An overview of the NASA methodology Urbanus Kioko Centre for Economic Governance and AIDS in Africa ASAP/TSF Costing Workshop April 9-11, 9 2008 Johannesburg, South Africa
Overview of this Presentation Introduction to resource tracking & NASA Purposes of NASA NASA relationship to NHA NASA methodology NASA objectives - expectations Anticipated process NASA requirements Review of the major findings made using NASA Challenges
Resource Tracking: Purposes To provide indicators of the financial country response to HIV/AIDS or health To support monitoring resource mobilization To obtain information in order to improve decision- making To define priorities regarding the distribution of resources Not an auditing process
National AIDS Spending Assessment NASA is a generic term currently used for all country s HIV/AIDS resource tracking activities. It provides a framework and tools for undertaking a comprehensive analysis of actual expenditures for HIV/AIDS - which can be applied to any HIV/AIDS activity (health and non-health).
NASA data usefulness Measurement of Spending Total Domestic Public (e.g. UNGASS indicator) Inflows by donors (e.g. GF additionality) Private OOPE, business, NGO Usefulness as input in the AIDS planning cycles Complimentary with the NSP categories Complimentary with Resource Needs Provides the base data to undertake further analysis: Equity, beneficiary analysis, Efficiency, Bottlenecks, Absorptive capacity, Allocative efficiency, etc.
Complimentarity to the Resource Needs Model NASA and the RNM use the same classification for HIV/AIDS activities This makes analysis of the financing gap between current expenditure and the projected resource needs more useful for Programme managers
Use of NASA results : Work in progress aimed at supporting better spending in countries Support in-country policy and decision making process, specifically for AIDS Provide indicators on the financing of AIDS Annual estimates of Financing Sources and Functions Comparison: resources available (PAST) and (FUTURE) resource needs Monitoring of Declaration of Commitment (e.g. UNGASS) International Comparability Utilization of data for country defined purposes by AIDS program managers/policy and decision makers
Use of NASA Results: Work in progress aimed at supporting better spending in countries Efficiency: Bottlenecks and absorptive capacity Additionality GF projects Improved tracking of non-health expenditures: Expanded response Timeliness of data: opportunity to influence policies Allocative effectiveness funding for the right interventions Equity funding for the right populations
NASA Framework for HIV/AIDS NASA is not limited to health expenditures for HIV/AIDS, but emphasizes the tracking of non-health expenditure such as social mitigation, education, labour, justice and other sectors expenditure related to HIV/AIDS Captures according to categories similar to the NSPs - more useful to NACs
NASA Relationship to NHAs Same accounting procedure Same data produced with more disaggregation of activities/ functions Data for non-health expenditure NASA is compatible and comparable with NHA (HIV sub-analysis), but provides greater detail for NSP usefulness
Relationship between National AIDS Spending Assessments and National Health Account Crosswalk NASA-NHA NHA Health portion of HIV/AIDS expenditures Nonhealth portion of HIV/AIDS expenditures NASA NASA- NHA Crosswalk NHA HIV/AIDS subaccount (represents health and health related portions of HIV/AIDS expenditures) Health related General NHA 11.3
NASA Classifications R.T. aims to collect comprehensive data regarding: Sources who pays Agents who manages the funds Service Providers who provides the services Functions/activities what is provided Beneficiaries who benefits Objects of expenditure what are the components of expenditure The primary responsibility of the resource tracking team is to ensure that the classification scheme used is made of mutually exclusive and exhaustive categories within each of the classifications.
Assessment Along 3 Dimensions To describe the AIDS health and non-health financial flows and expenditures according to three dimensions and six vectors: 3 dimensions and 6 vectors Financing: (1) Sources (2) Agents Provision: (3) Providers (4) Production factors Consumption (5) Activities (6) Beneficiary groups
Triangulation: Gathering, compiling and cross checking information from three sources Purchasers Providers Financing Provision Sources Commodities Consumption Beneficiaries Factors of production
Financial Source Financing Sources are entities that provide resources to the Financing Agents to be pooled and distributed NASA Financing Sources are aligned with NHA Financing Sources Sources: Public (Ministry of Health, Social Security, etc), Private (Households, Corporations, NGOs, etc) and International (Multilateral, Bilateral, NGOs, Foundations, etc).
Financial Agent The Financing Agents are entities that concentrate financing resources from different sources and transfer them to finance a program or as a payment to buy good and services, such as health treatment, prevention activities, etc. This entities make programmatic decisions on the use of the resources they receive from the Financing Sources. Financing Agent: Agent Purchaser
Programmatic decisions What to buy? (selecting ASC) For whom? (select beneficiary Populations) Produced by whom? (selecting the Provider)
Provider Entities that participate in the production of good and services for the response to HIV. To identify the provider, first identify the type of service and the final product (ASC) The provider is responsible for the delivery, provision and quality of the good and services. The provider is responsible for the final product, but can either subcontract services or personnel or the delivery of the product, or buy the inputs necessary for producing it itself. The providers consume the resources of different production factors to produce goods and services (programmatic interventions/asc) for a particular beneficiary population.
