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![Page 1: Teresa Guthrie M.PH (Health Economics) HIV modelling for in-country ownership solutions – generation of evidence IAS Conference, Washington DC, 19-20 July.](https://reader035.fdocuments.net/reader035/viewer/2022062716/56649de55503460f94add57b/html5/thumbnails/1.jpg)
Teresa Guthrie
M.PH (Health Economics)
HIV modelling for in-country ownership solutions – generation of evidence
IAS Conference, Washington DC, 19-20 July 2012
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RationaleThe Centre for Economic Governance and AIDS in Africa
(CEGAA) believes that:
• Governments require information to improve their estimates of need & resource requirements, their
allocative decisions, to ensure efficient expenditure on effective programmes, and to promote transparency,
accountability and good governance.
• Civil society needs to generate evidence on quality of services, spending & hold govt accountable.
• With this evidence governments can take leadership and full ownership of the national response to
HIV/AIDS and TB.
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Modelling & Collecting Data in the Fiscal Cycle
Assessment of Resource Need – costing analysis.Impact modelling & CEA
Fin.Gap AnalysisResource Mobilisation
Budget AllocationsInvestment Framework?
Execution of budget –Fin.Info systems for Expenditure Tracking.Absorption of budget/committed?
Proportion DP aid spent in country?
Systems forreporting:Public, Private& DPs
DP alignment
DP long-term commtmts
Budget Monitoring
Revenue & tax watch
Analysis of Process
Finance channels
Intended Spending
Auditing (financial)
Systems-Accountability
Output analysis – interim indicators.
Achievement of budget Objectives? Quality?
Auditing (internal performance)
Community Social Auditing
Outcome analysis – long-term indicators.Impact assessment
Clinical Trials
Cohort studies
Life years saved
Quality of lif
e
Reduced prevalence rates
Cost Effectiveness
(CEA/CBA/CUA)
All Levels:
National
Provincial
District
Modelling HIV
Epidemiological Trends,
Population Projections,
Scenario Building
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Examples of Modelling Data
Costings & Resource Mobilisation Options:
•2031 Estimates of Impact & Costs of various scenarios – SA & Thailand•SA-ART cost estimates (BU&HERO) – modelled & costed increased CD4 eligibility & impact•South Africa created new National Strategic Plan (NSP) for HIV, TB and STIs (2012/13 - 2015/16) – costs estimated by the costing team
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SA New Adult (15-49yrs) HIV infections (’93–’31)
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SA Adult (15-49yrs) HIV Prevalence (2000–31)
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SA - Total HIV/AIDS Resources Required by Scenario 2009 –2031 (ZAR billions)
NB. These estimations include all sectors and all sources of funding
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SA Expanded NSP – Total Costs and their Distribution (ZAR millions)
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Presentation NamePRESENTATION DATE
South Africa’s new NSP cost est.2016: R32b (US$4b)
2012: R18.6b (US$2.3b)
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Examples of Modelling DataExpenditure Tracking, Alignment & Gap Analysis:• NASA in ESA• South African National AIDS Council (SANAC)
commissioned the National AIDS Spending Assessment (NASA) (2007/08 - 2009/10).
• Compared the estimated cost of SA NSP (new & old) implementation with estimated current and future available funds, and measured the potential funding gap.
• Considered various scenarios for funding options.
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Sources of Funding in ESA
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Presentation NamePRESENTATION DATE
Spending Alignment with Country Priorities
Looking backwards to previous SA NSP costing & NASA (09/10)
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Alignment of All SA Partners?
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Is SA spending efficiently on ART? (ZAR, 2009/10)
14NB. GP also spent PEPFAR funds on public ART, not included above
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DRAFT - DO NOT DISSEMINATE.
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Is SA spending on the best prevention interventions? (%, 2009/10)
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Are we targetting the right Beneficiaries? (2006-2009)
DRAFT - DO NOT DISSEMINATE.
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Presentation NamePRESENTATION DATE
Projected funding availability – gap??
Forward projected available funding vs NSP costs (2012)
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Presentation NamePRESENTATION DATE
Anticipated gap/surplus by intervention
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Modelling Funding Scenarios
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Findings – Funding Options4. Mixed Scenario – 20% private, 20% increase in external, 22% public increase
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Presentation NamePRESENTATION DATE
Best Funding Scenario?
5. Alternative (Innovative?) Domestic Financing Options
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Presentation NamePRESENTATION DATE
Conclusions i.
• Sound objective evidence - modelling, costs, spending, quality of services, impact – all increase the govt’s ability to lead the response and inform policy choices.
• Research agenda should be aligned to national priorities, not pushed by development partners’ agendas.
• Aid dependency, and its unpredicatbility, short-cycles & lumpiness seriously hinders the country’s ability to future project available funding, plan, and manage the response.
• Improved public accountability & transparency re budgets, spending, outputs & outcomes – improve financial systems!
• Improved transparency of development partners’ commitments, disbursements and actual
spending, so as to measure alignment,
prioritisation & gaps
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Presentation NamePRESENTATION DATE
Conclusions ii.
• Need to model alternative domestic funding sources & mechanisms, such as a national health insurance, financial transaction tax, a currency conversion levy or an additional AIDS tax on individuals and businesses – to give greater power to governments in taking the leadership role.
• Far greater commitment and transparency from the business sector, the private health insurance industry and the development partners in terms of predictable, aligned and accountable spending on HIV/AIDS.
• Build capacity of civil society to monitor govt budgets & spending• Building local capacity & systems – govt and service providers –
real local ownership & investing in their
longer-term systems strengthening before
funding programme implementation.
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Thank youTeresa Guthrie
Centre for Economic Governance and AIDS in Africa
www.cegaa.org