Costing human rights and gender equality commitments in the context of HIV

UNAIDS Human Rights Costing Tool (HRCT)

Lina Nykänen-RettaroliHuman Rights, Gender and Community Mobilization Adviser UNAIDS Argentina, Chile, Paraguay and Uruguay

Global HIV Commitments

• UN General Assembly Special Session on HIV/AIDS 2001 Declaration of Commitment on HIV/AIDS

• UN High Level Meeting on HIV/AIDS 2006 Political Declaration on HIV/AIDS

• UN High Level Meeting on HIV/AIDS 2011 Political Declaration on HIV/AIDS, Intensifying Our Efforts to Eliminate HIV/AIDS

ALL THESE DECLARATIONS INCLUDE COMMITMENTS ON HUMAN RIGHTS AND GENDER EQUALITY

3

2011 Political Declaration Targets and Elimination Commitments

Sexual transmission

Drug injection

Children Treatment Tuberculosis

Systems integration

Travel restrictions

Stigma, discrimination

Gender inequalities

Resources

In the Political Declaration on HIV/AIDS (2011),Countries committed to:

“…eliminate gender inequalities and gender-based violence, increase the capacity of women and adolescent girls to protect themselves from the risk of HIV infection, …, ensure that women can exercise their right to have control over, and decide freely and responsibly on, matters related to their sexuality, including their sexual and reproductive health, free of coercion, discrimination and violence, in order to increase their ability to protect themselves from HIV infection, and take all necessary measures to create an enabling environment for the empowerment of women and to strengthen their economic independence, and, in this context, reiterate the importance of the role of men and boys in achieving gender equality”.

In the Political Declaration on HIV/AIDS (2011),Countries committed to:“…national HIV and AIDS strategies that promote and protect human rights, including programmes aimed at eliminating stigma and discrimination against people living with and affected by HIV, including their families, including through sensitizing the police and judges, training health-care workers in non-discrimination, confidentiality and informed consent, supporting national human rights learning campaigns, legal literacy and legal services, as well as monitoring the impact of the legal environment on HIV prevention, treatment, care and support”.

Commitment not on human rights outcome only, but also on the process to get there!

VISIONZERO NEW HIV INFECTIONS.

ZERO DISCRIMINATION.

ZERO AIDS-RELATED DEATHS.

UNAIDS Strategic Directions

Treatment, care & support Access to effective treatment

when people need it Strong national & community

systems Access to care, support &

social protection

HIV prevention Political commitment to why

people are getting infected Communities demand

transformative change Resources directed to

hotspots and what works

Advancing human rights & gender equality

Protective social & legal environments enable access

Equitable service provision reaches people most in need

HIV-related needs and rights of women and girls addressed and realised

Investment Approach to HIV

SYNERGIES WITH DEVELOPMENT SECTORSSocial protection; Education; Legal Reform; Gender equality; Poverty reduction; Gender-based violence; Health systems (incl. treatment of STIs, blood safety); Community systems; Employer practices.

CRITICAL ENABLERS

Social enablers

• Political commitment & advocacy

• Laws, policies & practices

• Community mobilization

• Stigma reduction• Mass media• Local responses, to

change risk environment

Programme enablers• Community-centered

design & delivery• Programme

communication• Management & incentives• Production & distribution• Research & innovation

Care & treatment

Male circumcision

Keeping people alive

BASIC PROGRAMME ACTIVITIES

Keypopulations

Children &mothers

Condoms

OBJECTIVES

Stopping new infections

Behaviourchange

0

5

10

15

20

25

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

USD (Billions)

The UNAIDS investment frameworkFocus on what makes a difference

Basic Programme Activities

Critical Enablers

Synergies

Are countries fulfilling their HIV-related human rights and gender commitments?

