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Linking Resource Needs and

Strategic PlanningDominic S. HaazenLead Health Policy SpecialistThe World BankASAP – A Service of UNAIDS

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Why is such a linkage important?To ensure that the interventions included in the strategic plan are realistic and affordableTo provide vital information to those managing and monitoring implementation of the strategy

Expected vs. actual program coverage Physical resources needed vs. obtainedMonetary resources needed vs. available

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When are resource needs estimated?Estimating resource needs happens at different points in the process

In theory, prioritization should precede the estimation of resource needs and the finalization of the strategyIn reality, planning, prioritizing and resource estimation are interrelated and often done as iterative processes (initial estimates may show that too many actions have been prioritized relative to the available funds, that coverage levels are not feasible, or physical resources are no available)

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Process – resource needs estimationReview and revise interventions, coverage or priorities to match resources

Select interventions

PrioritizeSet desired

coverage

Determine resource needs

Revise based on priority

Financial Resources Available?

Physical Resources Available?

Yes

Finalize Strategy

Yes

No

No

Start Review and revise interventions, coverage or priorities to match resources

Select interventions

PrioritizeSet desired

coverage

Determine resource needs

Revise based on priority

Financial Resources Available?

Physical Resources Available?

Yes

Finalize Strategy

Yes

No

No

Start

Approach 1:National Strategic

PlanActivity-based costing

Small teamExternal consultantsStandardised costsAccounting exercise

Approach 2:

Annual Action Plan

ParticipatoryLarge team

Wide stakeholder involvement

Costs estimated by implementers

Reviewing two approaches to estimating resource needs in Swaziland

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Approach 1: Activity-Based CostingApproach based on:

The Second National Multisectoral HIV and AIDS Strategic Plan 2006 – 2008 National Program of ActionUrgent and Priority Agenda

Dimensions:4 components 104 sub-thematic areas910 individual “actions”215 actions in urgent and priority agenda document

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This Approach Included: Priority setting exercise

To reduce number of items to be costedBased on “gut feel” that entire plan was not affordable/feasible

Identification and quantification of the target groups

Detailed costing activity beginning with the highest priority activities (per ratings) also included Urgent and Priority Agenda activities

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Priority Setting – Methodology3 factors (applied at sub-thematic level):

Available Capacity for carrying out specific action (weight = 3)Immediate Benefit to those at risk, OVC, PLWHA, others; (weight = 2)Potential for Long-term Improvement in quality of life of PLWHA or their families, or reduction in infection rates (weight = 1)

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Dimensioning ProcessSimilar for all resource needs

estimations:1. Identify target populations 2. Determine number of

beneficiaries by year for each action area and target population

3. Determine timing of any capital requirements and number of sites

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Resource estimation process used1. Develop a chart of accounts2. Establish standard costs by account

category3. Develop the number of units per

recipient/site 4. While costing individual action items, allow

alternative standard costs, where appropriate;

5. Complete detailed description of activities/ assumptions to document process

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Year 1 Year 2 Year 3 Total

Prevention 7.58 9.20 9.31 26.10 Care, Support and Treatment 13.43 15.80 19.65 48.87 Impact Mitigation 4.96 9.35 9.22 23.53 Mgt. of the National Response 3.62 2.78 2.39 8.80

29.60 37.14 40.57 107.30

Prevention 26% 25% 23% 24%Care, Support and Treatment 45% 43% 48% 46%Impact Mitigation 17% 25% 23% 22%Mgt. of the National Response 12% 7% 6% 8%

100% 100% 100% 100%

Annual Per Capita Cost by Year -- USDInitial Results:

All priority items: including scaling up in ARV therapy, PMTCT, nutritional support, education, micro-credit, housing and water

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Swaziland Results – FTEs:Year 1 Year 2 Year 3 Total

I nternational Consultants 1.1 1.1Local Consultants (higher level) 24.5 4.4 5.2 34.1Local Consultants (lower level) 71.9 63.7 64.8 200.4Staffi ng (higher level) 8.0 8.0 8.0 24.0Staffi ng (lower level) 13.8 13.8 10.8 38.3Staffi ng (middle level) 24.9 24.9 24.9 74.8Stipends Community Volunteers 1,014.7 1,373.8 1,373.6 3,762.1 Total FTE's 1,158.9 1,488.5 1,487.4 4,134.7

Approach 2: Participatory3-month process to develop Annual Action Plan

Consultant team facilitated planning and costing meetings with stakeholders14 different implementing agents (e.g., PLWHA network, NGO network, business coalition, gov’t)Planning and budgeting workshops 1-2 days each, depending on capacity of each implementing partner and scale of its operationsIndividual plans then collated into 4 sector plans: Public, Private, Civil Society, Traditional Scrutiny, modifications and approval by national AIDS co-ordinating body (NERCHA)

PrioritisationConducted by national AIDS coordinating body (NERCHA)

Analyzed the main ‘drivers’ of the epidemic (i.e. the main factors influencing the spread or curtailment of the epidemic)Correlated main strategic issues in the National Strategic Plan with these driversIdentified series of primary goals and objectives that address the key driversResult was list of 24 priority objectives to be tackled via 35 priority strategies

Resource needs estimation

Some costs standardized, but most estimates took the form of trend planning

based on knowledge of costs of similar previous activities

Facilitators assisted participants to generate simple formulae

Total Workshop Costs = [# of participants/facilitators x number of workshop days X workshop venue costs per person] + [number of participants x average transport cost] + [number of facilitators X number of preparation and workshop days X facilitation fee] + [budget for stationery and materials]

Experiences & Lessons LearnedUnwise to ask people to cost activities when they do not have capacity/relevant experience

Capacity building needs must be addressed

Participatory approach takes longer but may be better at building capacity of broader audience Activity-based approach has greater potential to pass on high-level skillsBoth approaches require staff and consultants with strong capacity

Improved tools needed to support Activity-based approach Standardized costs speed up and simplify budgeting and can promote consistency; but some variations are essentialEffective prioritization and optimal planning require targets/constraints

without budget or other resource limits, planning and resource estimation easily becomes ‘wish-listing’

Resource tracking is an integral part of the planning, prioritization and costing process

Experiences & Lessons Learned (2)

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Overview of New Costing ModelNeed highlighted by Swaziland (& Guyana) experienceDesigned specifically to support the ABC approachDesigned to complement to existing costing toolsIncorporates key elements of existing models

concept of target groups/coverage levels - RNMfunctional classification from NASA

Logical menu-driven sequence of stepsLevel of detail up to the user:

e.g., major drugs, laboratory supplies, other key cost itemsselected activitiesor comprehensive; all costs/activities

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Overview of the Model (2)User can do variance simulations to live within resource constraints

different coverage levels, unit cost reductionsfinancial and HR implications of task shiftingvarious combinations of activities

Allows expenditure mapping to government accounting frameworkFacilitates use as a budgeting and financial monitoring tool – e.g., variance analysisSupports complete cycle of planning, budgeting, operations and evaluation

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Model supports all parts of cycle

Planning

Operations/ Reporting

Budgeting Evaluation

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Who Should be Involved?Step Type of Staff

Entering Basic Data M&E, Program

Targets and Coverage LevelsM&E, Program, Management **

Chart of Accounts/Mapping Financial

Map Strategic Plan to Functions

Program

Costing Standard Interventions

Financial, Program, Management ** Costing Special Interventions

Review Total Costs Management **

Reporting Financial, Program

** Management involvement critical to ensure realism

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Thank you