The Polity Utility of Tracking State HIV/AIDS Allocations UNAIDS Satellite Meeting: “National AIDS Accounts” XV International AIDS Conference Bangkok, July 2004 Teresa Guthrie AIDS Budget Unit ~ Idasa Cape Town, South Africa

Teresa Guthrie ~ AIDS Budget Unit Policy Utility of Budget Analysis Budget allocations give an indication of the level of States’ commitment to health and HIV/AIDS. Budget allocations give an indication of the level of States’ commitment to health and HIV/AIDS. Allocations are indicators which can measure the attainment of global commitments: Allocations are indicators which can measure the attainment of global commitments: Abuja Commitments – 15% of total annual budget to health. Abuja Commitments – 15% of total annual budget to health. “We also pledge to make available the necessary resources for the improvement of the comprehensive multi-sectoral response, and that an appropriate and adequate portion of this amount is put at the disposal of the National Commissions/Councils for the fight against HIV/AIDS, Tuberculosis and Other Related Infectious Diseases.” “We also pledge to make available the necessary resources for the improvement of the comprehensive multi-sectoral response, and that an appropriate and adequate portion of this amount is put at the disposal of the National Commissions/Councils for the fight against HIV/AIDS, Tuberculosis and Other Related Infectious Diseases.” UNGASS Commitments UNGASS Commitments MDGs MDGs

Teresa Guthrie ~ AIDS Budget Unit Utility of Budget Analysis cont. Budget allocations give an indication of the attainment of human rights – issues of equity and efficiency in resource allocation, if based on need. Budget allocations give an indication of the attainment of human rights – issues of equity and efficiency in resource 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 spending on each of their citizens ~ per capita. Indicates what governments are spending on each of their citizens ~ per capita.

Teresa Guthrie ~ AIDS Budget Unit Importantly…. Resource tracking data is used by government officials, donors, and particularly civil society as an advocacy tool, to inform and influence policies and prioritisation of response, in terms of resource allocations. Resource tracking data is used by government officials, donors, and particularly civil society as an advocacy tool, to inform and influence policies and prioritisation of response, in terms of resource allocations.

Teresa Guthrie ~ AIDS Budget Unit Some key examples of the findings: Public Health Allocations in 4 African Countries

Are African States meeting the Abuja Target in their Public Health Allocations? Health 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% 2000/12001/22002/32003/42004/52005/6 Moz SA Ken Abuja Nam - health specific Nam - tot MoHSS Sources: Mozambique National Statistics Institute Database, South African Budget Review, 2003/04 and Estimates of National Expenditure, Kenyan Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, 2003.

Teresa Guthrie ~ AIDS Budget Unit How much are states committed… or dependent? Mozambique: Total Health Budget Sources (USD) Source: MISAU -DPC ,000,000 40,000,000 60,000,000 80,000, ,000, ,000, ,000, ,000, ,000, StateExternal 98,227, ,621,762 98,127, ,106,635 Source: Mozambique INE, 2003.

State annual health spending per capita Sources: Mozambique National Statistics Institute Database, South African Budget Review, 2003/04 and Estimates of National Expenditure, Kenyan Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, Dorrington, Kenya South Africa US$ 2000/ / / / / /06 Mozambique n/a

Teresa Guthrie ~ AIDS Budget Unit HIV/AIDS Allocations

Kenyan HIV/AIDS allocations (Kshs millions) 2000/ /06 Source: Kenyan National AIDS Resource Envelope, February ,000 4,000 6,000 8,000 10,000 12, /012001/022002/032003/042004/052005/06 Kshs millions Donor and NGO HIV allocations (Real)State HIV allocations (Real)

Are State’s prioritising HIV/AIDS Spending? Share of total expenditure 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 3.5% 4.0% 2000/012001/022002/032003/042004/052005/06 South Africa Kenya Mozambique Sources: Mozambique National Statistics Institute Database, South African Budget Review, 2003/04 and Estimates of National Expenditure, Kenyan Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, 2003.

HIV/AIDS allocations as Share of Total Health Expenditure 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 18.00% 2000/12001/22002/32003/42004/52005/6 Kenya SA Moz Sources: Mozambique National Statistics Institute Database, South African Budget Review, 2003/04 and Estimates of National Expenditure, Kenyan Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, 2003.

