The PThe Polity Utility of Tracking olity Utility of Tracking State State HIV/AIDSHIV/AIDS Allocations Allocations
UNAIDS Satellite Meeting: “National AIDS Accounts” XV International AIDS Conference
Bangkok, July 2004
Teresa GuthrieAIDS Budget Unit ~ IdasaCape Town, South [email protected]
Teresa Guthrie ~ AIDS Budget Unit
Policy Utility of Budget AnalysisPolicy Utility of Budget Analysis Budget allocations give an indication of the Budget allocations give an indication of the
level of States’ commitment to health and level of States’ commitment to health and HIV/AIDS.HIV/AIDS.
Allocations are indicators which can measure Allocations are indicators which can measure the attainment of global commitments: the attainment of global commitments:
Abuja CommitmentsAbuja Commitments – 15% of total annual – 15% of total annual budget to health.budget to health. “ “We also pledge to make available the necessary resources We also pledge to make available the necessary resources
for the improvement of the comprehensive multi-sectoral for the improvement of the comprehensive multi-sectoral response, and that an appropriate and adequate portion of response, and that an appropriate and adequate portion of this amount is put at the disposal of the National this amount is put at the disposal of the National Commissions/Councils for the fight against HIV/AIDS, Commissions/Councils for the fight against HIV/AIDS, Tuberculosis and Other Related Infectious Diseases.” Tuberculosis and Other Related Infectious Diseases.”
UNGASS CommitmentsUNGASS Commitments MDGsMDGs
Teresa Guthrie ~ AIDS Budget Unit
Utility of Budget Analysis cont.Utility of Budget Analysis cont. Budget allocations give an indication of Budget allocations give an indication of
the attainment of human rights – issues the attainment of human rights – issues of equity and efficiency in resource of equity and efficiency in resource allocation, if based on need.allocation, if based on need.
Indicates prioritisation of interventions Indicates prioritisation of interventions eg. Multi-sectoral vs health-dominated,eg. Multi-sectoral vs health-dominated, Prevention vs treatment focus.Prevention vs treatment focus.
Measures additionality.Measures additionality. Indicates what governments are Indicates what governments are
spending on each of their citizens ~ per spending on each of their citizens ~ per capita.capita.
Teresa Guthrie ~ AIDS Budget Unit
Importantly….Importantly….
Resource tracking data is used Resource tracking data is used by government officials, donors, by government officials, donors, and particularly civil society as and particularly civil society as an advocacy tool, to inform and an advocacy tool, to inform and influence policies and influence policies and prioritisation of response, in prioritisation of response, in terms of resource allocations.terms of resource allocations.
Teresa Guthrie ~ AIDS Budget Unit
Some key examples of the fSome key examples of the findings:indings:
Public Health AllocationsPublic Health Allocationsin 4 African Countriesin 4 African Countries
Are African States meeting the Abuja Are African States meeting the Abuja Target in their Public Health Allocations?Target in their Public Health Allocations?
Health as share of total govt. expenditureHealth as share of total govt. expenditure
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
16.00%
18.00%
2000/1 2001/2 2002/3 2003/4 2004/5 2005/6
Moz
SA
Ken
Abuja
Nam - health specific
Nam - tot MoHSS
Sources: Mozambique National Statistics Institute Database, 2003. South African Budget Review, 2003/04 and Estimates of
National Expenditure, 2003. Kenyan Estimates of Recurrent and Development Revenue, 2003,
and National Aids Resource Envelope, 2003.
Teresa Guthrie ~ AIDS Budget Unit
How much are states committed… How much are states committed… or dependent?or dependent?
Mozambique: Total Health Budget SourcesMozambique: Total Health Budget Sources (USD)(USD)
Source: MISAU -DPC 2003
0
20,000,000
40,000,000
60,000,000
80,000,000
100,000,000
120,000,000
140,000,000
160,000,000
180,000,000
2001 2002
State External
98,227,307
150,621,762
98,127,789
158,106,635
Source: Mozambique INE, 2003.
State annual health spending per capitaState annual health spending per capita
Sources: Mozambique National Statistics Institute Database, 2003. South African Budget Review, 2003/04 and Estimates of National Expenditure, 2003. Kenyan Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, 2003. Dorrington, 2002.
