Abt Associates Inc.  In collaboration with:I Aga Khan Foundation I BearingPoint I Bitrán y Asociados I BRAC University I Broad Branch Associates I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health

Evidence-based HIV/AIDS Programming:

A Couple Examples

Ann LionHealth Systems 20/20(a USAID funded HSS Project)

PEPFAR Supported Research in HSS

SWEFs: Ethiopia HSAs: Nigeria, Vietnam, Namibia HRAs*:HRAs*: Kenya, Nigeria, Cote d’Ivoire, Egypt, Kenya, Nigeria, Cote d’Ivoire, Egypt,

Ethiopia, and ZambiaEthiopia, and Zambia

NHAs*: Over half of 100 NHAs. e.g.,: Kenya, NHAs*: Over half of 100 NHAs. e.g.,: Kenya, Uganda, Mozambique, Yemen, Rwanda, NamibiaUganda, Mozambique, Yemen, Rwanda, Namibia

SPAs: Cote d’Ivoire, Nigeria HAPSATs: Zambia

Developing Empirical Evidence for HRH Planning: Four Steps

1. Assess current HRH situation Availability, skills mix and distribution of HRH Changes in the HRH stock (attrition and entry of new

graduates)

2. Project future availability of HRH

3. Estimate future HRH requirements consistent with health targets (PEPFAR and MDGs)

4. Use findings to develop policy recommendations

Nigeria: Projected and Required HRH

2015 Projected

2015 Required for MDGs

Surplus(+) or Shortage (-)

Doctors 25,521 24,147 5%

Nurses/Midwives 117,435 157,315 -34%

Pharmacists 14,211 19,021 -34%

Lab Technicians 18,625 24,003 -29%

CHWs 99,503 108,600 -9%

The public health sector in Nigeria will not have sufficient number of health workers to reach the MDGs,

at current rates of attrition and in-service training

Strategies to Address HRH Shortages

Incentives to attract and retain health workers Housing, in-service training and career development

opportunities, subsidy for school fees and transportation, hardship pay for rural/underserved areas

Utilization of unemployed and retired health workers Expanded hiring, contracting, in-service training

Scaling up and adjusting skills mix of pre-service training

Resource Tracking:National Health Accounts

NHA describes the flow of funds through a health system. It reveals: Who spends on health care How much they spend What types of health services/functions are purchased

Is inclusive of all financing actors in the public, semi-public, and private sectors

A tool for policymakers to make better informed decisions regarding health financing

Who Pays and How Much for HIV/AIDS Health Care - Zambia

65 122

0

20

40

60

80

100

120

140

160

180

Zambia (2002) Zambia (2006)

Millio

nsRe

al $

Public Households Other private Donors Others

48.7%

74.0%

0%

20%

40%

60%

80%

100%

Zambia (2002) Zambia (2006)

%

Public Households Other private Donors Others

Data Sources: National Health Account-HIV/AIDS subaccounts, Zambia

Evidence of Higher Out-of-pocket Spending by PLWHIV informs policy actions

Annual Per Capita Rwanda Zambia Tanzania

2000 2002 2006 2002 2006 2002 2006

General population(in real $)

4 3 8 7 17 7 6

PLWHIV( in real $)

16 11 10 40 21 16 10

Data sources: Country National Health Accounts Data; Rwanda, Zambia (5 yr GFATM eval), Tanzania (5 yr GFATM eval).

Evidence to Inform Shift in Donor Funding to Increase Local Stewardship

2002

Public

16%

NAC

8%

NGOs/donor

76%

2006

NGOs/donor

59%

Private

2%

NAC

35%

Public

4%

NHA shows how the Rwandan National AIDS Commission (NAC) has strengthened its coordination role over time

Rwanda HIV subaccounts 2006

Use of NHA Data: Civil Society in Kenya Lobby Government for ART Line Item

Civil society had difficulties engaging in national debates, due to paucity of data to substantiate their claims/requests

2002 NHA HIV/AIDS subaccount finding showed that: The government did not contribute to ARV The Spending was largely on prevention

Impact: Kenya Treatment Access Movement

(KETAM) used finding to lobby government for budget line-item for ARV

Public hearings ongoing and government is discussing how to introduce this budget allocation

NHA and National AIDS Spending Assessment (UNGASS Reporting) Harmonized

NHANHA

NASA/UNGASS NASA/UNGASS

Crosswalk

Subaccounts Subaccounts

Reproductive health

HIV/AIDS

Malaria

All other health spending

Developed at the international level and

applied in Rwanda during the 2006 estimation

Developed at the international level and

applied in Rwanda during the 2006 estimation

Conclusions

PEPFAR research exemplifies “Positive Synergies” through broader health system impact: research to guide decision making for programs empirical evidence for national level planning and

coordination among donors

Because of the diversity of the GHIs, program research needs to be comprehensive, coordinated, and useful to planners/policy makers