AIDS Resource Flows in the Caribbean
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The document discusses the assessment of HIV expenditures in the Caribbean, focusing on the allocation and efficiency of funds towards prevention efforts for most at-risk populations (MARPs). It highlights significant challenges in data accessibility, financial coordination, and the need for better resource tracking to improve HIV prevention programs, especially for MSM and CSW. Recommendations are provided to enhance capacity building, align funding with national strategies, and increase investments in interventions targeting MARPs.
AIDS Resource Flows in the Caribbean
- 1. Challenges and Opportunities for Sustainable Actions to Address HIV among Special Populations in the Caribbean National AIDS Spending Assessments in the Caribbean Andrew Fearon: afearon.consulting@gmail.com
- 2. Total HIV Expenditure 2002- 2009 Trinidad & Tobago 140 120 100 80 TT$m 60 40 20 0 2002 2003 2004 2005 2006 2007 2008 2009
- 3. Presentation Outline 1. BACKGROUND - Why Track HIV Expenditures - Why Track HIV Prevention Expenditures on MARPs - HIV Prevalence in the Caribbean (Gen Pop, MSM, FSW) 2. METHODS - National AIDS Spending Assessment (NASA) - National Health Accounts (NHA) - UNGASS Reporting on National HIV Spending 3. RESULTS 4. DISCUSSION 5. CONCLUSIONS AND RECOMMENDATIONS
- 4. Background
- 5. 1. Why Track HIV Expenditures Since 2001 there has been an unprecedented level in external financial and technical assistance from mechanisms like the UN Joint Team, PEPFAR, the GF, World Bank and other donors in the region While this surge in funding is a welcome development, perhaps more critical than the amount invested is how those funds are spent and whether or not they are meeting intended targets i.e. more efficiency and with greater impact – or are they targeted at all? Tracking HIV expenditures can measure the extent of government / donor commitment over time—towards a sustainable national and regional response The Global Economic Crisis has forced all partners to do more to meet unmet needs with finite resources.
- 6. Why Track HIV Prevention Expenditure on Most At Risk Populations Three of the largest Anglophone Caribbean countries (Jamaica, Trinidad and Tobago, and Guyana) report an HIV prevalence of 20 percent or more among MSM. (UNAIDS 2008). For many other countries, it is not clear if MARPs are the drivers of the Epidemic Preventing HIV transmission among MARPS benefits society as a whole because they can serve as a bridge to spread HIV to the wider population
- 7. Comparing Adult HIV Prevalence with HIV Prevalence in MSM (2005-2008) 35% 31.8% Adult HIV Prevalance 30% MSM Prevalance 25% 21% 20% 20% 15% 10% 8.2% 7% 6% 5% 2.4% 2.5% 3% 1.1% 1.5% 1.6% 0% DOR T&T JAM SUR GUY BAH
- 8. Comparing Adult HIV Prevalence with HIV Prevalence in FSWs (2008-2009) 30% 27% Adult HIV Prevalance 25% 21% SW Prevalance 20% 15% 10% 9% 5% 3% 2.4% 2.5% 1.1% 1.6% 0% DOR JAM SUR GUY
- 9. Methods
- 10. Study Methods Data collected from the (UNAIDS) National AIDS Spending Assessment (NASA), (WHO) National Health Accounts (SHA) and UNGASS Indicator 1 on Four countries in the Caribbean was utilized for this study. Using data collected from this study we conducted the following analysis: 1. Described the trends in HIV expenditures related to GDP 2. Compare contributions of domestic and international financing sources for HIV 3. Compared HIV expenditures on MARPS with overall prevention expenditures. 4. Based on current HIV expenditure on MARPs, discuss utility of expenditure tracking surveys for making resource allocation and mobilization decisions with a view to sustainability for MARPs programming
- 11. National AIDS Spending Assessment (NASA) Developed by UNAIDS to track all financial flows relating to HIV and AIDS Designed to give decision makers critical financial information to enable improved decision making on sustained and efficient allocation of resources. NASA is a globally recognized methodology, linked to the SHA that reveals sources of funds, expenditure by provider, expenditure by activity, expenditure by beneficiary population. Can point to greater efficiencies in resource utilization – Visualize Resource Gaps Tracking trends in expenditure in HIV & AIDS performance can be benchmarked against the priorities and objectives as outlined in the NSP and facilitate a better understanding of needs and identify gaps in programs 11
- 12. NASA Methodology Financing Source Financing Agent Provider AIDS Spending Categories (ASCs) ASC1 ASC2 Production Beneficiary Production Beneficiary Factors1 Populations1 Factors2 Populations2