0
10
20
30
40
50
60
70
80
90
100
Kenya South Africa
US$
2000/01
2001/02
2002/032003/04
2004/05
2005/06
Mozambique
n/a
Teresa Guthrie ~ AIDS Budget Unit
HIV/AIDS AllocationsHIV/AIDS Allocations
Kenyan HIV/AIDS allocations Kenyan HIV/AIDS allocations (Kshs millions) 2000/01-2005/06(Kshs millions) 2000/01-2005/06
Source: Kenyan National AIDS Resource Envelope, February 2003.
0
2,000
4,000
6,000
8,000
10,000
12,000
2000/01 2001/02 2002/03 2003/04 2004/05 2005/06
Ksh
s m
illio
ns
Donor and NGO HIV allocations (Real)State HIV allocations (Real)
Are State’s prioritising HIV/AIDS Are State’s prioritising HIV/AIDS Spending? Share of total Spending? Share of total expenditureexpenditure
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
2000/01 2001/02 2002/03 2003/04 2004/05 2005/06
South Africa
Kenya
Mozambique
Sources: Mozambique National Statistics Institute Database, 2003. South African Budget Review, 2003/04 and Estimates of National Expenditure, 2003. Kenyan Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, 2003.
HIV/AIDS allocations as Share of HIV/AIDS allocations as Share of Total Health ExpenditureTotal Health Expenditure
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
16.00%
18.00%
2000/1 2001/2 2002/3 2003/4 2004/5 2005/6
Kenya
SA
Moz
Sources: Mozambique National Statistics Institute Database, 2003. South African Budget Review, 2003/04 and Estimates of National Expenditure, 2003. Kenyan Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, 2003.
Teresa Guthrie ~ AIDS Budget Unit
HIV/AIDS annual allocations per capitaHIV/AIDS annual allocations per capita in South Africa and Kenya (US$)in South Africa and Kenya (US$)
Sources: South African Budget Review, 2003/04 and Estimates of National Expenditure, 2003. Kenyan Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, 2003. Dorrington, 2002.
0
0.5
1
1.5
2
2.5
3
3.5
4
2000/01 2001/02 2002/03 2003/04 2004/05 2005/06
USD
$
South Africa
Kenya
Teresa Guthrie ~ AIDS Budget Unit
Composition of Kenyan HIV/AIDS Composition of Kenyan HIV/AIDS by Activity Typeby Activity Type
0
2000
4000
6000
8000
10000
12000
14000
16000
2000/01 2001/02 2002/03 2003/04 2004/05
Kshs
mill
ions
Policy development &management
Research and M&E
Mitigation of socio-economic impact (incl.IGA)Treatment/ care affected& infected
Prevention of Mother toChild Transmission(PMTC)STI treatment
Blood safety
Behaviour change
Kenyan National Aids Resource Envelope, 2003.
Teresa Guthrie ~ AIDS Budget Unit
ARV treatment consumes increasing ARV treatment consumes increasing share of HIV/AIDS budget share of HIV/AIDS budget inin SA. SA.
Sources: South Africa 2003/04 Estimates of National Expenditure. 2003 MTBPS. Idasa Calculations.
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
2000/2001 2001/2002 2002/2003 2003/2004 2004/2005 2005/2006
ZAR
'000
Research
Management
Treatment
Care & Support
Prevention
NGO Transfers
Teresa Guthrie ~ AIDS Budget Unit
What SA spends per population What SA spends per population group on HIV/AIDS group on HIV/AIDS
(ZAR real terms) (2000/01-2005/06)(ZAR real terms) (2000/01-2005/06)
Sources: South African 2003 IGFR. 2003 Estimates of National Expenditure.2003 Budget Review. 2003 Provincial Budget Statements. Dorringtotn et al (2002). Idasa calculations.
0
200
400
600
800
1000
1200
1400
1600
2000/01 2001/02 2002/03 2003/04 2004/05 2005/06
Ran
d For Public Pop.For HIV+ Pop.For AIDS sick Pop.
