National HIV Investment Plan (NHIP) – a new wine in old bottle: a case from Nepal This study aims to examine the value addition, if any, in using New Investment Framework as a tool to develop costed action or investment plan at the country level.
Introduction and background Search for an ideal method, tool or a model for resource allocation and projection – an on going process Simple costing tools to more elaborated models are available Various tools, models are being used depending on country context and capacity
Introduction and background This study is based on three premises 1.New Investment Framework, (Schwartländer, et al), June 11, 2011) 2.Redefining AIDS in Asia - Commission Report National AIDS Spending Assessment (NASA) and other AIDS spending assessments
The New Investment Framework Introduced during the resource crunch period Contributed in regaining global resource confidence Intervention, allocation Investment The term investment got into Global Fund dictionary more firmly GF require NFM concept note based on investment case/plan
(..contd): The New Investment Framework (4 pillars) 1. Basic Programme activities Critical enablers 2. social enablers 3. Programme enablers 4. Synergy with development sectors Global resource need and return on investment for 139 LIC and MIC countries Country specific use of model
2. AIDS Commission Report (2008) An independent body created by UN Secretary General -Reviewed Asian epidemic -Analysed course and impact of epidemic -provided region specific recommendation -Estimated resources to content the epidemic
Investing in high impact areas
NASA Monitor the resource mobilisation and utilisation Support in-country policy and decision making process, Promote accountability and transparency
…..Introduction and background Nepal HIV Investment Plan –NHIP ( ) prepared in line with New Investment Framework-NIF (S. et.al, 2011) In the past, country had prepared several costed strategies and national action plans (NAP) Country had also conducted AIDS spending assessments in the past
Country context
Country context Treatment cascade
Methods retrospective analysis of o AIDS spending reports (NASA 2007 and RTS 2010) and o National Action Plan - NAP ( ) allocations recalculated and regrouped the spending and budgets according to four NIF pillars compared the results with NHIP ( ) allocations also reviewed the process followed during the preparation of NAP and NHIP to examine if any significant departure existed in the process
Methods
Results Process followed for preparing NAP ( ) and NHIP ( ) was similar o Consultations with KAP and key stakeholders o Epidemiological data review o Unit cost analysis o Active CCM engagement (New) Two AIDS spending assessments – similar pattern in spending
Key feature in NHIP ( ) KAP focused, disaggregation of MSM/TG for better targeting Female sex workers who inject drug Rapid scale of HIV testing and treatment A robust eVT programme Community Test and Treat Competence (CTTC) Hepatitis C/HIV co-infection Acceptance of NHIP – up to higher level
….Result:
Similar pattern is seen in actual spending, NAP and NHIP High spending and high allocation in Basic Programme Similar pattern in programme Enablers Social Enablers and Synergy with Dev Sectors received less allocation than spending trend
Conclusion
Conclusions Compared to spending data, a significantly higher budget estimate/investment in NAP and NHIP is noted despite different methods, different point of time, similar patterns of spending and resource allocation observed with Basic Programme as a priority followed by Programme Enabler. Neither any significant departure is noticed in the process nor any major shift in allocation priorities in NHIP
……Conclusion increase in volume of investment can be attributed to one or more factors o programme expansion, o Unfolding realities, lessons from past o introduction of new approaches, new technology o increase in international financing Limited value addition is observed in using NIF as a tool for budget plan at the country level