WZ ASC 1.3. VCT( incl. (programmatic and personal) XY NHA HIV/AIDS subaccount NASA – UNGASS table UNAIDS Implemented in Rwanda by MOH and CNLS team

5. Rwanda experience: Both NHA (for health and non-health) and NASA were carried out in 2007 The teams of NACC and MOH worked together to harmonise the findings of the two exercises in one table only, with some difficulties: respondent fatigue given two sets of surveys (one for NASA and one for NHA) in some case estimates were conflicting inefficient use of human resources (two teams!) some gaps and inconsistencies were identified in the harmonization process

6. Current gaps and inconsistencies for harmonization NHA treats all donor funding into one basket called “Rest of the World” while NASA/UNGASS requires distinction for each donor funding NHA had a non-health addendum, but not comprehensively addressed (insufficient to fill UNGASS matrix) – e.g. no data on income generating activities Rwandan Experience

7. Current gaps and inconsistencies for harmonization con’t With a small team of consultants and resources NASA exercise was only able to identify declared expenditure by funding agents and not to track funding flows down to the implementers to avoid double counting – NHA could do that (the team was bigger and with more resources) Expenditure for condoms distribution under NASA is totally attributed to HIV, while NHA makes a distinction with family planning (need to include data from the RH sub-account as well) Rwandan Experience

8. Current gaps and inconsistencies for harmonization con’t It is very difficult for NACC with a small NASA team to collect data country wide. e.g. from private sector and for out-of pocket expenditure Rwandan Experience

9. Recommendations At international level (UNAIDS, WHO, and USAID) Refine (disaggregate) categories of expenditure for NHA to allow a better “crosswalk” with NASA (for UNGASS table) For NHA, maintain distinction across donors (who finance what for each category) in order to allow UNGASS reporting Better one complete exercise from the beginning than two parallel ones with “last minute” harmonization Keep all stakeholders at country level informed

10. Recommendations cont ’ At country level One exercise only (one questionnaire only): NHA or NASA Need to know real expenditure by implementers in country (declared expenditure by donors is not sufficient) If using NHA, make sure it includes non-health information as well, it keeps each donor funding separate, and make sure representative from NAC are included into the MOH team Make use of existing data collection (e.g. information on expenditure by stakeholders at district level included into the CDLS database) – define “ crosswalk ” between existing database and NHA/NASA

11. Lessons learned: AIDS money is a catalyst for improvements in all sectors. Tool for making the money work: With this exercise we had a better tracking of funds We are improving our financial reporting e.i: We gave evidence of 40% PEPFAR money, voted for Rwanda, missing in country reports This will lead to better allocation of funds and planning We are applying the methodology to other sectors A better tracking of other sectorial money will assure alignment to EDPRS and our vision 2020

12. Malaria, HIV/AIDS, and RH in the context of general health expenditures 2006

13. Financing Sources: Where do HIV/AIDS monies come from?

15. Providers: Where do PLHIV spend their money? = RWF 1,020,258,690 ($1,849,166) =RWF 950,475,493 ($1,722,687)

16. Thank you to make our day to day work simple