planning for sustainable hiv/aids services using the hapsat elijah sinyinza, md,mph health services...
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Planning for Sustainable HIV/AIDS Services using the HAPSAT
Elijah Sinyinza, MD,MPH
Health Services and Systems Program (HSSP) May 27 2008
The USAID-funded HSSP Project is implemented by a consortium of partners. Abt Associates Inc. as prime contractor, JHPIEGO, ISTI and Save the Children as sub partners
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Outline of Today’s presentation
Policy Context What is sustainability analysis? Rationale for conducting a sustainability analysis Planning tool : HIV/AIDS Program Sustainability
Analysis Tool (HAPSAT)
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Policy Context
Policymakers are interested in the allocation of financial and human resources across public programs
Donors and policymakers interested in understanding the medium- and long-term impact of HIV/AIDS service provision on the health budget and human resources.
Concerns about ‘donor fatigue’ and the volatility of external funding streams.
Desire to find ways to deliver HIV/AIDS services to more of the people who need them.
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Definition of Sustainability analysis
Sustainability refers to ability of the country to provide HIV/AIDS services to those who need them as external resources are reduced.
Sustainability analysis seeks to identify points of vulnerability in a planned HIV/AIDS program
How much does the planned program for delivering HIV/AIDS services cost?
How many human resources will be needed to carry out the planned program?
What type of resource limitations are likely to constrain the scale-up of services?
Is the pipeline of human and financial resources adequate to meet future demand for services?
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Rationale for Conducting a Sustainability Analysis
Sustainability analysis is needed to guide policy decisions regarding resource mobilization
What share of the total cost will the government, donors, and patients contribute?
How many health workers are needed to sustain/scale-up the services?
Can scale-up occur in a sustainable way that ensures services can be maintained at a higher level over time without having perverse effects on the broader health care system?
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HAPSATHIV/AIDS Program Sustainability Analysis Tool
HAPSAT is a Microsoft Excel (version 2003) software tool for rational planning of HIV/AIDS services over a 3-10 year time horizon
To estimate the total cost of, and resources required to sustain/scale up a national HIV/AIDS program
To identify resource shortfalls (bottlenecks) that threaten the achievement of HIV/AIDS program goals
To support policy decisions, program planning, budgeting for HIV/AIDS provision, and resource mobilization
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Scope of HIV/AIDS Program in HAPSAT ModelScope of HIV/AIDS Program in HAPSAT Model
1. Antiretroviral Therapy (ART)
2. Counseling and Testing (CT)
3. Prevention of Mother-to-Child Transmission (PMTCT)
4. Testing & Treatment for Tuberculosis (TB)
5. Prophylaxis and Treatment for other OIs
6. Prevention (ABC, IEC, Condoms, microbicides etc.)
7. Orphans and vulnerable children (OVC)
8. Program administration and management
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Data Inputs for HAPSAT
Demographic, epidemiological, and financial trends
Financing sources for HIV/AIDS program
Current volume of HIV/AIDS services delivered annually
Current stock of health workers by cadre
Clinical protocols (visits, lab tests, drug regimens, etc)
Current costs for labor, drugs, supplies, laboratory tests, equipment, and management
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Outputs from HAPSAT
How much does the current HIV/AIDS Program cost?
What are expected future resource gaps ( in financing, health workers, and physical infrastructure) for maintaining current volume of services?
What are expected resources required ( in financing, health workers, and physical infrastructure) to achieve target levels of services?
What are various options of financial resource mobilization and use (to address the gaps identified)?
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Example Output of HAPSAT(NOTE: not real data)
$ 56.2 $ 51.0$ 45.0
$ 37.0
$ 21.0
$ 58.4$ 31.2$ 16.2
$ 6.4$ 0.0
$ 0.0
$ 10.0
$ 20.0
$ 30.0
$ 40.0
$ 50.0
$ 60.0
$ 70.0
$ 80.0
$ 90.0
2007 2008 2009 2010 2011
Fin
an
cia
l Re
sou
rce
s (U
S$
1M
)
Satisfied GapResource Shortfalls in Red
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Application to date
HAPSAT was applied to assess HIV/AIDS program sustainability in Zambia (MOH, HSSP, HS20/20, UNZA)
Upcoming assessments – Ethiopia, Coted’lvoire and Swaziland
Thank you
Reports related to this presentation are available at www.HS2020.org or email: [email protected]