1. Planning for Sustainable HIV/AIDS Services using the HAPSAT Elijah Sinyinza, MD,MPH Health Services and Systems Program (HSSP) May 27 2008 The USAID-funded HSSP Project is implemented by a consortium of partners. Abt Associates Inc. as prime contractor, JHPIEGO, ISTI and Save the Children as sub partners

2. 2 Outline of Today’s presentation Policy Context What is sustainability analysis? Rationale for conducting a sustainability analysis Planning tool : HIV/AIDS Program Sustainability Analysis Tool (HAPSAT)

3. 3 Policy Context  Policymakers are interested in the allocation of financial and human resources across public programs  Donors and policymakers interested in understanding the medium- and long-term impact of HIV/AIDS service provision on the health budget and human resources.  Concerns about ‘donor fatigue’ and the volatility of external funding streams.  Desire to find ways to deliver HIV/AIDS services to more of the people who need them.

4. 4 Definition of Sustainability analysis  Sustainability refers to ability of the country to provide HIV/AIDS services to those who need them as external resources are reduced.  Sustainability analysis seeks to identify points of vulnerability in a planned HIV/AIDS program How much does the planned program for delivering HIV/AIDS services cost? How many human resources will be needed to carry out the planned program? What type of resource limitations are likely to constrain the scale-up of services? Is the pipeline of human and financial resources adequate to meet future demand for services?

5. 5 Rationale for Conducting a Sustainability Analysis  Sustainability analysis is needed to guide policy decisions regarding resource mobilization  What share of the total cost will the government, donors, and patients contribute?  How many health workers are needed to sustain/scale-up the services?  Can scale-up occur in a sustainable way that ensures services can be maintained at a higher level over time without having perverse effects on the broader health care system?

6. 6 HAPSAT HIV/AIDS Program Sustainability Analysis Tool HAPSAT is a Microsoft Excel (version 2003) software tool for rational planning of HIV/AIDS services over a 3-10 year time horizon To estimate the total cost of, and resources required to sustain/scale up a national HIV/AIDS program To identify resource shortfalls (bottlenecks) that threaten the achievement of HIV/AIDS program goals To support policy decisions, program planning, budgeting for HIV/AIDS provision, and resource mobilization

7. 7 Scope of HIV/AIDS Program in HAPSAT Model 1.Antiretroviral Therapy (ART) 2.Counseling and Testing (CT) 3.Prevention of Mother-to-Child Transmission (PMTCT) 4.Testing & Treatment for Tuberculosis (TB) 5.Prophylaxis and Treatment for other OIs 6.Prevention (ABC, IEC, Condoms, microbicides etc.) 7.Orphans and vulnerable children (OVC) 8.Program administration and management

8. 8 Data Inputs for HAPSAT Demographic, epidemiological, and financial trends Financing sources for HIV/AIDS program Current volume of HIV/AIDS services delivered annually Current stock of health workers by cadre Clinical protocols (visits, lab tests, drug regimens, etc) Current costs for labor, drugs, supplies, laboratory tests, equipment, and management

9. 9 Outputs from HAPSAT How much does the current HIV/AIDS Program cost? What are expected future resource gaps ( in financing, health workers, and physical infrastructure) for maintaining current volume of services? What are expected resources required ( in financing, health workers, and physical infrastructure) to achieve target levels of services? What are various options of financial resource mobilization and use (to address the gaps identified)?

10. 10 Example Output of HAPSAT (NOTE: not real data) Resource Shortfalls in Red

11. 11 Application to date HAPSAT was applied to assess HIV/AIDS program sustainability in Zambia (MOH, HSSP, HS20/20, UNZA) Upcoming assessments – Ethiopia, Coted’lvoire and Swaziland

12. Thank you Reports related to this presentation are available at www.HS2020.org or email: info@healthsystems2020.orgwww.HS2020.org