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MoscowMoscow,, 5 June 2007 5 June 2007

MDG costing experience from MDG costing experience from Tajikistan & the regionTajikistan & the region

Europe and CIS

Jacek Cukrowski

MDG Advisor, UNDP RBEC

Bratislava Regional Centre

RESPONDING TO HIV/AIDS IN EUROPE AND THE CIS4th RBEC Community of Practice Meeting

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2000 Millennium Summit2000 Millennium Summit

In September 2000 189 In September 2000 189 heads of states adopted the heads of states adopted the Millennium DeclarationMillennium Declaration Human rights, Democracy, Human rights, Democracy,

Good governanceGood governance Peace, Security, Peace, Security, DisarmamentDisarmament Environment protectionEnvironment protection Development and poverty Development and poverty

eradicationeradication

The Millennium Declaration The Millennium Declaration is our key program documentis our key program document Available atAvailable at

www.un.org/millennium/declaration/www.un.org/millennium/declaration/

ares552e.htmares552e.htm

Europe and CIS

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Millennium Development Millennium Development GoalsGoals

MDGs were proposed in MDGs were proposed in the Report of the the Report of the Secretary-General in Secretary-General in September 2001 September 2001 ““Road map towards the Road map towards the

implementation of the implementation of the United Nations Millennium United Nations Millennium Declaration”Declaration”

Available at: Available at: www.un.org/documents/ga/www.un.org/documents/ga/

docs/56/a56326.pdf docs/56/a56326.pdf

Europe and CIS

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Global MDG agendaGlobal MDG agenda

Goal 1Goal 1:: Halving extreme Halving extreme poverty and hungerpoverty and hunger

Goal 2Goal 2:: Achieving universal primary Achieving universal primary educationeducation

Goal 3Goal 3:: Promoting Promoting gendergender equality equality

Goal 4Goal 4:: Reducing Reducing under-five mortalityunder-five mortality

Goal 5Goal 5:: Reducing Reducing maternal mortalitymaternal mortality

Goal 6Goal 6:: Reversing the spread of Reversing the spread of HIV/AIDS, malaria and TBHIV/AIDS, malaria and TB

Goal 7Goal 7:: Ensuring Ensuring environmental sustainabilityenvironmental sustainability

Goal 8Goal 8:: Developing a Developing a global partnershipglobal partnership for development for development

Europe and CIS

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The report of the The report of the Secretary-General has Secretary-General has been approved been approved

all the countries-members of UN are committed to all the countries-members of UN are committed to MDGsMDGs

All CIS/CEE countries adjusted global All CIS/CEE countries adjusted global agenda to national circumstancesagenda to national circumstances

participatory processparticipatory process weak national ownership of national MDGsweak national ownership of national MDGs

national MDG reports developed in most of the national MDG reports developed in most of the countriescountries

unclear reporting requirementsunclear reporting requirements

Europe and CIS

MDGs in Europe and the MDGs in Europe and the CISCIS

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Regional MDG Report for Regional MDG Report for Europe and the CISEurope and the CIS

ContentsContents IntroductionIntroduction The MDGs and development The MDGs and development

trends in CEE and CIStrends in CEE and CIS National MDG agendasNational MDG agendas Priorities, challenges and Priorities, challenges and

opportunitiesopportunities ConclusionsConclusions AnnexAnnex

A global agenda A global agenda Monitoring progress towards nationally Monitoring progress towards nationally

adopted goals adopted goals Assessing progressAssessing progress

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MDG6: Combat HIV/AIDS, MDG6: Combat HIV/AIDS, TB, malaria, other diseasesTB, malaria, other diseases Europe

and CIS

HIV/AIDS relatively low, asymmetric prevalenceHIV/AIDS relatively low, asymmetric prevalence… but… but

High growth (incidence)High growth (incidence) 270,000 new infections in 2006 EECA representing a 270,000 new infections in 2006 EECA representing a

twenty-fold increase in less than a decade !*twenty-fold increase in less than a decade !* bringing total number of people living with HIV to approx. bringing total number of people living with HIV to approx.

1.7 million ( 20% annual growth – outpacing other issues)1.7 million ( 20% annual growth – outpacing other issues) Highly concentrated among youth and vulnerable Highly concentrated among youth and vulnerable

groups, with extreme social exclusiongroups, with extreme social exclusion

* Source: AIDS Epidemic update: December 2006, UNAIDS

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MDG6: Target 1 (HIV/AIDS) MDG6: Target 1 (HIV/AIDS) –national formulations*–national formulations* Europe

and CIS

““Have halted by 2015 and begun to reverse the spread of HIV/AIDS” (global Have halted by 2015 and begun to reverse the spread of HIV/AIDS” (global formulation):formulation): Albania, Bosnia and Herzegovina, Croatia, Macedonia, Montenegro, Turkey, Armenia, Azerbaijan, Georgia, Albania, Bosnia and Herzegovina, Croatia, Macedonia, Montenegro, Turkey, Armenia, Azerbaijan, Georgia, Moldova, Russian Federation, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan, Czech RepublicMoldova, Russian Federation, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan, Czech Republic

