1. 1 Moscow, 5 June 2007 MDG costing experience from Tajikistan & the region Europe and CIS Jacek Cukrowski MDG Advisor, UNDP RBEC Bratislava Regional Centre RESPONDING TO HIV/AIDS IN EUROPE AND THE CIS 4th RBEC Community of Practice Meeting

2. 2 2000 Millennium Summit  In September 2000 189 heads of states adopted the Millennium Declaration Human rights, Democracy, Good governance Human rights, Democracy, Good governance Peace, Security, Disarmament Peace, Security, Disarmament Environment protection Environment protection Development and poverty eradication Development and poverty eradication  The Millennium Declaration is our key program document Available at www.un.org/millennium/declaration/ Available at www.un.org/millennium/declaration/ www.un.org/millennium/declaration/ ares552e.htm ares552e.htm Europe and CIS

3. 3 Millennium Development Goals  MDGs were proposed in the Report of the Secretary-General in September 2001 “Road map towards the implementation of the United Nations Millennium Declaration” “Road map towards the implementation of the United Nations Millennium Declaration” Available at: www.un.org/documents/ga/ Available at: www.un.org/documents/ga/ www.un.org/documents/ga/ docs/56/a56326.pdf Europe and CIS

4. 4 Global MDG agenda Goal 1: Halving extreme poverty and hunger Goal 2: Achieving universal primary education Goal 3: Promoting gender equality Goal 4: Reducing under-five mortality Goal 5: Reducing maternal mortality Goal 6: Reversing the spread of HIV/AIDS, malaria and TB Goal 7: Ensuring environmental sustainability Goal 8: Developing a global partnership for development Goal 8: Developing a global partnership for development Europe and CIS

5. 5  The report of the Secretary-General has been approved all the countries-members of UN are committed to MDGs all the countries-members of UN are committed to MDGs  All CIS/CEE countries adjusted global agenda to national circumstances participatory process participatory process  weak national ownership of national MDGs national MDG reports developed in most of the countries national MDG reports developed in most of the countries  unclear reporting requirements Europe and CIS MDGs in Europe and the CIS

6. 6 Regional MDG Report for Europe and the CIS Contents Introduction Introduction The MDGs and development trends in CEE and CIS The MDGs and development trends in CEE and CIS National MDG agendas National MDG agendas Priorities, challenges and opportunities Priorities, challenges and opportunities Conclusions Conclusions Annex Annex A global agenda A global agenda Monitoring progress towards nationally adopted goals Monitoring progress towards nationally adopted goals Assessing progress Assessing progress Europe and CIS

7. 7 MDG6: Combat HIV/AIDS, TB, malaria, other diseases Europe and CIS  HIV/AIDS relatively low, asymmetric prevalence … but  High growth (incidence) 270,000 new infections in 2006 EECA representing a twenty-fold increase in less than a decade !* 270,000 new infections in 2006 EECA representing a twenty-fold increase in less than a decade !* bringing total number of people living with HIV to approx. 1.7 million ( 20% annual growth – outpacing other issues) bringing total number of people living with HIV to approx. 1.7 million ( 20% annual growth – outpacing other issues)  Highly concentrated among youth and vulnerable groups, with extreme social exclusion * Source: AIDS Epidemic update: December 2006, UNAIDS

8. 8 MDG6: Target 1 (HIV/AIDS) – national formulations* Europe and CIS  “Have halted by 2015 and begun to reverse the spread of HIV/AIDS” (global formulation): Albania, Bosnia and Herzegovina, Croatia, Macedonia, Montenegro, Turkey, Armenia, Azerbaijan, Georgia, Moldova, Russian Federation, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan, Czech Republic  “Prevent the epidemic spread of HIV/AIDS”: Bulgaria, Turkmenistan  “Maintain, by 2007, the incidence of HIV at the level of 2002”: Romania  “Stop the spread of HIV/AIDS including among the most vulnerable groups”: Belarus  “Reduce the rate of spread of HIV/AIDS by 13% (in 2015)”: Ukraine  “Reduce by yearly 10% in the period up to 2015, the number of HIV cases” +”Achieve adequate care and treatment for 50% of HIV patients by 2015”: Latvia  No HIV/AIDS target: Hungary, Poland, Slovakia, Slovenia * Estonia, Malta and Cyprus did not produce National MDG Reports

9. 9 MDG needs assessment Europe and CIS  An assessment seeks to quantify the resources — when combined with appropriate policies — to meet the goals specified in the national MDG agendas Objective: Inform the national budget and aid allocations Objective: Inform the national budget and aid allocations  Two steps Identifying the policy reforms (key interventions) needed to achieve national targets/goals Identifying the policy reforms (key interventions) needed to achieve national targets/goals Calculating the resources required to meet these targets/goals (MDG costing) Calculating the resources required to meet these targets/goals (MDG costing)

10. 10 MDG needs assessment – regional experience Europe and CIS  Tajikistan, Kyrgyzstan and Moldova* simple methodology proposed in the framework of the Millennium Project simple methodology proposed in the framework of the Millennium Project sectoral approach based on national income accounting sectoral approach based on national income accounting costing under different scenarios costing under different scenarios unit cost approach unit cost approach  Tajikistan detail but resource and time consuming exercise detail but resource and time consuming exercise financing needs for combating HIV/AIDS estimated based on detail model developed for UNAIDS by Futures Group financing needs for combating HIV/AIDS estimated based on detail model developed for UNAIDS by Futures Group  Kyrgyzstan and Moldova brief and short analyses brief and short analyses * In Uzbekistan MDG needs has been started, and it is going to be based on Computable General Equilibrium (CGE) model (it is to early to discuss the results). Equilibrium (CGE) model (it is to early to discuss the results).

