1. Tackling the Decline in HIV Resources: Lessons Learned from HIV/AIDS Program Sustainability Analysis Tool (HAPSAT) Itamar Katz 1, Wendy Wong 1, Douglas Glandon 1, Brima Kargbo 2, Regina Ombam 3, Shanti Singh 4, John Osika 1 Abt Associates Inc. In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health 1 Abt Associates, Health Systems 20/20, International Health Division, Bethesda, United States 2 National AIDS Secretariat, Freetown, Sierra Leone 3 National AIDS Control Council, Nairobi, Kenya 4 National AIDS Programme Secretariat, Georgetown, Guyana

2. Background  Heavy dependence on donor funding  Expansion of HIV services beyond the levels that can be sustained 2

3. HAPSAT: HIV/AIDS Program Sustainability Analysis Tool  Sustainability of HIV programs in limited- resource settings:  What should be prioritized?  What efficiency measures should be applied?  How should additional resources be mobilized? 3

4. Objectives of the presentation  In relation to prioritization and resource mobilization:  HAPSAT framework  Interests of policy makers of HIV responses  Examples from Guyana, Kenya, Sierra Leone and South Sudan (conducted in additional 10 countries) 4

5. Prioritization 5  Effectiveness of interventions: mainly for medical interventions  Capacity (versus universal access)  Cost  Contextual issues

6. Prioritization South Sudan: HIV awareness through radio vs. billboards 6 Cost per exposure ContextPriority Radio ads and talkshows US$ 0.003 Major information source for South Sudanese High BillboardsUS$ 0.05 Low literacy levels limits its use, potentially useful in urban areas Low

7. Prioritization among MARPs  South Sudan: Scaling up CSW outreach rather than constructing costly prevention centers  Sierra Leone: Under the program leadership and support from UNAIDS, Global Fund and USAID (the latter through HAPSAT)  Inclusion of MSM in the national strategic plan 7

8. Resource mobilization strategies 8  Increased govt. budgetary allocations to HIV/AIDS interventions  Earmarked taxation for HIV/AIDS  Concessionary loans for HIV/AIDS programs  Debt conversion (known also debt2health)  Risk-pooling schemes (e.g. insurance) and special social assistance programs covering HIV/AIDS services  Fundraising (special/endowment HIV/AIDS funds)

9. 9 Resource mobilization: Financing Kenya’s National HIV Response 2008/09 vs. 2012/13 2008/09 $687 million 2012/13 $1,003 million

10. Lessons learned  Understanding the reality  Need for prioritization  Need for diverse funding sources  Resource mobilization  Need for sustainability plans  Sierra Leone: Govt. pledges to replace Global Fund financing once ends  Guyana: Preparing for PEPFAR gradual pull out 10

11. 11 Email: hapsat@abtassoc.com itamar_katz@abtassoc.com Visit: www.hs2020.org/hapsat: Country reports, the HAPSAT tool and document on target setting For more information… Thank you