1 Linking Resource Needs and Strategic Planning Dominic S. Haazen Lead Health Policy Specialist The World Bank ASAP – A Service of UNAIDS

2 Why is such a linkage important? To ensure that the interventions included in the strategic plan are realistic and affordable To provide vital information to those managing and monitoring implementation of the strategy Expected vs. actual program coverage Physical resources needed vs. obtained Monetary resources needed vs. available

3 When are resource needs estimated? Estimating resource needs happens at different points in the process In theory, prioritization should precede the estimation of resource needs and the finalization of the strategy In reality, planning, prioritizing and resource estimation are interrelated and often done as iterative processes (initial estimates may show that too many actions have been prioritized relative to the available funds, that coverage levels are not feasible, or physical resources are no available )

4 Process – resource needs estimation

Approach 1: National Strategic Plan Activity-based costing Small team External consultants Standardised costs Accounting exercise Approach 2: Annual Action Plan Participatory Large team Wide stakeholder involvement Costs estimated by implementers Reviewing two approaches to estimating resource needs in Swaziland

6 Approach 1: Activity-Based Costing Approach based on: The Second National Multisectoral HIV and AIDS Strategic Plan 2006 – 2008 National Program of Action Urgent and Priority Agenda Dimensions: 4 components 104 sub-thematic areas 910 individual “actions” 215 actions in urgent and priority agenda document

7 This Approach Included: Priority setting exercise To reduce number of items to be costed Based on “gut feel” that entire plan was not affordable/feasible Identification and quantification of the target groups Detailed costing activity beginning with the highest priority activities (per ratings) also included Urgent and Priority Agenda activities

8 Priority Setting – Methodology 3 factors (applied at sub-thematic level) : Available Capacity for carrying out specific action (weight = 3) Immediate Benefit to those at risk, OVC, PLWHA, others; (weight = 2) Potential for Long-term Improvement in quality of life of PLWHA or their families, or reduction in infection rates (weight = 1)

9 Dimensioning Process Similar for all resource needs estimations: 1.Identify target populations 2.Determine number of beneficiaries by year for each action area and target population 3.Determine timing of any capital requirements and number of sites

10 Resource estimation process used 1.Develop a chart of accounts 2.Establish standard costs by account category 3.Develop the number of units per recipient/site 4.While costing individual action items, allow alternative standard costs, where appropriate; 5.Complete detailed description of activities/ assumptions to document process

11 Initial Results: All priority items: including scaling up in ARV therapy, PMTCT, nutritional support, education, micro-credit, housing and water

12 Swaziland Results – FTEs:

Approach 2: Participatory 3-month process to develop Annual Action Plan Consultant team facilitated planning and costing meetings with stakeholders 14 different implementing agents (e.g., PLWHA network, NGO network, business coalition, gov ’ t) Planning and budgeting workshops 1-2 days each, depending on capacity of each implementing partner and scale of its operations Individual plans then collated into 4 sector plans: Public, Private, Civil Society, Traditional Scrutiny, modifications and approval by national AIDS co-ordinating body (NERCHA)

Prioritisation Conducted by national AIDS coordinating body (NERCHA) Analyzed the main ‘ drivers ’ of the epidemic (i.e. the main factors influencing the spread or curtailment of the epidemic) Correlated main strategic issues in the National Strategic Plan with these drivers Identified series of primary goals and objectives that address the key drivers Result was list of 24 priority objectives to be tackled via 35 priority strategies

Resource needs estimation Some costs standardized, but most estimates took the form of trend planning based on knowledge of costs of similar previous activities Facilitators assisted participants to generate simple formulae Total Workshop Costs = [# of participants/facilitators x number of workshop days X workshop venue costs per person] + [number of participants x average transport cost] + [number of facilitators X number of preparation and workshop days X facilitation fee] + [budget for stationery and materials]

Experiences & Lessons Learned Unwise to ask people to cost activities when they do not have capacity/relevant experience Capacity building needs must be addressed Participatory approach takes longer but may be better at building capacity of broader audience Activity-based approach has greater potential to pass on high-level skills Both approaches require staff and consultants with strong capacity

Improved tools needed to support Activity- based approach Standardized costs speed up and simplify budgeting and can promote consistency; but some variations are essential Effective prioritization and optimal planning require targets/constraints without budget or other resource limits, planning and resource estimation easily becomes ‘wish-listing’ Resource tracking is an integral part of the planning, prioritization and costing process Experiences & Lessons Learned (2)

18 Overview of New Costing Model Need highlighted by Swaziland (& Guyana) experience Designed specifically to support the ABC approach Designed to complement to existing costing tools Incorporates key elements of existing models concept of target groups/coverage levels - RNM functional classification from NASA Logical menu-driven sequence of steps Level of detail up to the user: e.g., major drugs, laboratory supplies, other key cost items selected activities or comprehensive; all costs/activities

19 Overview of the Model (2) User can do variance simulations to live within resource constraints different coverage levels, unit cost reductions financial and HR implications of task shifting various combinations of activities Allows expenditure mapping to government accounting framework Facilitates use as a budgeting and financial monitoring tool – e.g., variance analysis Supports complete cycle of planning, budgeting, operations and evaluation

20 Model supports all parts of cycle

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22 Who Should be Involved? StepType of Staff Entering Basic DataM&E, Program Targets and Coverage Levels M&E, Program, Management ** Chart of Accounts/MappingFinancial Map Strategic Plan to FunctionsProgram Costing Standard Interventions Financial, Program, Management ** Costing Special Interventions Review Total CostsManagement ** ReportingFinancial, Program ** Management involvement critical to ensure realism

23 Thank you