Production Factors: The ASC and the Providers classifications are focused in the outputs (good & services). However it is also desirable to analyze the inputs that are transformed into outputs: the production factors, which combined in a specific production function of the Provider are transformed into goods & services. The analysis of the resources consumed (human resources, materials, etc.) are crucial for doing efficiency analysis. The classification includes two categories: (1) Current expenditures & (2) Capital expenditures
Activities/ Spending Categories All the interventions, services and activities undertaken/ provided in response to HIV/AIDS. They are comparable across resource needs and resource tracking i.e. must be standardised across studies and between countries for comparison purposes.
NASA Spending Categories for HIV/AIDS Classified for eight HIV/AIDS programmatic areas Prevention - Mass media, condoms, HRPs etc. Treatment & care ARVs, OI Rx, palliative care etc. Orphans and vulnerable children education, family support, nutrition etc. Programme development & strengthening health care systems for HIV/AIDS program management, monitoring, training, upgrading/new buildings etc. Human resources for HIV/AIDS activities monetary incentives Social mitigation social/financial support, human rights etc. Community development and enhanced environment institutional development, IGAs, women s programmes etc. Research biomedical, social, psychological, behavioural, vaccine
Target Group or Beneficiaries Population of interest addressed by / benefiting from the activities: People living with HIV and AIDS MARPs (MSM,CSW,IDUs etc) Vulnerable groups OVCs Migrants Refugees Men who have sex with men (MSMs) Accessible populations STI clinic patients Women reproductive health clinics Police, military, truckers, sailors Children at school General populations
Object of Expenditure Production factors purchased to produce a good or deliver a service, under any determined production function e.g. Current expenditure Wages/ salaries/ non-wage income Pharmaceutical products (ARVs, other drugs) Reagents, materials, supplies Condoms Services Capital Transport Training of staff Consultant services Administrative Buildings, equipment, vehicles, capital transfers
Tracking the Transaction Is the basic unit of the financial flow, that describes the transit of resources from a source to a provider, who purchases objects of expenses to develop one or more functions benefiting target groups, specified or not.
Flow of resources from origin to end users: reconstruction of transactions Source Provider Functions A C B Objects of Expenditure Target Groups
Sources of Data for NASA Top-down: from sources of funds eg donor reports, commitment reports, government budgets etc. Bottom-up: service providers expenditure records, facility level records, governmental dept. expenditure accounts. Missing data: costing techniques are used to estimate actual expenditure
Flow of resources from origin to users: reconstruction of transactions ( Top Down ) Sources Financing Agents Functions (Health or non-health) Financing Use Providers of services Provision Beneficiaries - Specific Target Groups - Or unspecified Production Factors
Reconstruction of transactions ( Bottom Up ) to reconcile with flows from sources (ceiling) Financial Sources Financing Financing Agents Providers of services Provision Production Factors Functions (Health or non-health) Beneficiaries Use
REPORTING TO UNGASS Expenditure on HIV and AIDS MANDATORY (as agreed in the UNGASS DoC) RECOMMENDED (Components of the total figure to be reported) OPTIONAL Functions TOTAL Total USD $ Central (National) ORIGIN OF THE SOURCES by FINANCING AGENT PUBLIC Subnational Development Bank Reimbursable PRIVATE Corporations INTERNATIONAL Multilaterals Development Bilaterals Banks Grants UN GF (nonreimbursable) Out-ofpocket 1. Prevention 2. Care and Treatment 3. Orphans and Vulnerable children 4. Program Management costs 5. Incentives for Human Resources 6. Social Mitigation 7. Community development and enhanced environment 8. Research
Challenge of estimating information not easily accessible There are several components for which the information is not easily accessible e.g. unlikely to be reported and leave administrative trail Example: Treatment of Opportunistic Infections in public settings Part of the hospital budget Need to use costing tools to provide the best possible estimations
Costing Techniques for Estimations Internationally accepted costing methods and standards used to retrogressively measure past actual expenditure Ingredient and step-down costing is used for direct and shared expenditure for HIV/AIDS Shared costs are allocated on the most appropriate utilization factor Donated goods and in-kind services are valued at their valve in the year of consumption Capital goods costs are annualised and adjusted for inflation (where appropriate)
NASA process/ timeframe Planning & training Key stakeholder meeting Identification of key sources of data & appointment setting Obtaining permissions, letters of access Data collection (interviews, site visits) Data capturing in the software ongoing Data analysis Draft 1 of report Validation meeting prelim findings to stakeholders Editing and improving report Finalisation of report Time frame-min 4-5 months full time
NASA Team Requirements Permissions letters to key sources of data especially Moh, MoE, MoLG (SS), district level services Comprehensive database of all sources, agents, providers in the country Assistance with sample selection & site visit preps Secondary data Access to expenditure records et al electronic and hard copies NAC & UNAIDS representatives, research team Data capturers Transportation & accommodation for site visits Printing of data collection tools, laptops etc.