- 13. Results Trinidad & Tobago 2002-2009
- 14. Results: Trinidad and Tobago 2002-2009 Expenditure by Priority Area Prevention 60 Treatment 50 A & HR 40 S&R TT$m 30 Programme Mgmt 20 10 0 2002 2003 2004 2005 2006 2007 2008 2009
- 15. Results: Trinidad and Tobago 2002-2009 Prevention Expenditure General Population TT$m20 MARP 18 16 PMTCT and VCT 14 12 10 8 6 4 2 0 2002 2003 2004 2005 2006 2007 2008 2009
- 16. Results: Trinidad and Tobago 2002-2009 HIV Expenditure Targeting Beneficiary Populations 2002-20009 70% 60% 50% PLWHA 40% MARP 30% General Population 20% 10% 0% 2002 2003 2004 2005 2006 2007 2008 2009
- 17. Results: Trinidad and Tobago 2002-2009 Sources of Funding for Prevention Health 2002-2009 $25 NACC Other Gov't $20 International $15 Private TT$ $10 $5 $0 2002 2003 2004 2005 2006 2007 2008 2009
- 19. HIV Expenditure % Share of GDP and Total HIV Expenditure USD. 2008 2009 2010 1.20% 1.00% 0.80% 2008 0.60% 2009 0.40% 2010 0.20% 0.00% A B C D 0.03 0.02 0.02 2008 2009 0.01 2010 0.01 - A B C D
- 20. Total HIV Expenditure per Capita USD 2008 2009 2010 35.00 30.00 25.00 20.00 2008 2009 15.00 2010 10.00 5.00 - A B C D
- 21. HIV Expenditure by Priority Country A 2008 2009 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 2008 2009 20.0% 15.0% 10.0% 5.0% 0.0% Prevention Treatment OVC Programme Human Social Enabling Research Managment Resources Protection Enviroment
- 22. HIV Expenditure by Priority Country B 2008 2009 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 2008 2009 20.0% 15.0% 10.0% 5.0% 0.0% Prevention Treatment OVC Programme Human Social Enabling Research Managment Resources Protection Enviroment
- 23. HIV Expenditure by Priority Country C 2009 2010 45.00% 40.00% 35.00% 30.00% 25.00% 2009 20.00% 2010 15.00% 10.00% 5.00% 0.00% Prevention Treatment OVC Programme Human Social Enabling Research Managment Resources Protection Enviroment
- 24. HIV Expenditure by Priority Country D 2008 2008 45.00% 40.00% 35.00% 30.00% 25.00% 20.00% 2008 15.00% 10.00% 5.00% 0.00% Prevention Treatment OVC Programme Human Social Enabling Research Managment Resources Protection Enviroment
- 25. Percentage Share HIV Expenditure Prevention: Sex Workers 2008 2009 2010 4.00% 3.50% 3.00% 2.50% 2008 2.00% 2009 2010 1.50% 1.00% 0.50% 0.00% A B C D
- 26. Percentage Share HIV Expenditure Prevention: MSM 2008 2009 2010 3.50% 3.00% 2.50% 2.00% 2008 2009 1.50% 2010 1.00% 0.50% 0.00% A B C D
- 27. Percentage Share HIV Expenditure Prevention: Drug Users 2008 2009 2010 0.035 0.03 0.025 0.02 2008 2009 0.015 2010 0.01 0.005 0 A B C D
- 28. Percentage Share HIV Expenditure Prevention: General Population 2008 2009 2010 70.00% 60.00% 50.00% 40.00% 2008 2009 30.00% 2010 20.00% 10.00% 0.00% A B C D
- 29. Percentage Share HIV Expenditure Stigma & Discrimination 2008 2009 2010 8.0% 7.0% 6.0% 5.0% 2009 4.0% 2009 2010 3.0% 2.0% 1.0% 0.0% A B C D
- 30. Percentage Share HIV Expenditure Civil Societies 2008 2009 2010 40% 35% 30% 25% 2008 20% 2009 2010 15% 10% 5% 0% A B C D
- 31. Measurement Challenges Inaccessibility and unavailability of expenditure data Unavailability and limited recognition of the need for expenditure to be disaggregated by activity and by beneficiary population. Lack of financial coordination between funding agents - donors and governments – varying budgeting, accounting and financial reporting Donors financial plans are not harmonised with Country National HIV Strategic Plans Not all National Strategic Plans are costed – comparison of expenditure against the budgets.. 31
- 32. Measurement Challenges Lack of an Agenda. Expenditure analysis is seen as a donor led activity with limited country buy-in Piecemeal implementation reduces the value of the expenditure analysis for decision making
- 33. Challenges Lack of Institutionalisation of expenditure tracking – UNGASS Indicator 1 findings: Little emphasis on data collection Confusion between Budgets and Expenditure Confusion between Objectives and Activities Technical Capacity – emphasis on data production, not translation into policy Lack of transfer of capacity to local staff Lack of Dissemination of expenditure reports Lack of understanding between Expenditure Analysis and Auditing
- 34. Recommendations Governance – expenditure assessments should be incorporated into the strategic planning cycle, International agencies should promote capacity building in financial policy making, CSO need to ensure that financial commitments are maintained by Governments and Donors
