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Funding the Fight Against HIVAIDS

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Funding the Fight Against HIVAIDS Powered By Docstoc
					    Review of Phase 1 ~
HIV and Aids budget tracking
        Methodological approach
            and challenges


   Teresa Guthrie
   AIDS Budget Unit, IDASA
   25-29 July 2005
                            Why budgets?

       Fundamental tool in implementation of public policy
           sets out the allocation of public resources.

       More telling indicator of the priority accorded to fighting
        HIV/AIDS than policy or legislation

       National budget is key to sustainability of any government
        programme

       Informed budgets and funding mechanisms for HIV/AIDS
        therefore enhance ability of governments to plan and implement
        HIV/AIDS interventions effectively.




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                Using budget analysis
             as a resource-tracking tool
     Adequacy: How much is budgeted?

     Priority: How does the budget for this purpose
      compare to resources spent in other areas?

    Progress: Is government’s response on this issue
     improving?

    Equity: Are resources being allocated fairly?

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            Are we meeting international
           commitments and obligations?
     Budgets are a clear indication of a state’s commitment.
     Abuja Commitments – 15% of total annual budget to
      health.
       “We also pledge to make available the necessary resources for the
        improvement of the comprehensive multi-sectoral response, and
        that an appropriate and adequate portion of this amount is put at
        the disposal of the National Commissions/Councils for the fight
        against HIV/AIDS, Tuberculosis and Other Related Infectious
        Diseases.”

     UNGASS Commitments.
     Rights obligations in international covenants.
     Also critical to track donor funds/ foreign aid.


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        10-country HIV/AIDS budget study
       Africa: Kenya, Mozambique, Namibia, South Africa.

       Latin America: Argentina, Chile, Ecuador, Mexico,
        Nicaragua.

       Study period: 2000/01 to 2005/06
        (where MTEF available)

       Length of study: 18 months

       Study co-ordinated by: AIDS Budget Unit, Idasa,
        South Africa, and FUNDAR, Mexico

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                    Study objectives
    1.   To track HIV/AIDS public expenditure and analyse
         budget from an HIV/AIDS perspective.
    2. To build capacity for HIV/AIDS budget analysis in
       the participating countries.

    3.   To develop common framework/methodology for
         tracking HIV/AIDS expenditure in national budgets.

    4.   To make recommendations to policy-makers and
         stakeholders.

    5.   To use allocations and budget indices as indicators of
         progress towards realisation of human rights.

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        What the country reports cover
       Budget format and process.
       AIDS policy/implementation structures and their role in
        resource allocation.
       Funding channels and reporting mechanisms.
       Priority given to health in national budgets.
       Allocations for HIV/AIDS in national budget.
       Mix of HIV/AIDS interventions funded.
       Donor funds to HIV/AIDS activities.
       Actual expenditure on HIV/AIDS budgets.
       Regional distribution of HIV/AIDS allocation and
        criteria used.

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                      Research process
       Partner NGOs in each country conduct research/analysis
           Primarily budget analysis using formal budget records in each
            country.
           Face-to-face and telephonic interviews with key officials and
            stakeholders.
       Thrashed out common terms of reference in workshop
           Training with researchers from each country on budget analysis
            skills.
       Ongoing support to researchers
           Close peer review of draft reports by team.
           Intermediate workshops to share prelim findings; joint problem
            solving.
           Formal internal & external review process.

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                 Study methodology

       Literature review.

       Review & analysis: budget & treasury
        documents, Co-ordinating AIDS bodies’
        records, National AIDS Accounts, others.

       Face-to-face interviews with key officials &
        stakeholders.



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                        Study outputs
        Country-specific reports and overall African and Latin
         American reports which contain synthesis and
         comparative chapters.
        Various appropriate dissemination products, including
         regional launches.
        Training workshops with researchers.
        Workshops to review prelim findings.
        Info dissemination and training workshops for
         government officials, parliamentarians and civil society.