Teresa Guthrie ~ AIDS Budget Unit HIV/AIDS annual allocations per capita in South Africa and Kenya (US$) Sources: South African Budget Review, 2003/04 and Estimates of National Expenditure, Kenyan Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, Dorrington, /012001/022002/032003/042004/052005/06 USD $ South Africa Kenya

Teresa Guthrie ~ AIDS Budget Unit Composition of Kenyan HIV/AIDS by Activity Type Kenyan National Aids Resource Envelope, 2003.

Teresa Guthrie ~ AIDS Budget Unit ARV treatment consumes increasing share of HIV/AIDS budget in SA. Sources: South Africa 2003/04 Estimates of National Expenditure MTBPS. Idasa Calculations , , , ,000 1,000,000 1,200,000 1,400,000 1,600, / / / / / /2006 ZAR '000 Research Management Treatment Care & Support Prevention NGO Transfers

Teresa Guthrie ~ AIDS Budget Unit What SA spends per population group on HIV/AIDS (ZAR real terms) (2000/ /06) Sources: South African 2003 IGFR Estimates of National Expenditure Budget Review Provincial Budget Statements. Dorringtotn et al (2002). Idasa calculations /012001/022002/032003/042004/052005/06 Rand For Public Pop. For HIV+ Pop. For AIDS sick Pop.

South Africa: Actual expenditure of HIV/AIDS transfers by sector (includes funds rolled over from previous year) Source: 2001 SA Intergovernmental Fiscal Review Budget Review. Statement of the National and Provincial Governments' Revenue and Expenditure and National Borrowing (March02&03). Intervs EducationHealthSocial Development TOTAL R million 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 recommendations Increase political will ito action and allocations. Increase political will ito action and allocations. Increase state health allocations to meet Abuja Target & strengthen system. Increase state health allocations to meet Abuja Target & strengthen system. Increase multisectoral budgets for HIV/AIDS. Increase multisectoral budgets for HIV/AIDS. Funded National Strategic HIV/AIDS plans (NSPs) Funded National Strategic HIV/AIDS plans (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 Parliamentarians to regularly monitor government expenditure. Build capacity of local civil society and Parliamentarians to regularly monitor government expenditure.

Teresa Guthrie ~ AIDS Budget Unit Way Forward Increase capacity in-country - both within govt and civil society - to undertake resource tracking as sustained activity. Increase capacity in-country - both within govt and civil society - to undertake resource tracking as sustained activity. Improve state tracking and management of donor funds. Improve state tracking and management of donor funds. Harmonise the definitions and type of data collected to allow cross-comparison and tri- angulation. Harmonise the definitions and type of data collected to allow cross-comparison and tri- angulation. Deepen analysis – actual expenditure, output assessment using programme indicators, efficiency and equity analysis based on costed need requirements. Deepen analysis – actual expenditure, output assessment using programme indicators, efficiency and equity analysis based on costed need requirements. Develop/ support networks of organisations involved in HIV/AIDS resource tracking. Develop/ support networks of organisations involved in HIV/AIDS resource tracking.

Teresa Guthrie ~ AIDS Budget Unit Critical Recommendations for establishing regional networks ~enabling civil society’s participation Civil society organisations must be empowered to undertake HIV/AIDS budget monitoring, and participate in networks for resource tracking. Civil society organisations must be empowered to undertake HIV/AIDS budget monitoring, and participate in networks for resource tracking. Capacity-building should occur through the process of budget analysis, undertaken by the CSOs. Capacity-building should occur through the process of budget analysis, undertaken by the CSOs. On-going technical support and harmonisation of methods necessary. On-going technical support and harmonisation of methods necessary. Sharing of experiences and skills essential ~ electronically, study visits, peer-review and collaborative meetings. Sharing of experiences and skills essential ~ electronically, study visits, peer-review and collaborative meetings. External review processes & reference teams input to verify data and ensure appropriateness. External review processes & reference teams input to verify data and ensure appropriateness.

Thank you! Teresa Guthrie AIDS Budget Unit ~ Idasa Cape Town, South Africa

Teresa Guthrie ~ AIDS Budget Unit AIDS Budget Unit provides 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 perspective 2. Produce recommendations for policy-makers on allocations and effective funding mechanisms for transferring money for HIV/AIDS interventions 3. Build capacity in Parliament and civil society to participate in the budget process on HIV/AIDS issues