• Almost all countries report including human rights in their national strategies for HIV (89% in UNGASS 2010)

• However, UNAIDS Assessment (2009) of the level of inclusion of human rights and gender equality activities, indicators and budgets in national strategic plans for HIV and major funding proposals showed that:o Human rights and gender equality mentioned as guiding

principles or cross-cutting strategieso Some concrete activities includedo BUT most drop off in budgets and M&E frameworks

Moving from human rights as guiding principles to concrete action

Seven key programmes to reduce stigma and discrimination and increase access to justice

1. Programmes to reduce stigma and discrimination

2. HIV-related legal services

3. Programmes to reform and monitor laws relating to HIV

4. Legal literacy programmes (“know your rights and laws”)

5. Human rights training for health care workers

6. Training and sensitization of law enforcement agents on HIV and human rights

7. Programmes to promote the rights of women in the context of HIV

Challenges in costing of HIV–related human rights programmes

Lack of clarity on the definition of the human rights and gender programmes

Absence of literature and data on costs of HIV-related HR programmes

Little experience in costing and budgeting human rights - Existing tools do not refer to HR in detail

Cross-cutting vs. stand alone approach to human rights

Differences in knowing your rights affects demand

UNAIDS Human Rights Costing Tool (HRCT)Objectives:•Conduct detailed activity based costing of human rights•Estimate average unit costs•Estimate resources needed to operationalize HR commitments

Steps to frontloading human rights programmes

HRCT

Source: Victor Steenbergen, a guide to Costing Human Rights, 2011

HRCT

Strategic planning, costing landscape and the HRCT

Characteristics of the tool

Excel Based Built over the 7 key programmes recommended

by UNAIDS Flexible and adaptable Designed to be used at the provider level, i.e. at

the facility The tool can be used by programme officers and

financial officers when developing or extending existing human right programmes

Complementary to existing costing tools

The HRCT approach: costing HR programmes in five steps

Step 1: Defining programmes and activities

Step 2: Reporting on outputs (or outcomes) of services achieved or targeted

Step 3: Reporting on the cost of human resources directly associated to the implementation of the programmes

Step 4: Reporting on indirect costs of the organisation (i.e. overheads)

Step 5: Reporting on specific operational costs directly associated to each activity; i.e. inputs directly related to the implementation of an activity

Baskets of services for each of the 7 programmes

HIV-related legal servicesProvision of legal information and referral

Legal advice

Legal representation

Mediation between local service providers, communities, police, etc

Strategic litigation

Alternative forms of dispute resolution (e.g. village courts)

Research and analysis

Programmes to support the rights of women in the context of HIVCommunity mobilization and education

Legal information, advice and representation

Law reform (e.g. property, inheritance, custody, equality within marriage)

Working with traditional leaders to address gender norms

Life-skills at school

Development of tools and guidance

Research and analysis

Uses of the data generated by the HRCT

• To estimate the funds required for operational planning or budget proposals

• To inform development of the national strategic plan for HIV• To support the monitoring of these 7 key programmes • To evaluate past HIV response by using service unit costs as an

input for cost-efficiencies and cost-effectiveness analyses • To provide key inputs for other normative costing tools focusing

on national programmes or strategies • To support advocacy of the key programmes by producing

strategic information on the cost and outcomes of these programmes; and

• To help make decisions in the routine implementation and management of these programmes.

Piloted in 14 countries

HRCT currently being applied in

Jamaica Indonesia Mozambique Argentina

Lessons learnt

• Has helped identify the real costs, including indirect costs

• Process of applying the tool allows broader discussion on what it takes to address human rights in the context of HIV

• Places costing at the centre of defining the content of programmes (not at the end)

• Has strengthened capacity of civil society in strategic planning and resource mobilisation

Challenges

• Difficulty in classifying activities into the 7 key programmes

• Better definition of activities needed • The tool needs to be applied in a large number of

organisations implementing HR activities to be able to generate unit costs for planning at national level

• Difficult to engage partners beyond National AIDS Programme and civil society working on HIV

• Budgeting: whose budget is should be in?