1. Washington D.C., USA, 22-27 July 2012www.aids2012.org Mapping HIV Spending in Central America And the need of renewing the policy agenda Ricardo Valladares–Cardona Regional M&E Systems Advisor, USAID - PASCA Washington D.C., USA, 22-27 July 2012www.aids2012.org

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org Central America 35 Million Inhabitants 220 thousand squared miles USD 25 billion GDP USD 283 per capita Health Expenditure USD 5.05 per capita HIV AIDS Expenditure CountryHDI Rank Out of 169 countries Life Expectancy at birth Years of schooling adults GNI per capita Panama5876.19.46,970 Costa Rica6979.38.36,810 Belize9376.18.0NA El Salvador10572.27.53,380 Honduras12173.16.51,870 Nicaragua12974.05.81,110 Guatemala13171.24.12,740

3. Washington D.C., USA, 22-27 July 2012www.aids2012.org Central America Poverty, hunger, migration Youth population Effective health coverage: low in most countries Sex tourism, human traffic, child exploitation PWA, SW and MSM face stigma, discrimination, violence and prosecution Adult HIV Prevalence (UNAIDS Estimates, 2009)

4. Washington D.C., USA, 22-27 July 2012www.aids2012.org USAID PASCA Mapping HIV Spending in Central America Expected Result Strategy Elements Sub-Intermediate Result Improved policies implemented. Lower Level Result C “Surveillance Systems Developed and Used for Strategic Planning, Resource Allocation and Program Evaluation” National AIDS Spending Assessments for Central America 2010 comparable and policy relevant. Key research questions Common reporting tools Support on data collection Database audits Results validation Use for high level policy dialogue Harmonized resource tracking baseline for 2010 at regional level

5. Washington D.C., USA, 22-27 July 2012www.aids2012.org Funding Gap Key Findings Are we spending too much or too little on the national response to HIV AIDS? USD 214.6

6. Washington D.C., USA, 22-27 July 2012www.aids2012.org Funding Gap Key Findings Are we spending too much or too little on the national response to HIV AIDS? CENTRAL AMERICA Per capita spending 2010 HIV AIDS = USD 5 Carbonated Beverages USD 114 Alcoholic Beverages USD 447 USD 214.6

7. Washington D.C., USA, 22-27 July 2012www.aids2012.org Vulnerability Key Findings At regional level, the weight of external funding is 27%. Some countries urgently need to find ways of reducing dependency in the short term. How catastrophic would be a drastic reduction in external funding for HIV AIDS?

8. Washington D.C., USA, 22-27 July 2012www.aids2012.org Vulnerability Key Findings How catastrophic would be a drastic reduction in external funding for HIV AIDS? Most of the Central American Countries have secured public funds for HIV AIDS Care & Treatment. In Nicaragua, a cut in C&T external funds would be catastrophic.

9. Washington D.C., USA, 22-27 July 2012www.aids2012.org Vulnerability Key Findings How catastrophic would be a drastic reduction in external funding for HIV AIDS? A third of HIV AIDS Prevention resources come from external sources, and more than a half in some countries. Downsizing in prevention would be catastrophic in a funding reduction scenario

10. Washington D.C., USA, 22-27 July 2012www.aids2012.org Vulnerability Key Findings How catastrophic would be a drastic reduction in external funding for HIV AIDS? Policy making, strategic planning, monitoring and evaluation, financial management and investment in HIV AIDS depend on foreign funding in all Central American countries.

11. Washington D.C., USA, 22-27 July 2012www.aids2012.org Efficiency Key Findings Are resources used to obtain the best value for money? - Palmer S and DJ Torgenson BMJ 1999 318(7191): 1136 85% out of Total HIV AIDS Expenditures go to Health Sector Activities. Excluding Program Management, Multi- Sectoral interventions have a 6% share of the HIV AIDS Spending.

12. Washington D.C., USA, 22-27 July 2012www.aids2012.org Efficiency Key Findings Are resources used to obtain the best value for money? - Palmer S and DJ Torgenson BMJ 1999 318(7191): 1136 Some countries allocate more than a half of HIV AIDS resources in Care & Treatment Activities. Program Management takes a large share in countries where Care & Treatment Expenditures represent less than 25%.

13. Washington D.C., USA, 22-27 July 2012www.aids2012.org Targeting Key Findings Does the resource allocation by human groups address key populations, i.e. the most affected, exposed and vulnerable groups facing HIV AIDS? The epidemic is concentrated in all Central American Countries and fueled by unprotected sex among MSM. However, 90% of the resources are directed to general population and PWHA.

14. Washington D.C., USA, 22-27 July 2012www.aids2012.org Targeting Key Findings Does the resource allocation by human groups address key populations, i.e. the most affected, exposed and vulnerable groups facing HIV AIDS? In Central America, MSM have 33 times probability of acquiring HIV than other men from general population. However, countries are more willing to prevent HIV transmission during paid sex.

15. Washington D.C., USA, 22-27 July 2012www.aids2012.org Targeting Key Findings Does the resource allocation by human groups address key populations, i.e. the most affected, exposed and vulnerable groups facing HIV AIDS? Antiretroviral treatment cost per person varies from Belize to Panama. CA is a USD 33 million marketplace of ART. There is room for bloc negotiation and manufacturing. Wherever spending per PWA is lower than ART per capita, it means poor ART coverage.

16. Washington D.C., USA, 22-27 July 2012www.aids2012.org Targeting Key points: Central America NASA 2010: 7 countries baseline Key changes: increased funding, mainly from public sources Domestic spending covers most of prevention and treatment expenditures Multi sectoral components (management, research, enabling environment) depend on external funding. Main challenges : – Reducing vulnerability – Improving allocation (interventions and populations) – Containing cost escalation – Taking stock of regional scale & mechanisms New policy agenda: address equity, transparency and sustainability. Central American Health Ministers Council, examining these results, resolved to commission the Regional Coordinating Mechanism to develop a sustainability strategy, with emphasis on improving spending quality, containing costs and mobilizing resources.

17. Washington D.C., USA, 22-27 July 2012www.aids2012.org Thank you for your attention