““Prevent the epidemic spread of HIV/AIDS”:Prevent the epidemic spread of HIV/AIDS”: Bulgaria, TurkmenistanBulgaria, Turkmenistan

““Maintain, by 2007, the incidence of HIV at the level of 2002”:Maintain, by 2007, the incidence of HIV at the level of 2002”: RomaniaRomania

““Stop the spread of HIV/AIDS including among the most vulnerable Stop the spread of HIV/AIDS including among the most vulnerable groups”:groups”: BelarusBelarus

““Reduce the rate of spread of HIV/AIDS by 13% (in 2015)”:Reduce the rate of spread of HIV/AIDS by 13% (in 2015)”: UkraineUkraine

““Reduce by yearly 10% in the period up to 2015, the number of HIV cases” Reduce by yearly 10% in the period up to 2015, the number of HIV cases” +”Achieve adequate care and treatment for 50% of HIV patients by 2015”:+”Achieve adequate care and treatment for 50% of HIV patients by 2015”: LatviaLatvia

No HIV/AIDS target:No HIV/AIDS target: Hungary, Poland, Slovakia, SloveniaHungary, Poland, Slovakia, Slovenia

* Estonia, Malta and Cyprus did not produce National MDG Reports

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MDG needs assessmentMDG needs assessmentEurope and CIS

An assessment seeks to quantify the resources — An assessment seeks to quantify the resources — when combined with appropriate policies — to meet when combined with appropriate policies — to meet the goals specified in the national MDG agendasthe goals specified in the national MDG agendas

Objective:Objective: Inform the national budget and aid allocations Inform the national budget and aid allocations

Two stepsTwo steps Identifying the policy reforms (key interventions) needed Identifying the policy reforms (key interventions) needed

to achieve national targets/goalsto achieve national targets/goals Calculating the resources required to meet these Calculating the resources required to meet these

targets/goals (MDG costing)targets/goals (MDG costing)

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MDG needs assessment – MDG needs assessment – regional experienceregional experience Europe

and CIS

Tajikistan, Kyrgyzstan and Moldova*Tajikistan, Kyrgyzstan and Moldova* simple methodology proposed in the framework of the simple methodology proposed in the framework of the

Millennium ProjectMillennium Project sectoral approach based on national income accountingsectoral approach based on national income accounting costing under different scenarioscosting under different scenarios unit cost approachunit cost approach

Tajikistan Tajikistan detail but resource and time consuming exercise detail but resource and time consuming exercise financing needs for combating HIV/AIDS estimated based on detail model financing needs for combating HIV/AIDS estimated based on detail model

developed for UNAIDS by Futures Groupdeveloped for UNAIDS by Futures Group

Kyrgyzstan and MoldovaKyrgyzstan and Moldova brief and short analysesbrief and short analyses

* In Uzbekistan MDG needs has been started, and it is going to be based on * In Uzbekistan MDG needs has been started, and it is going to be based on Computable General Computable General EquilibriumEquilibrium (CGE) model (it is to early to discuss the results). (CGE) model (it is to early to discuss the results).

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Key differencesKey differences

Common objective, but significant differences Common objective, but significant differences ProcessesProcesses

government engagement (ownership), resources allocated for government engagement (ownership), resources allocated for MDG needs assessments, time frame, etc.MDG needs assessments, time frame, etc.

ApproachesApproaches development of different policy options and assessment of the development of different policy options and assessment of the

resources neededresources needed assessment of the resources needed for achieving MDGs assessment of the resources needed for achieving MDGs

assuming that existing sectoral strategies will be implementedassuming that existing sectoral strategies will be implemented

Methods Methods simple sectoral models (Tajikistan, Kyrgyzstan, Moldova) simple sectoral models (Tajikistan, Kyrgyzstan, Moldova) complex CGE models (Uzbekistan)complex CGE models (Uzbekistan)

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ExampleExample

MDG6 costing in TajikistanMDG6 costing in Tajikistan AssumptionsAssumptions

Adult prevalence rate Adult prevalence rate rises to 5.4 by 2010 and remains constant thereafterrises to 5.4 by 2010 and remains constant thereafter

Reduction in the cost of palliative therapiesReduction in the cost of palliative therapies 10-per cent annually 10-per cent annually

Peer education Peer education for 20 percent of the labour force each yearfor 20 percent of the labour force each year

Unit costs of interventions Unit costs of interventions based on regional average (in some cases adjusted to based on regional average (in some cases adjusted to

Tajikistan’s specifics)Tajikistan’s specifics)

Cost estimates depend on (assumptions)Cost estimates depend on (assumptions) Pace of epidemic expansionPace of epidemic expansion Price of drug therapiesPrice of drug therapies Range of care and treatment offeredRange of care and treatment offered