Examples of RT Findings
Sources of HIV/AIDS Funds in Ghana 35,000,000 30,000,000 Sources of Funds for HIV/AIDS in Ghana (2005-2006) 25,000,000 20,000,000 15,000,000 10,000,000 International Organizations Private sector Public sector 5,000,000 0 International Organizations 2005 2006 17,195,129 21,984,015 Private sector 315,210 416,819 Public sector 7,850,376 10,174,465
Sources of HIV Financing in Botswana (excl.pvt)
Sources of HIV/AIDS Funds (2005/06 & 2006/07) 400,000,000 350,000,000 300,000,000 Emalangen 250,000,000 200,000,000 150,000,000 100,000,000 50,000,000-2005/2006 2006/2007 International funds 239,520,821 220,816,750 Public Funds 32,835,809 136,915,968 Year International funds Public Funds
Composition of international sources of funds 300,000,000 250,000,000 Emalange 200,000,000 150,000,000 100,000,000 50,000,000 International not-for-profit organizations and foundations Multilateral Agencies servicing earmarked grants Direct bilateral contributions International notfor-profit organizations and foundations Multilateral Agencies servicing earmarked grants Direct bilateral contributions - 2005/2006 2006/2007 21,308,130 47,318,039 205,340,217 153,449,193 12,872,474 20,049,518 Years
Spending Priorities in Botswana 100% 80% Proportional Spending Priorities 2005 FN 8..HIV- and AIDS-Related Research FN 7..Community Development & Enhanced Environment FN 6..Social mitigation 60% FN 5..Human Resources for HIV and AIDS activities 40% FN 4..Prog.Devmt & HSS strengthening 20% 0% Public sector Internat.Orgs FN 3..Orphans and Vulnerable Children (OVC) FN 2..Treatment and care components Total FN 1..Prevention Programmes
Spending Categories in Ghana
Spending categories (2005/2006) Human resources' recruitment and retention incentives, SDL 3,127,776, 1% Programme management and administration strengthening, SDL 24,815,235, 11% Social protection and social services(excluding OVC), SDL 8,272,745, 4% Enabling environment and community development, SDL 9,177,463, 4% Prevention, SDL 45,247,814, 20% OVC, SDL 22,823,820, 10% Care and tretments, SDL 112,323,633, 50%
Spending categories (2006/2007) Enabling environment and community development, SDL SDL4,557,631, 2% Social protection and social services(excluding OVC), SDL27,201,892, 14% Human resources' recruitment and retention incentives, SDL4,038,661, 2% HIV and AIDS- related researches( Excluding operations research), SDL 16,521, 0% Prevention, SDL 34,217,071, 17% Programme management and administration strengthening, SDL44,955,654, 22% Care and treatement, SDL60,755,823, 30% OVC, SDL25,463,577, 13%
Treatment Spending Activities
Changing Priorities
Treatment Spending in Botswana PUBLIC Treatment Expenditure 2005 6% Antiretroviral therapy. 37% Prophylaxis for Opportunistic Infections - mainly IPT Treatment of Opportunistic Infections. 40% Hospital treatment and care. Palliative care (incl. HBC) 1% 16%
Treatment Spending -2006/07 Care and treatment services not elsewhere classified (n.e.c.) 6% Opportunistic infections (OI) treatment 12% Opportunistic infection (OI) prophylaxis 0% Palliative care 1% Home-based care 19% Antiretroviral therapy notdesegregated by age or line of treatment 49% Psychological treatment and support services 9% Specific HIV-related laboratory monitoring 1% Nutritional support associated to ARV therapy 3%
Beneficiaries in Ghana Agent to Beneficiaries (2006) 29% 56% 11% 1% 3% PLWHA Most at risk populations Vulnerable groups Accessible populations General Pop
Changing Beneficiaries over Time
Beneficiaries of Public and External Spending
Comparison of Costed NSP Priorities with NASA Spending
NSP Priorities vs Actual Spending
Harmonization, comparability and standardization Resource needs model: Future requirements Package of interventions Resource tracking: Current spending Categories of spending
Thank you! Urbanus M. Kioko Centre for Economic Governance and AIDS in Africa