evidence-based hiv/aids programming: a couple examples
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Evidence-based HIV/AIDS Programming: A Couple Examples. Ann Lion Health Systems 20/20 (a USAID funded HSS Project). PEPFAR Supported Research in HSS. SWEFs: Ethiopia HSAs: Nigeria, Vietnam, Namibia HRAs*: Kenya, Nigeria, Cote d ’ Ivoire, Egypt, Ethiopia, and Zambia - PowerPoint PPT PresentationTRANSCRIPT
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