1. 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

2. 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

3. 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.

4. 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).

5. 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.

6. 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.

7. 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.

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

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

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

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

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

13. Sources of Private HIV and AIDS spending 2007/08

14. Sources of External HIV and AIDS spending 2007/08

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

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

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

18. 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.

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

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

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

22. 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

23. Total KZN HIV and AIDS Spending Activities

24. Comparison with Activities in SADC

25. Public Spending Activities

26. Private Spending Activities

27. External Spending Activities

28. Prevention Activities

29. Treatment Activities DRAFT - DO NOT DISSEMINATE.

30. OVC Spending DRAFT - DO NOT DISSEMINATE.

31. Programme Management etc. DRAFT - DO NOT DISSEMINATE.

32. Service Providers DRAFT - DO NOT DISSEMINATE.

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

34. Beneficiaries of Spending DRAFT - DO NOT DISSEMINATE.

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

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

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

38. MARP Spending MARPS in KZN (2007/08)

39. OVCs & Vulnerable Groups

40. Access.Pops. 2007/08 2008/09

41. DOH HIV and AIDS Spending in KZN

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

43. Total DOH ES & CG for HIV and AIDS (2007/08-2009/10)

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

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

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

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

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

49. DOH Programme Costs in ART Delivery

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

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

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

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

54. KZN District Service Delivery Voted Funds for HIV and AIDS (%) (2007/08-2008/09) DRAFT - DO NOT DISSEMINATE.

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

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

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

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

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

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

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

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

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

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

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

66.  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)

67. 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.

68.  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)

69. Thank you DRAFT - DO NOT DISSEMINATE.