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”

Civil Society Tracks Civil Society Tracks State HIV/AIDS Budgets State HIV/AIDS Budgets

in Africain 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 GuthrieAIDS Budget Unit ~ IdasaCape Town, South [email protected]

AIDS Budget Unit, Idasa

Multi-country Budget Study ~Multi-country Budget Study ~State Revenue to public health and State Revenue to public health and

HIV/AIDS.HIV/AIDS. Africa: Kenya, Mozambique, South Africa, Africa: Kenya, Mozambique, South Africa,

Namibia. Namibia. Latin America: Argentina, Chile, Ecuador, Latin America: Argentina, Chile, Ecuador,

Mexico, Nicaragua.Mexico, Nicaragua. Study period: Study period: 2000/01 to 2005/06 (where MTEF 2000/01 to 2005/06 (where MTEF

available)available) Length of study: 18mthsLength of study: 18mths Study co-ordinated by: Study co-ordinated by: AIDS Budget Unit, Idasa, South Africa, and FUNDAR, MexicoAIDS Budget Unit, Idasa, South Africa, and FUNDAR, Mexico


Study objectivesStudy objectives To track HIV/AIDS public expenditure To track HIV/AIDS public expenditure

and analyse budget from an and analyse budget from an HIV/AIDS perspective.HIV/AIDS perspective.

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

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

To increase NGO capacity for To increase NGO capacity for HIV/AIDS budget analysis.HIV/AIDS budget analysis.


NAA and the ABU Budget studiesNAA and the ABU Budget studies

Health Health SystemsSystems

PH

RplusNHA

HIV/AIDS Sub-

analysisSID

AL

AC

National AIDS

Accounts

HIV HIV AIDSAIDS

State Budget

Analysis

Idasa - ABU

State State BudgetsBudgets

Adjusted from PHR+ presentation, Feb 04. Adjusted from PHR+ presentation, Feb 04. PHR+.PHR+.


Similarities and differencesSimilarities and differences

NAANAA

Actual ExpendituresActual Expenditures by by donors, public and donors, public and private entitiesprivate entities

Health and non-healthHealth and non-healthexpenditureexpenditure

Prevention and Prevention and treatmenttreatment

ABU Budget studiesABU Budget studies

State Budgetary State Budgetary allocationsallocations to health & to health & HIV/AIDSHIV/AIDS

Sources - State vs donor Sources - State vs donor

(no private/ OOP)(no private/ OOP)

Across sectorsAcross sectors

Composition of spending Composition of spending by Activity typeby Activity type



Similarities and differencesSimilarities and differences

NAANAA OutputsOutputs Total expenditures on Total expenditures on

HIV/AIDSHIV/AIDS Distribution across public, Distribution across public,

donor and private donor and private subsectors, incl. subsectors, incl. households, for profit and households, for profit and non profit institutionsnon profit institutions

Expenditures on HIV/AIDS as Expenditures on HIV/AIDS as a share of GDP & Total health a share of GDP & Total health expenditure & Total expenditure & Total ExpenditureExpenditure

Out of pocket expenditures by Out of pocket expenditures by sex, income group and sex, income group and rural/urbanrural/urban

Per capita expenditures on Per capita expenditures on HIV/AIDSHIV/AIDS

ABU Budget studiesABU Budget studies OutputsOutputs

Total state public health Total state public health allocations, as share of allocations, as share of GDP, total expenditureGDP, total expenditure

Total state allocations Total state allocations to HIV/AIDS, as a share to HIV/AIDS, as a share ofof

Of total public Of total public expenditureexpenditure

Total public health Total public health expendituresexpenditures

Per capita allocations Per capita allocations for HIV/AIDSfor HIV/AIDS



Similarities and DifferencesSimilarities and Differences

NAANAA OECD System of OECD System of

Health AccountsHealth Accounts

Financing SourcesFinancing Sources

ProvidersProviders

FunctionsFunctions

ABU Budget studiesABU Budget studies National Budget National Budget

DocumentsDocuments

Financing SourcesFinancing Sources(excluding private & (excluding private &

OOP)OOP)

FunctionsFunctionsAdjusted from PHR+ presentation, Feb 04. Adjusted from PHR+ presentation, Feb 04.

PHR+.PHR+.


Study Process & MethodologyStudy Process & Methodology Research undertaken by local in-country Research undertaken by local in-country

NGOs.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 & Face-to-face interviews with key officials &

stakeholders.stakeholders.


Content of Country Reports Content of Country Reports Budget format and process.Budget format and process. AIDS policy/implementation structures and AIDS policy/implementation structures and

their role in resource allocation.their role in resource allocation. Funding channels and reporting mechanisms.Funding channels and reporting mechanisms. Health allocations, sources, as a share of GDP Health allocations, sources, as a share of GDP

and total expenditure, per capita.and total expenditure, per capita. Allocations for HIV/AIDS, per capita & as Allocations for HIV/AIDS, per capita & as

share of health expenditure.share of health expenditure. Mix of HIV/AIDS interventions funded.Mix of HIV/AIDS interventions funded. Consider efficiency and equity from an Consider efficiency and equity from an

HIV/AIDS perspective.HIV/AIDS perspective.


Project ChallengesProject Challenges

Inaccessibility and unavailability of budget Inaccessibility and unavailability of budget documentation, little disaggregation.documentation, little disaggregation.

Varying budgetary and accounting systems – Varying budgetary and accounting systems – undermined comparability. undermined comparability.

Lack of central database of donor funds.Lack of central database of donor funds. Ensuring quality and validity of data in Ensuring quality and validity of data in

country reports, especially if done by non-country reports, especially if done by non-academic CSOs.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.