South Africa: Actual expenditure of South Africa: Actual expenditure of HIV/AIDS transfers by sectorHIV/AIDS transfers by sector
(includes funds rolled over from previous year)
Source: 2001 SA Intergovernmental Fiscal Review. 2001 Budget Review. Statement of the National and Provincial Governments' Revenue and Expenditure and National Borrowing (March02&03). Intervs.
0
50
100
150
200
250
300
350
400
450
Education Health SocialDevelopment
TOTAL
R m
illio
n
R 18 m
2000/1
R 109 m
2001/2
R 385 m
2002/3
37%
75%
85%
Teresa Guthrie ~ AIDS Budget Unit
Budget-related recommendationsBudget-related recommendations Increase political will ito action and allocations.Increase political will ito action and allocations. Increase state health allocations to meet Abuja Increase state health allocations to meet Abuja
Target & strengthen system.Target & strengthen system. Increase multisectoral budgets for HIV/AIDS.Increase multisectoral budgets for HIV/AIDS. Funded National Strategic HIV/AIDS plans Funded National Strategic HIV/AIDS plans
(NSPs)(NSPs) Funded National AIDS coordinating bodies.Funded National AIDS coordinating bodies. Allocation based on need and equity.Allocation based on need and equity. Mix of funding channels.Mix of funding channels. Mix of funding sources.Mix of funding sources. Increase provincial and local skills.Increase provincial and local skills. Improve budgetary information.Improve budgetary information. Build capacity of local civil society and Build capacity of local civil society and
Parliamentarians to regularly monitor Parliamentarians to regularly monitor government expenditure.government expenditure.
Teresa Guthrie ~ AIDS Budget Unit
Way ForwardWay Forward Increase capacity in-country - both within Increase capacity in-country - both within
govt and civil society - to undertake resource govt and civil society - to undertake resource tracking as sustained activity.tracking as sustained activity.
Improve state tracking and management of Improve state tracking and management of donor funds.donor funds.
Harmonise the definitions and type of data Harmonise the definitions and type of data collected to allow cross-comparison and tri-collected to allow cross-comparison and tri-angulation. angulation.
Deepen analysis – actual expenditure, output Deepen analysis – actual expenditure, output assessment using programme indicators, assessment using programme indicators, efficiency and equity analysis based on efficiency and equity analysis based on costed need requirements.costed need requirements.
Develop/ support networks of organisations Develop/ support networks of organisations involved in HIV/AIDS resource tracking.involved in HIV/AIDS resource tracking.
Teresa Guthrie ~ AIDS Budget Unit
Critical Recommendations for Critical Recommendations for establishing regional networks establishing regional networks
~enabling civil society’s participation~enabling civil society’s participation Civil society organisations must be empowered Civil society organisations must be empowered
to undertake HIV/AIDS budget monitoring, and to undertake HIV/AIDS budget monitoring, and participate in networks for resource tracking.participate in networks for resource tracking.
Capacity-building should occur through the Capacity-building should occur through the process of budget analysis, undertaken by the process of budget analysis, undertaken by the CSOs.CSOs.
On-going technical support and harmonisation of On-going technical support and harmonisation of methods necessary. methods necessary.
Sharing of experiences and skills essential ~ Sharing of experiences and skills essential ~ electronically, study visits, peer-review and electronically, study visits, peer-review and collaborative meetings.collaborative meetings.
External review processes & reference teams External review processes & reference teams input to verify data and ensure appropriateness.input to verify data and ensure appropriateness.
Thank you!Thank you!
Teresa GuthrieAIDS Budget Unit ~ IdasaCape Town, South [email protected]
Teresa Guthrie ~ AIDS Budget Unit
AIDS Budget UnitAIDS Budget Unitprovides research and analysis, and conducts training on the public finance issues related to government’s response to HIV/AIDS.
1. Analyse government budget from an HIV/AIDS 1. Analyse government budget from an HIV/AIDS perspectiveperspective2. Produce recommendations for policy-2. Produce recommendations for policy-makers on allocations and effective funding makers on allocations and effective funding mechanisms for transferring money for mechanisms for transferring money for HIV/AIDS interventionsHIV/AIDS interventions3. Build capacity in Parliament and civil 3. Build capacity in Parliament and civil society to participate in the budget process society to participate in the budget process on HIV/AIDS issueson HIV/AIDS issues