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 Africateresa@idasact.org.za

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

2002/03

2003/04

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

US

D $

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

Ksh

s m

illi

on

s

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

ZA

R '0

00

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

illi

on

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 Increase political will ito action and

allocations.allocations. Increase state health allocations to meet Increase state health allocations to meet

Abuja Target & strengthen system.Abuja 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 On-going technical support and harmonisation of methods necessary. of 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 input to verify data and ensure appropriateness.appropriateness.

Thank you!Thank you!

Teresa GuthrieAIDS Budget Unit ~ IdasaCape Town, South Africateresa@idasact.org.za

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 perspectiveperspective

2. 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