11. 11 Key differences Common objective, but significant differences Common objective, but significant differences Processes Processes government engagement (ownership), resources allocated for MDG needs assessments, time frame, etc. government engagement (ownership), resources allocated for MDG needs assessments, time frame, etc. Approaches Approaches development of different policy options and assessment of the resources needed development of different policy options and assessment of the resources needed assessment of the resources needed for achieving MDGs assuming that existing sectoral strategies will be implemented assessment of the resources needed for achieving MDGs assuming that existing sectoral strategies will be implemented Methods Methods simple sectoral models (Tajikistan, Kyrgyzstan, Moldova) simple sectoral models (Tajikistan, Kyrgyzstan, Moldova) complex CGE models (Uzbekistan) complex CGE models (Uzbekistan) Europe and CIS

12. 12 Example MDG6 costing in Tajikistan Assumptions Assumptions Adult prevalence rate Adult prevalence rate rises to 5.4 by 2010 and remains constant thereafter rises to 5.4 by 2010 and remains constant thereafter Reduction in the cost of palliative therapies Reduction in the cost of palliative therapies 10-per cent annually 10-per cent annually Peer education Peer education for 20 percent of the labour force each year for 20 percent of the labour force each year Unit costs of interventions Unit costs of interventions based on regional average (in some cases adjusted to Tajikistan’s specifics) based on regional average (in some cases adjusted to Tajikistan’s specifics) Cost estimates depend on (assumptions) Cost estimates depend on (assumptions) Pace of epidemic expansion Pace of epidemic expansion Price of drug therapies Price of drug therapies Range of care and treatment offered Range of care and treatment offered Europe and CIS

13. 13 MDG costing – basic results (1) Europe and CIS  Tajikistan : total need until 2015 (food security, gender, education, health, water and sanitation, and the environment): $13.0 billion* $4.7 billion (14% of GDP) needs to be financed by donors $4.7 billion (14% of GDP) needs to be financed by donors $3.6 billion for health $3.6 billion for health financial estimates for combating HIV/AIDS: $0.4 billion financial estimates for combating HIV/AIDS: $0.4 billion break down of financial estimates for combating HIV/AIDS break down of financial estimates for combating HIV/AIDS (million USD) Source: MDG Needs Assessment, Republican Centre on AIDS Prevention and Control of the MoH, 2005 * About 50% of GDP per annum Per cent of total 18.8 76.2 5.0

14. 14 MDG costing – basic results (2) Europe and CIS  Kyrgyzstan: total need until 2015 (poverty reduction, gender, education, health, and environmental sustainability): 22% of GDP per annum ($9.0 billion) $2.4 billion for health (5.9% of GDP) $2.4 billion for health (5.9% of GDP) financial estimates for combating HIV/AIDS: $0.042 billion financial estimates for combating HIV/AIDS: $0.042 billion Prevention: 92.0% Prevention: 92.0% Care and treatment: 3.2% Care and treatment: 3.2% Policy, administration and research: 4.8% Policy, administration and research: 4.8%  Moldova: total need until 2015 (poverty reduction, gender, education, health, and environmental sustainability): 25-27% of GDP per annum for health (MDG4-MDG6): 5.4%-6.5% of GDP annually for health (MDG4-MDG6): 5.4%-6.5% of GDP annually financial estimates for combating HIV/AIDS: 0.1% of GDP annually financial estimates for combating HIV/AIDS: 0.1% of GDP annually

15. 15 MDG costing – problems Europe and CIS  Deriving credible estimates of the resources required to reach the MDGs is not a simple task numerous risks and uncertainties numerous risks and uncertainties lack of statistical data, international benchmarks lack of statistical data, international benchmarks numerous assumptions numerous assumptions imperfect methodologies and modelling tools (sectoral models, CGE models) imperfect methodologies and modelling tools (sectoral models, CGE models)  Key weaknesses of MDG costing over simplifications (linear trends, constant marginal costs, etc.) over simplifications (linear trends, constant marginal costs, etc.) difficulties to cover links between interconnected goals and targets difficulties to cover links between interconnected goals and targets different approaches -- no singe methodology can be recommended different approaches -- no singe methodology can be recommended results highly dependent on assumptions, indicate nothing more than an order of magnitude results highly dependent on assumptions, indicate nothing more than an order of magnitude  Ownership of the results

16. 16 Conclusion Europe and CIS  The cost estimates are by far not precise and are subject to different internal and external risks  There is no single methodology to be recommended for needs assessment in all the countries approaches depend on the country needs, timeframes, resources, data availability, etc., approaches depend on the country needs, timeframes, resources, data availability, etc., but there are experts in different methodologies that can be employed in other countries, if needed but there are experts in different methodologies that can be employed in other countries, if needed  The results of MDG costing, independently on the methods used, need to be used with caution should not pretend to nothing more than indicating the scale of the resources needed should not pretend to nothing more than indicating the scale of the resources needed  MDG costing yield results with reasonable degree of accuracy within 2-3 year time frame ill advised to make detail estimates over an extended period of time ill advised to make detail estimates over an extended period of time  MDG costing needs to be repeated periodically when new data are available

17. 17 Thank you… United Nations Development Programme, United Nations Development Programme, Europe and the Commonwealth of Independent States, Europe and the Commonwealth of Independent States, Bratislava Regional Centre http://europeandcis.undp.org http://europeandcis.undp.org Jacek.Cukrowski@undp.org Jacek.Cukrowski@undp.org Europe and CIS