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National AIDS Spending Assessments NASA CONCEPTUAL FRAMEWORK: 

National AIDS Spending Assessments NASA CONCEPTUAL FRAMEWORK Carlos Avila, M.D., Sc.D. Resource Tracking and Projections Unit UNAIDS

Background UNGASS (1/2): 

Background UNGASS (1/2) UNGASS stands for the United Nations General Assembly Special Session on AIDS, which took place in June 2001 Declaration of Commitment on AIDS was issued and signed by the leaders of 189 countries This Declaration states the action framework to achieve, by the year 2015, the Milennium Development Goal of halting and reversing the HIV/AIDS epidemic in the world

Background: UNGASS (2/2): 

Background: UNGASS (2/2) The Declaration stipulates monitoring progress in the implementation of the commitments and the achievement of the targets. With this purpose, a set of indicators was issued in 2002, to provide information for the report the Secretary General have to issue every year, as the Declaration itself states. In 2003, a total of 103 country reports were submitted, most were incomplete, mainly in subjects as the national public spending on AIDS

Indicators supplied by the National AIDS Spending Assessments (NASA): 

Indicators supplied by the National AIDS Spending Assessments (NASA) Governmental funding for HIV/AIDS Public Sources Disbursment (expenditures) All sectors, not just health Certified expenditure (budget reports) Estimation (based on number of services delivered, inputs purchased or users attended) International funding for HIV/AIDS Official Assistance to Development Bilateral sources Multilateral sources (international organizations) Committed resources Disbursed resources Amount of national funds disbursed by governments in low- and middle-income countries Amount of bilateral and multilateral financial flows (commitments and disbursements) for the benefit of low and middle income countries

Resource Tracking Tools at Country Level: 

Resource Tracking Tools at Country Level UNFPA/UNAIDS/NIDI: Resource Flows analysis. Mail government & NGO survey. UNFPA/UNAIDS/NIDI RF Project, bi-annual Budget Analysis IDASA (South African initiative with results in 5 African countries and 5 LAC countries) National AIDS Accounts (NAAs) SIDALAC (Capacity building initiative, with UNAIDS CRD/LAC desk, more recently with RTU): Stand alone RT Tool National Health Accounts-HIV/AIDS Sub-analysis (PHR+/ABT; US-AID funded project) Country initiatives: Thailand, Russia (Imperial College)

NAAs and Budget Analysis: 

NAAs and Budget Analysis

To generate information useful for the decision-making process and for the design of policies aimed to reduce the burden of disease caused by the HIV/AIDS epidemic.- Help in the monitoring of the implementation of strategic plans- To track the financing of the resource needs (gap analysis): 

To generate information useful for the decision-making process and for the design of policies aimed to reduce the burden of disease caused by the HIV/AIDS epidemic. - Help in the monitoring of the implementation of strategic plans - To track the financing of the resource needs (gap analysis) NASA: Objectives

Characteristics of NASA: 

Characteristics of NASA Comprehensive: An inventory of all resources addressed to HIV/AIDS Internally consistent: Totals must add-up and be congruent across different variable dimensions and tables. Internationally comparable accounts: The breakdown of tables, the content of categories and the methods of calculation must be harmonized (e.g. use of compatible classifications) Compatible with upper-level or aggregated systems NHA and SNA. Systems developed during the last 30 years. Mainly OECD based. Producers guide for NHA: WHO

National AIDS Spending Assessments: 

National AIDS Spending Assessments Distribution of resources to the institutions, by source of financing, type (public/private) provider of services, etc. International financial cooperation NGO’s expenditures Result of applying specifically to HIV/AIDS, the methodology to estimate the national accounts (e.g. health sector); plus non-health expenditure Functions, providers, target groups classifications, object of expenditures have been adapted to fit HIV/AIDS, including Non-Health actions, following the specified classifications (OECD, UNAIDS)

Flow of resources from origin to end up users: reconstruction of transactions: 

Flow of resources from origin to end up users: reconstruction of transactions Non Specific

Expenditure in Functions by Source in 13 LAC countries, 2002. : 

Expenditure in Functions by Source in 13 LAC countries, 2002. Total expenditure = USD$ 588,550,000

Out-of-pocket AIDS expenditure as a percentage of total AIDS expenditure, selected countries, 2002-2003: 

Out-of-pocket AIDS expenditure as a percentage of total AIDS expenditure, selected countries, 2002-2003 Source: SIDALAC & Abt/ PHR+ Associates

Expenditure in Prevention and Care. BRAZIL 1997-2000 (million $USD): 

Expenditure in Prevention and Care. BRAZIL 1997-2000 (million $USD) Source: SIDALAC/ Brazil Ministry of Health. 2001.

Preventive expenditure on MSM and percentage of AIDS cases among MSM: 

Preventive expenditure on MSM and percentage of AIDS cases among MSM Beneficiary Analysis in concentrated epidemics Source: SIDALAC/ UNAIDS. 2001.

Plans for National Spending Assessments to be conducted in 2005: 

Plans for National Spending Assessments to be conducted in 2005

Next Steps: 

Next Steps Increase the number of countries with NASAs to report Domestic Public expenditure on HIV/AIDS for UNGASS (~60 countries by end 2005) Create/strengthen regional networks to conduct National Spending Assessments (7 regions) Significantly increase the number of country experts in NASAs

Challenges: 

Challenges Harmonization of tools used as National AIDS Spending Assessments Timeliness and precision Frequency Ownership of the data from stakeholders Acceptance of data by Government, NGOs Capacity building/strengthening Sustainability Use of the information Harmonization with other tools using financial/economic information