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Tracking Expenditure for HIV and AIDS in Africa ~ Cross-Country Comparisons Guthrie, T., Kioko, U. Inaugural Conference of the African Health Economics and Policy Association Accra - Ghana, 10th - 12th March 2009 PS 04/8
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Objectives Determine the total flows of financing and expenditures for HIV/AIDS, from all international and public (domestic) sources of financing To identify the flow of expenditures by sources, agent, providers of services activities, and target population To make recommendations for improved efficiency and prioritization of HIV and AIDS spending, and for improved financial information systems.
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Methodology Review of UNGASS Indicator 1 for SSA countries ( Source: UNAIDS Global Report 2008 Annex2) Review of Country NASA Reports for further detail: Ghana, Botswana, Zambia, Swaziland National AIDS Spending Assessment is an approach to comprehensively measure: ▫All spending for HIV/AIDS ▫From all sources, through agents, providers, activities to beneficiaries ▫From a multi-sectoral perspective ▫According to interventions reflected in the NSPs ▫Allows countries to monitor their own progress towards the national and international commitments. Acknowledgements to UNAIDS, the NACs and NASA team members for access to their data
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Comparison of UNGASS Indicator1 - Sources of Financing for HIV/AIDS
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SSA Low Income Countries HIV Prevalence (%) and Spending per Capita on HIV/AIDS (2006, in current US$)
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Per Capita HIV/AIDS Spending (current US$) & HIV Prevalence (%) in Middle Income SSA Countries (2006)
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Levels & Sources of Financing (US$m, 2006)
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Agents of HIV/AIDS Spending (US$m, 2006)
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Providers of HIV/AIDS Services (US$m, 2006)
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AIDS Spending Activities ~ Priorities (US$m, 2006)
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Botswana ~ Public Trends (Pula, 2003-2005)
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Swaziland ~ HIV/AIDS Priorities by Source of Funds (SZL, 2006)
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Swaziland ~ funds for Programme Management by NERCHA (SZL, 2006)
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Swaziland Prevention Spending (SZL, 05/06-06/07) Prevention CommMobl VCT Condoms PMTCT Blood Safety
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Swaziland ~ Social Protection spending (SZL, 05/06-06/07)
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Swazi~ environment and community development spending (SZL, 2006/07)
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Beneficiaries of HIV/AIDS Spending (%, 2006)
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Botswana HIV Spending that may Contribute to general HSS (9.83% of THAE)
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HIV/AIDS Spending on HSS & General Health: Zambia 2007, 15% of THAE Swaziland, 11% of THAE
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Recommendations Need for more sustainable predictable financing for HIV/AIDS and health Need for increasing public agents ie. Control of funds ~ through common funds, DBS, IHPs. LNGOs playing important role in delivery of HIV/AIDS services ~ need to be supported through efficient funding mechanisms Treatment requiring increasing share of financing, prevention and other interventions requiring increasing, especially mitigation and social protection activities
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Recommendations cont. Increase public funds for enabling environment esp. Promotion and protection of human rights Improve output indicators to enable beneficiary incidence analysis Increase funds for MARPs and vulnerable groups Increase HSS funding and mechanisms (eg.IHPs) and increase allocations to HIV/AIDS activities that contribute to general HSS (eg. Blood safety, laboratories, upgrading facilities)
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Recommendations cont. Increasing alignment with NSPs, but some donors still have own agenda, own systems ~ need harmonisation Increase absorptive capacity: ▫Reduce donor ‘dumping’ of funds at the end of the financial year ▫Improve predictability of donor commitments, over longer period ▫Increase speed of disbursements, reduce tedious systems, while improving public accountability systems ▫Improve public programmatic and human resource capacity to deliver services
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Recommendations cont. Improve public financial reporting & information systems Routine resource tracking ~ institutionalise NASA in M&E systems Harmonise to 1 national system for reporting on commitments, disbursements & spending Civil society play greater role in monitoring public spending & in sharing their own spending activities Critical to have good financial monitoring systems in place before implementing IHPs etc.
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Thank You Teresa Guthrie Centre for Economic Governance and AIDS in Africa Email: teresa@cegaa.org Tel: +27-21-425-2852 Cell: +27-82-872-4694
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