- 35. Recommendations Human Resources– Commitment to Learn by doing Support by external consultants should focus on capacity building rather than data collection. Training in financial capacity building – government, international and CSO sector Financial Information Develop systems that can link financial information to activity based budgeting Integrate expenditure analysis into the country planning and budgeting process
- 36. Recommendations For Sustainability Align external support to national Strategic Plans which are costed. Recognise where the funding is currently flowing from and where it is flowing to. Identify current challenges in funding Recognise what funding (Technical Support as well as cash transfer) the government already provide Examine areas that can gradually be incorporated into government annual plans and commitments Develop a domestic sustainable funding strategy
- 37. Conclusions Expenditure on HIV prevention programs for MSM and CSW is very low relative to overall prevention expenditure—despite the proportion of HIV transmission attributed to sex between men. The evidence, both on the magnitude of the issue and the effectiveness of MSM interventions, demands that countries increase resource allocations for MSM programming. Government policymakers and program planners will require more evidence of the cost- effectiveness of MSM interventions so that they understand the value of investing in programs for most-at-risk groups—this needs to be part of future research agendas
- 38. Post Script – International Agencies Commitment PANCAP Caribbean Based Resource Mapping Project Resource Mapping in the British Overseas Territories World Bank. The Global Strategic Action Plan for the Promotion of National Health Accounts UNAIDS. The National AIDS Spending Assessment OECD, World Bank, WHO and USAID. Where is the money and what are we doing with it? Creating an Evidence Base for Better Health Financing and Greater Accountability
Editor's Notes
- #6: Monitoring the flow of resources for the HIV response provides valuable strategic information that can improve operations and planning and greater mobilization of and efficient use of resources Since 2008 there has been an unprecedented increase in external financial and technical assistance from mechanisms like the like the UN Joint Team, the US presidents emergency plan for AIDS Relief, the Global Fund for AIDS, Tuberculosis and Malaria, the World Bank’s Multi-country HIV/AIDS Program and other donors in the region in the regionFunding from 2001 for the WB from Loans and grants since 2001 in the Caribbean has been USD114m against budgeted support of USD156m. (The Status of HIV in the Caribbean – UNAIDS 2010)Do countries even know the total level of resources received – for example, GTZ/KfW and some USAID funding is made externally of governments and the PANCAP GF support is there reporting to countries on the budgeted support and levels of expenditure? – Indicator 1 UNGASS Domestic and international AIDS spending by categories and financing source has been the only method of capturing this data but this indicator has not been prioritized by countries nor is he data, with a few exceptions of doubtful quality.With the economic crisis and the reduction in resources theneed for policy makers to determine where HIV resourceshave been spent has never been more important.
- #7: Monitoring the flow of resources for the HIV response provides valuable strategic information that can improve operations and planning and greater mobilization of and efficient use of resources As countries develop multi sectoral plans for the involvement of non health sector in the fight against HIV/AIDS, it becomes critical to monitor resource allocations and financial flows. To measure trends over time – changing priorities.
- #8: Reference: The Status of HIV in the Caribbean. UNAIDS 2010
- #9: Reference: Reference: Keeping Score II: UNAIDS 2008
- #11: UNGASS Indicator 1: INDICATOR 1:Domestic and international AIDS spending by categories and financing sources
- #12: Two tracking systems exist for tracking health spending by countries and by donors. Both are conducted on a periodic basis and in some countries provide the most comprehensive information on health and HIV spending by governments, donors, and out of pocket expenses. However, these data comes with a considerable time lag and may require annual financial audits to supplement the efforts to track, leverage, and provide transparency for annual funding.The United Nations General Assembly Special Session (UNGASS)INDICATOR 1:Domestic and international AIDS spending by categories and financing sources – W
- #13: Financing: Sources and AgentsProvision: Providers and Production FactorsConsumption: AIDS Spending Categories or Activities, intended beneficiary populations