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National HIV Investment Plan (NHIP) – a new wine in old bottle: a case

from Nepal

This study aims to examine the value addition, if any, in using New Investment Framework as a tool to develop costed action or investment plan at the country level.

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Introduction and background

Search for an ideal method, tool or a model for resource allocation and projection – an on going process

Simple costing tools to more elaborated models are available

Various tools, models are being used depending on country context and capacity

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Introduction and background

This study is based on three premises1. New Investment Framework, (Schwartländer, et

al), www.thelancet.com.Vol 377 June 11, 2011)

2. Redefining AIDS in Asia - Commission Report 2008

3. National AIDS Spending Assessment (NASA) and other AIDS spending assessments

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The New Investment FrameworkIntroduced during the resource crunch period

Contributed in regaining global resource confidence

Intervention, allocation Investment

The term investment got into Global Fund dictionary more firmly

GF require NFM concept note based on investment case/plan

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(..contd): The New Investment Framework (4 pillars)

1. Basic Programme activities

Critical enablers

2. social enablers 3. Programme

enablers

4. Synergy with development sectors

Basic programmes Critical enablers Synergies with dev sectors

0

10

20

30

40

50

60

70

42.2

35.76

21.82

58.37

15.38

26.24

53.81

18.78

27.41

Resource needed for NIF (%)

2011 (16.5 bil) 2015 (22.1 bil) 2020 (19.7 bil)

Global resource need and return on investment for 139 LIC and MIC countries

Country specific use of model

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2. AIDS Commission Report (2008)

An independent body created by UN Secretary General

- Reviewed Asian epidemic- Analysed course and

impact of epidemic- provided region specific

recommendation- Estimated resources to

content the epidemic

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Investing in high impact areas

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NASA

• Monitor the resource mobilisation and utilisation

• Support in-country policy and decision making process,

• Promote accountability and transparency

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…..Introduction and backgroundNepal HIV Investment Plan –NHIP (2014-2016)

prepared in line with New Investment Framework-NIF (S. et.al, 2011)

In the past, country had prepared several costed strategies and national action plans (NAP)

Country had also conducted AIDS spending assessments in the past

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Country context

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Country contextTreatment cascade

45,000

40,000

35,000

30,000

25,000

20,000

15,000

10,000

5,000

-

40,700

Estimated people living with HIV (2013)

23,977

HIV diagnosed

(1988-2013)

8,866

On ART (December, 2013)

1,080

Suppressed viral load

(a)

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Methods retrospective analysis of

o AIDS spending reports (NASA 2007 and RTS 2010) and

o National Action Plan - NAP (2008-2011) allocations recalculated and regrouped the spending and

budgets according to four NIF pillars compared the results with NHIP (2014-2016)

allocations also reviewed the process followed during the

preparation of NAP and NHIP to examine if any significant departure existed in the process

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Methods

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ResultsProcess followed for preparing NAP (2008 -

2011) and NHIP (2014-2016) was similaro Consultations with KAP and key stakeholderso Epidemiological data reviewo Unit cost analysiso Active CCM engagement (New)

Two AIDS spending assessments – similar pattern in spending

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Key feature in NHIP (2014-1016)

KAP focused, disaggregation of MSM/TG for better targeting

Female sex workers who inject drugRapid scale of HIV testing and treatmentA robust eVT programme Community Test and Treat Competence

(CTTC)Hepatitis C/HIV co-infectionAcceptance of NHIP – up to higher level

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Basic Programme Program Enablers Social Enablers Synergies with dev sectors

0

2

4

6

8

10

12

14

16

18

20

0

20

40

60

80

100

120

140

160

180

200

8.60 2.22 2.61 4.22 9.72 6.05 3.40 1.28

89.17

17.18 17.19 4.48

103.16

29.94 2.30

5.42

AIDS investment/allocation and actual spending (US$ million)

NASA 2007 RTS 2009 NAP 2009-10 NHIP 2014

AID

S s

pend

ing

(mill

ion

US$

)

NAP

and

NH

IP

….Result:

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NASA 2007 RTS 2009 NAP 2009-10 NHIP 20140

10

20

30

40

50

60

70

80

90

100

48.72 47.53

69.65 73.26

12.5929.59

13.4221.26

14.79

16.6213.43

1.63

AIDS investment/allocation and actual spending (%)

Basic Programme Program Enablers Social Enablers Synergies with dev. sectors

%

• Similar pattern is seen in actual spending, NAP and NHIP• High spending and high allocation in Basic Programme• Similar pattern in programme Enablers• Social Enablers and Synergy with Dev Sectors received less

allocation than spending trend

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Conclusion

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0

10

20

30

40

50

60

0

5

10

15

20

25

30

35

40

45

52.83

20.74 19.63

6.80

42.42

21.82

35.76

0

Spending in AP region (2007-2009) and NIF es-timates for 2011 (%)

Total spending in AP countries (%)NIF estimates (%) 2011

Spen

ding

200

7 -2

009

NIF

Esti

mat

es (%

)

Source: UNAIDS 2010

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Conclusions Compared to spending data, a significantly higher

budget estimate/investment in NAP and NHIP is noted

despite different methods, different point of time, similar patterns of spending and resource allocation observed with Basic Programme as a priority followed by Programme Enabler.

Neither any significant departure is noticed in the process nor any major shift in allocation priorities in NHIP

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……Conclusion increase in volume of investment can be

attributed to one or more factorso programme expansion,o Unfolding realities, lessons from pasto introduction of new approaches, new technology o increase in international financing

Limited value addition is observed in using NIF as a tool for budget plan at the country level