National AI DS Spending Assessment Conceptual Framework Overview Glion November 26 th , 2007 Carlos Avila Resource Tracking and Projections Unit UNAI DS EXO/ EVA 1
Acronyms: English: National AIDS spending Assessment (NASA) Spanish: Medición de Gasto en SIDA (MEGAS) French: Évaluation des Flux de Ressources et des Dépenses nationales contre le Sida (EF-REDES) Portuguese: Medição do Gasto em Aids (MEGAA) 2
National Aids Spending Assessment NASA is not: � A Software. � Resource Needs. � Economic impact. 3
NASA: Com ponents T o de sc ribe the fina nc ia l flows for HIV a nd AIDS - who pa ys (so urc e s)? - who ma na g e s the funds (fina nc ing a g e nts) - who pro vide s the se rvic e s (pro vide rs)? - wha t wa s pro vide d (func tio ns: pre ve ntio n, c a re , T x, so c ia l mitig a tio n, o the r se c to r a c tivitie s)? - whic h a re the c o mpo ne nts (Ob je c ts o f e xpe nditure )? - who b e ne fits (b e ne fic ia rie s)? 4
National AI DS Spending Assessm ents • Ba se d o n the Na tio na l He a lth Ac c o unts fra me wo rk – Co nsiste nc y a c ro ss se ve ra l va ria b le s; NHA-HI V/ AI DS sub a c c o unts – Use o f fina nc ia l tra c king , a c c o unting a nd c o sting princ iple s – Bo unda rie s a nd func tio ns (he a lth/ no n- he a lth) 5
NASA Boundaries HIV Social Health Education “The functions are no longer limited to health expenditures, following the framework of the NHA, but emphasize the tracking of social mitigation, education, labour, justice and other sectors for an expanded response to HIV/AIDS” 6
T account Revenues Expenditures All the re ve nue s in o ne side a nd a ll the e xpe nditure s o n the o the r side , pro duc e a b a la nc e a nd re duc e e rro r I nfo rma tio n syste ms a nd b o o k ke e ping o n e xpe nditure s Pro o f o f purc ha se , b ills, c ha rg e s, de b its, invo ic e s, sta te me nts 7
8 Gathering, compiling and cross checking information from three sources Provider Financing Triangulation Provision Purchaser Pooling Consumption Three party transactions Citizen
The agents’ triangulation Financing Sources Financing Sources & Financing Agents & Financing Agents Purchasers Providers = = Production Factors Production Factors Providers & Providers & Financing Financing Provision Provision Factors of Sources = production = = = Consumption Consumption Commodities Beneficiaries Aids Spending Categories & Beneficiary Populations Aids Spending Categories & Beneficiary Populations 9
NASA: � One of the most important characteristics of a classification scheme is assuring that the categories are mutually exclusive and exhaustive . � Using standardized classifications for Resource Tracking allows both international comparisons and comparisons at country level in time trends . � The classifications scheme must answer to politically relevant questions in order to help monitoring the national strategic action plans . 10
NASA: � Comprehensive : An inventory of all resources addressed to HIV/AIDS � I nternally consistent : Totals must add-up and be congruent across different variable dimensions and tables. 11
NASA Dim ensions and vectors T o de sc rib e the AI DS he a lth a nd no n-he a lth fina nc ia l flo ws a nd e xpe nditure s a c c o rding to T HRE E Dime nsio ns a nd six ve c to rs: INANCING : F 1) So urc e s; 2) Ag e nts PROVISION : 3) Pro vide rs; 4) Pro duc tio n F a c to rs USE : 5) F unc tio ns; 6) Be ne fic ia rie s 12
Flux de financement SOURCES Agents Financiers Prestataires Public Ministere de la Sante Hôpitaux Autres ministères CTA CNLS Des autres ministères ONG Internation ANCS Bilatéral ONG Internationales ONG/OCB Coopération bilatérale Multilatéral Système des Nations Unit et autres multilatéraux Cabinets médicaux Hôpitaux privés Laboratoire privée Privée Ménages Pharmacies Medicine Traditionnelle 13
Transactions • Sources (Public, Private, International) – Financing Agents (to decide the use of the funds) • Providers of services and goods – (e.g. hospitals, ambulatory services, pharmacies, NAP, MoH, other Ministries, etc.) • Functions: (Health, Health Related, Non-health) • Target Groups (or beneficiaries; vulnerable and at-risk epidemiologically defined populations): MSM, CSW, IDU; Accessible groups: military, school children; Recipients of treatment: PLWH, PLWA • Object of Expenditure (budgetary items): salary of health personnel, non-health personnel, material and equipment, administration, etc.) 14
Tracking the Transaction Tracking the Transaction Transaction: the basic unit of the financial flow, that describes the transit of resources from a source to an agent, who purchases from a provider one or more ASC benefiting beneficiary populations, specified or not, and produced consuming production factor. 15
16 “Top down” & “Bottom up” Resource Tracking Transactions
Flow of resources from origin to users: reconstruction of transactions (“Top Down”) Functions Financing Sources (Health or non-Health) Agents Financing Use Beneficiaries Providers of - Specific Target services Groups Provision - Or unspecified Production Factors 17
Categories of Spending 1. Pre ve ntio n 2. T re a tme nt a nd c a re 3. Orpha n a nd vulne ra b le c hildre n 4. Pro g ra mme ma na g e me nt 5. Huma n re so urc e s fo r AI DS 6. So c ia l pro te c tio n 7. E na b ling e nviro nme nt & c o mmunity de ve lo pme nt 8. Re se a rc h: AI DS re la te d 18
Reconstruction of transactions (“Bottom Up”) to reconcile with flows from sources (ceiling) Financial Financing Sources Financing Agents Functions (Health or non-Health) Providers of services Use Use Beneficiaries Provision Production Factors 19
Results and cross-tabulation system • This methodology is based on double entry tables –matrices- – Represent the origin and the destination of resources – Help to avoid doubling counting of expenditures. • A NASA report typically includes matrices, summary tables, auxiliary tables and synthetic indicators to facilitate the situation analysis and exposition to selected audiences. 20
NASA – Sta nda rdiza tion of c onc e pts • Ro b ust inte r-te mpo ra l c o mpa riso ns to tra c k re so urc e a va ila b ility • E nsure va lid c o mpa riso ns a c ro ss c o untrie s • Sta nda rd de finitio ns, b o unda rie s a nd c la ssific a tio ns – Sta nda rdiza tion on e stima tion me thods • Co mpa ra b le me tho ds in e stima ting spe c ific ite ms o f e xpe nditure • Ho spita l tre a tme nt a nd ho use ho ld OOPS re q uire so me a mo unt o f e stima tio n a nd imputa tio n in mo st c o nte xts 21
Use of NASA results • 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 • Utiliza tio n o f da ta fo r c o untry de fine d purpo se s b y AI DS pro g ra m ma na g e rs/ po lic y a nd de c isio n ma ke rs 22
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