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                    What key issues emerged?
        Location of AIDS policy/coordination body
         related to political commitment.
        Varying degrees of inter-sectoral response and
         mainstreaming
            Do separate HIV/AIDS line items undermine true integrated
             response?
        HIV/AIDS management structures and funding
         mechanisms/flows.
        Need to increase state health allocations to meet
         Abuja Target.
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                          Key issues cont.

        Who determines the global amount allocated for
         HIV/AIDS interventions?

        Changing composition of HIV/AIDS
         expenditure
            Moving away from prevention towards treatment and
             support?


        Where did donor funds fit into the national
         budget? Lack of co-ordinated donor funding.
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                          Key issues cont.
        Resource allocation between geographic areas must balance
         need (disease burden and demand for services) with
         absorption capacity (ability to spend).

        Mix of funding channels – earmarked and unconditional –
         required to provide flexible financing.

        Mix of funding sources necessary to ensure sustainability –
         state and donor.

        Problems of absorption capacity, bottlenecks in spending and
         poor financial management systems.


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         Challenges and limitations of the study
        Primarily only public funds examined (and some
         donor funds).
        Source of data primarily only from budget
         documents – no expenditure estimates were
         undertaken where data was lacking.
        Inaccessibility and unavailability of budgetary data,
         little disaggregation to HIV and Aids specific
         allocations.
        Budget allocations rarely the actual expenditure &
         audited figures not easily available.
        Countries had different data presented in budget
         documents, making comparison tricky.
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         Challenges and limitations of the study
                          cont.
        Varying budgetary and accounting systems –
         undermines comparability.
        No standardized classifications and definitions.
        Limited analysis of the services provided (nothing
         on target groups).
        Lack of central database of donor funds.
        Ensuring quality and accuracy of data in country
         reports.
        Could not measure outputs, ito programme
         indicators, nor impact.
        National/federal and regional/provincial analysis.
         No district level analysis.
15
      Findings highlighting
     methodological challenges




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              Are African states meeting the Abuja
                          declaration?
                   (Public Health as share of total expenditure)
           18%
                                                                                           Mozambique
           16%               Abuja target

           14%                                                                Namibia - Total for MoHSS

           12%
                                                                                 South Africa
           10%
                                                           Namibia – Health specific
            8%
                                                                                                Kenya
            6%

            4%

            2%

            0%
                        2000/1        2001/2         2002/3        2003/4         2004/5         2005/6
Sources: Mozambique National Statistics Institute Database, 2003. South African Budget Review, 2003/04 and Estimates of
National Expenditure, 2003. Kenyan Estimates of Recurrent and Development Revenue, 2003,
and National Aids Resource Envelope, 2003.
       Africa ~ HIV/AIDS allocations as share
              of total health expenditure
18%
                                                                                            South Africa
16%
                                                                                            Mozambique
14%
                                                                                            Kenya
12%
10%
 8%
 6%
 4%
 2%
 0%
             2000/1           2001/2            2002/3            2003/4            2004/5           2005/6
Sources: Mozambique National Statistics Institute Database, 2003. South African Budget Review, 2003/04
and Estimates of National Expenditure, 2003. Kenyan Estimates of Recurrent and Development Revenue,
2003, and National Aids Resource Envelope, 2003.
      Total HIV/AIDS Expenditure in Kenya
                  by Source
                               (2000/01-2005/06)
            14,000,000

            12,000,000

            10,000,000
     Kshs




             8,000,000

             6,000,000

             4,000,000

             2,000,000
                 0




     Other (pvt, NGOs, CBOs,     Public Sector (government &                 Bilateral/
              FBOs)             donors)                                   Multilateral/NGOs
19
                         Source: National Aids Resource Envelope, 2003.
South Africa – HIV/AIDS allocations by nat.depts
                        2,500                                                                      Dept. of Public
                                                                                                   Service &
                                                                                                   Admin. and
                                                                                                   Dept. of
                        2,000
                                                                                                   Science &
                                                                                                   Tech.
  R million (nominal)




