1. Civil Society Tracks State HIV/AIDS Budgets in Africa An Overview of the Multi-Country HIV/AIDS Budget Study UNAIDS Satellite Meeting: “National AIDS Accounts” XV International AIDS Conference Bangkok, July 2004 Teresa Guthrie AIDS Budget Unit ~ Idasa Cape Town, South Africa teresa@idasact.org.za

2. AIDS Budget Unit, Idasa Multi-country Budget Study ~ State Revenue to public health and HIV/AIDS. Africa: Kenya, Mozambique, South Africa, Namibia. Africa: Kenya, Mozambique, South Africa, Namibia. Latin America: Argentina, Chile, Ecuador, Mexico, Nicaragua. Latin America: Argentina, Chile, Ecuador, Mexico, Nicaragua. Study period: 2000/01 to 2005/06 (where MTEF available) Study period: 2000/01 to 2005/06 (where MTEF available) Length of study: 18mths Length of study: 18mths Study co-ordinated by: Study co-ordinated by: AIDS Budget Unit, Idasa, South Africa, and FUNDAR, Mexico AIDS Budget Unit, Idasa, South Africa, and FUNDAR, Mexico

3. AIDS Budget Unit, Idasa Study objectives To track HIV/AIDS public expenditure and analyse budget from an HIV/AIDS perspective. To track HIV/AIDS public expenditure and analyse budget from an HIV/AIDS perspective. To develop common framework/ methodology for tracking HIV/AIDS expenditure in national budget. To develop common framework/ methodology for tracking HIV/AIDS expenditure in national budget. To make recommendations to policy makers and stakeholders. To make recommendations to policy makers and stakeholders. To increase NGO capacity for HIV/AIDS budget analysis. To increase NGO capacity for HIV/AIDS budget analysis.

4. AIDS Budget Unit, Idasa NAA and the ABU Budget studies Health Systems PHRplus NHA HIV/AIDS Sub- analysis SIDALAC National AIDS Accounts HIV AIDS State Budget Analysis Idasa - ABU State Budgets Adjusted from PHR+ presentation, Feb 04. PHR+.

5. AIDS Budget Unit, Idasa Similarities and differences NAA NAA Actual Expenditures by donors, public and private entities Actual Expenditures by donors, public and private entities Health and non-health Health and non-healthexpenditure Prevention and treatment Prevention and treatment ABU Budget studies State Budgetary allocations to health & HIV/AIDS Sources - State vs donor (no private/ OOP) Across sectors Composition of spending by Activity type Adjusted from PHR+ presentation, Feb 04. PHR+.

6. AIDS Budget Unit, Idasa Similarities and differences NAA NAA Outputs Outputs Total expenditures on HIV/AIDS Total expenditures on HIV/AIDS Distribution across public, donor and private subsectors, incl. households, for profit and non profit institutions Distribution across public, donor and private subsectors, incl. households, for profit and non profit institutions Expenditures on HIV/AIDS as a share of GDP & Total health expenditure & Total Expenditure Expenditures on HIV/AIDS as a share of GDP & Total health expenditure & Total Expenditure Out of pocket expenditures by sex, income group and rural/urban Out of pocket expenditures by sex, income group and rural/urban Per capita expenditures on HIV/AIDS Per capita expenditures on HIV/AIDS ABU Budget studies Outputs Total state public health allocations, as share of GDP, total expenditure Total state allocations to HIV/AIDS, as a share of Of total public expenditure Total public health expenditures Per capita allocations for HIV/AIDS Adjusted from PHR+ presentation, Feb 04. PHR+.

7. AIDS Budget Unit, Idasa Similarities and Differences NAA NAA OECD System of Health Accounts OECD System of Health Accounts Financing Sources Financing Sources Providers Providers Functions Functions ABU Budget studies National Budget Documents Financing Sources (excluding private & OOP) Functions Adjusted from PHR+ presentation, Feb 04. PHR+.

8. AIDS Budget Unit, Idasa Study Process & Methodology Research undertaken by local in-country NGOs. Research undertaken by local in-country NGOs. Training in budget analysis. Training in budget analysis. Common framework for analysis. Common framework for analysis. Ongoing technical assistance. Ongoing technical assistance. Close peer review of draft reports by team. Close peer review of draft reports by team. Formal internal & external review process. Formal internal & external review process. Literature review. Literature review. Official budget documents review & analysis. Official budget documents review & analysis. Face-to-face interviews with key officials & stakeholders. Face-to-face interviews with key officials & stakeholders.

9. AIDS Budget Unit, Idasa Content of Country Reports  Budget format and process.  AIDS policy/implementation structures and their role in resource allocation.  Funding channels and reporting mechanisms.  Health allocations, sources, as a share of GDP and total expenditure, per capita.  Allocations for HIV/AIDS, per capita & as share of health expenditure.  Mix of HIV/AIDS interventions funded.  Consider efficiency and equity from an HIV/AIDS perspective.

10. AIDS Budget Unit, Idasa Project Challenges Inaccessibility and unavailability of budget documentation, little disaggregation. Inaccessibility and unavailability of budget documentation, little disaggregation. Varying budgetary and accounting systems – undermined comparability. Varying budgetary and accounting systems – undermined comparability. Lack of central database of donor funds. Lack of central database of donor funds. Ensuring quality and validity of data in country reports, especially if done by non-academic CSOs. Ensuring quality and validity of data in country reports, especially if done by non-academic CSOs. Could not measure: Could not measure: allocations against actual expenditure, allocations against actual expenditure, outputs, according to programme indicators, outputs, according to programme indicators, impact of expenditure. impact of expenditure.