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MDG costing – basic results MDG costing – basic results (1)(1) Europe

and CIS

TajikistanTajikistan:: total need until 2015 (food security, total need until 2015 (food security, gender, education, health, water and sanitation, gender, education, health, water and sanitation, and the environment): $13.0 billion*and the environment): $13.0 billion*

$4.7 billion (14% of GDP) needs to be financed by donors$4.7 billion (14% of GDP) needs to be financed by donors $3.6 billion for health$3.6 billion for health financial estimates for combating HIV/AIDS: $0.4 billionfinancial estimates for combating HIV/AIDS: $0.4 billion

break down of financial estimates for combating HIV/AIDSbreak down of financial estimates for combating HIV/AIDS

(million USD)

Source: MDG Needs Assessment, Republican Centre on AIDS Prevention and Control of the MoH, 2005

* About 50% of GDP per annum

Per cent of total

18.8

76.2 5.0

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MDG costing – basic results MDG costing – basic results (2)(2) Europe

and CIS

Kyrgyzstan:Kyrgyzstan: total need until 2015 (poverty reduction, total need until 2015 (poverty reduction, gender, education, health, and environmental gender, education, health, and environmental sustainability): 22% of GDP per annum ($9.0 billion)sustainability): 22% of GDP per annum ($9.0 billion)

$2.4 billion for health (5.9% of GDP)$2.4 billion for health (5.9% of GDP) financial estimates for combating HIV/AIDS: $0.042 billionfinancial estimates for combating HIV/AIDS: $0.042 billion

Prevention: Prevention: 92.0%92.0% Care and treatment: Care and treatment: 3.2%3.2% Policy, administration and research: Policy, administration and research: 4.8%4.8%

Moldova:Moldova: total need until 2015 (poverty reduction, gender, total need until 2015 (poverty reduction, gender, education, health, and environmental sustainability): education, health, and environmental sustainability): 25-27% of GDP per annum25-27% of GDP per annum

for health (MDG4-MDG6): 5.4%-6.5% of GDP annuallyfor health (MDG4-MDG6): 5.4%-6.5% of GDP annually financial estimates for combating HIV/AIDS: 0.1% of GDP annuallyfinancial estimates for combating HIV/AIDS: 0.1% of GDP annually

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MDG costing – problemsMDG costing – problemsEurope and CIS

Deriving credible estimates of the resources required to Deriving credible estimates of the resources required to reach the MDGs is not a simple taskreach the MDGs is not a simple task

numerous risks and uncertaintiesnumerous risks and uncertainties lack of statistical data, international benchmarkslack of statistical data, international benchmarks numerous assumptionsnumerous assumptions imperfect methodologies and modelling tools (sectoral models, imperfect methodologies and modelling tools (sectoral models,

CGE models)CGE models)

Key weaknesses of MDG costing Key weaknesses of MDG costing over simplifications (linear trends, constant marginal costs, etc.)over simplifications (linear trends, constant marginal costs, etc.) difficulties to cover links between interconnected goals and targets difficulties to cover links between interconnected goals and targets different approaches -- no singe methodology can be different approaches -- no singe methodology can be

recommended recommended results highly dependent on assumptions, indicate nothing more results highly dependent on assumptions, indicate nothing more

than an order of magnitudethan an order of magnitude

Ownership of the resultsOwnership of the results

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ConclusionConclusionEurope and CIS

The cost estimates are by far not precise and are subject The cost estimates are by far not precise and are subject to different internal and external risksto different internal and external risks

There is no single methodology to be recommended for There is no single methodology to be recommended for needs assessment in all the countriesneeds assessment in all the countries

approaches depend on the country needs, timeframes, resources, data approaches depend on the country needs, timeframes, resources, data availability, etc.,availability, etc.,

but there are experts in different methodologies that can be employed in other but there are experts in different methodologies that can be employed in other countries, if needed countries, if needed

The results of MDG costing, independently on the The results of MDG costing, independently on the methods used, need to be used with cautionmethods used, need to be used with caution

should not pretend to nothing more than indicating the scale of the resources should not pretend to nothing more than indicating the scale of the resources neededneeded

MDG costing yield results with reasonable degree of MDG costing yield results with reasonable degree of accuracy within 2-3 year time frameaccuracy within 2-3 year time frame

ill advised to make detail estimates over an extended period of timeill advised to make detail estimates over an extended period of time

MDG costing needs to be repeated periodically when new MDG costing needs to be repeated periodically when new data are availabledata are available

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Thank you…Thank you…

United Nations Development Programme,United Nations Development Programme,

Europe and the Commonwealth of Independent States,Europe and the Commonwealth of Independent States,

Bratislava Regional CentreBratislava Regional Centre

http://europeandcis.undp.orghttp://europeandcis.undp.org

Jacek.Cukrowski@undp.orgJacek.Cukrowski@undp.org

Europe and CIS