                                                                                                   Social
                        1,500                                                                      Development:
                                                                                                   HIV/AIDS
                                                                                                   Programme
                                                                                                   (including
                        1,000
                                                                                                   condtl grants)
                                                                                                  Education:
                                                                                                  HIV/AIDS condtl
                         500                                                                      grant
                                                                                                  Health:
                                                                                                  HIV/AIDS and
                                                                                                  TB Sub-
                           0
                                                                                                  programme
            2000/1 2001/2 2002/3 2003/4 2004/5 2005/6 2006/7                                      includes condtl
  NB: Does not include funds from provinces' own budgets.
                                                                                                  grant
20 Sources: Division of Revenue Bill 2004; Estimates of National Expenditure 2004. Idasa calculations
                  South Africa: Improving efficiency in
                     HIV/AIDS spending by sector
                                   (includes funds rolled over from previous year)
            450
                                                                                                              R 385 m
            400
                                                                                                       85%
            350
                         2000/1
            300          2001/2
R million




            250          2002/3

            200
                                                                                                      75%
            150
                                                                                                    R 109 m
            100
                                                                                                 37%
             50
                                                                                               R 18 m
              0
                    Education                     Health                     Social                        TOTAL
                                                                          Development
    Source: 2001 SA Intergovernmental Fiscal Review. 2001 Budget Review. Statement of the National and Provincial
 21 Governments' Revenue and Expenditure and National Borrowing (March02&03). Intervs.
                        Composition of Kenyan HIV/AIDS
                                 by activity type
                     16,000

                     14,000                                                   Policy development &
                                                                              management
                     12,000
                                                                              Research and M&E
     Kshs millions




                     10,000
                                                                              Care and Support
                      8,000                                                   (including IGAs)

                      6,000                                                   STI Treatment and
                                                                              care (not ARVs)
                      4,000
                                                                              Prevention Activities
                      2,000                                                   (including PMTCT)

                          0
                              2000/01 2001/02 2002/03 2003/04 2004/05

          Sources: Estimates of Recurrent and Development Revenue, 2003, and National Aids
22        Resource Envelope, 2003.
                                 Annual Per capita HIV/AIDS
                              expenditure (Kenya & South Africa)
                        6.0
                                  SA State HIV/AIDS per
                        5.0
                                  capita (public population)
                                  Kenya PUBLIC HIV/AIDS
      Real US dollars




                        4.0
                                  per capita spending

                        3.0

                        2.0

                        1.0

                        0.0
                              2000/01   2001/02      2002/03    2003/04        2004/05        2005/06
Sources: South African Budget Review, 2003/04 and Estimates of National Expenditure, 2003. Kenyan
Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, 2003.
Dorrington, 2002.
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              Impact of Phase 1 Findings
        Kenya seminar hosted by IPAR, engagement with MPs
        LA counties went to International Human Rights
         Court which decreed they must provide ARVs
        Mexico findings in media pressurised govt to increase
         federal HIV/AIDS programme by 200 million pesos,
         incl prevention
        UNAIDS Global Consortium on Resource Tracking
        Inclusion of HIV/AIDS budget tracking in SADC
         workplan
        Joint CSO Monitoring Forum to monitor roll-out of
         ARV programme in South Africa
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                 Plans for improvements
        Exploratory visits and stakeholder meetings in each
         country
        Research team broadened to civil society & govt
         partnership
        Research reference teams being established including
         all relevant stakeholders
        Acknowledgement that the budget documents are
         insufficient. Decision of what sources to include
         required.
        Decision to include all sources – public, private and
         international?
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             Plans for improvements cont.
        Decision to track all transactions and all services
         provided?
        Decision to identify the beneficiary groups of all
         services provided?
        Decision to include actual outputs and outcomes,
         where possible. Spillage, leakage, corruption?
        Efficiency and quality of spending.
        Improving on classifications and definitions – ensuring
         standardisation across countries.
        Broadening the network of countries and organisations
         involved in HIV/AIDS resource tracking.
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                                     AIDS BUDGET UNIT


                  Thank you!

     For more information contact:
     Teresa Guthrie
     AIDS Budget Unit
     Budget Information Service ~
     Idasa
     Email: teresa@idasact.org.za
     Web: www.idasa.org.za/bis
     Phone: (+27) 21 467 5600


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