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HIV/AIDSHIV/AIDS AND THE AND THE BUDGET IN NAMIBIABUDGET IN NAMIBIA
Presented by Presented by Hopolang PhororoHopolang Phororo
John AshipalaJohn AshipalaNEPRU NEPRU
Funding the Fight SeminarFunding the Fight SeminarSeptember 20, 2004September 20, 2004Benoni, South AfricaBenoni, South Africa
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22
HIV/AIDS EpidemicHIV/AIDS Epidemic National adult prevalence steadily National adult prevalence steadily
increased – 4.2% (1992) to 23.3% increased – 4.2% (1992) to 23.3% (2002)(2002)
Most critical public health problemMost critical public health problem HIV prevalence among pregnant women HIV prevalence among pregnant women
ranged from 9% to 43% in 2002ranged from 9% to 43% in 2002 Women are worse affected - 56% of all Women are worse affected - 56% of all
reported new HIV infectionsreported new HIV infections Number of orphans rising – 87,587 lost Number of orphans rising – 87,587 lost
one parent and 9,590 lost bothone parent and 9,590 lost both
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33
HIV-related hospital admissions as % HIV-related hospital admissions as % of total admissions quadrupled from of total admissions quadrupled from 1.2% in 1995 to 4.5% in 20001.2% in 1995 to 4.5% in 2000
AIDS-related deaths as a % of total AIDS-related deaths as a % of total deaths more than doubled from 9.8% deaths more than doubled from 9.8% in 1995 to 22.4% in 2001in 1995 to 22.4% in 2001
In some hospitals, 50% of the beds In some hospitals, 50% of the beds occupied by AIDS-related patientsoccupied by AIDS-related patients
Strain is placed on health servicesStrain is placed on health services Burden placed on families and Burden placed on families and
communitiescommunities
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Government responses to Government responses to HIV/AIDSHIV/AIDS
POLICIES AND PLANSPOLICIES AND PLANS Namibian constitutionNamibian constitution Namibian HIV/AIDS Charter of Rights – 2000Namibian HIV/AIDS Charter of Rights – 2000 In NDP2, HIV/AIDS is a separate chapter In NDP2, HIV/AIDS is a separate chapter HIV/AIDS is central to Vision 2030HIV/AIDS is central to Vision 2030 1987 – AIDS Advisory Committee1987 – AIDS Advisory Committee 1990 – National AIDS Coordination 1990 – National AIDS Coordination
Programme launchedProgramme launched
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55
Short-Term Plan developed and Short-Term Plan developed and implemented (1990-1992)implemented (1990-1992)
Medium-Term Plan (MTPI) – 1992-1998Medium-Term Plan (MTPI) – 1992-1998 1996 – External & intersectoral team assess 1996 – External & intersectoral team assess
implementation of MTPIimplementation of MTPI MTPII covering 1999-2004 - 5 broad areas MTPII covering 1999-2004 - 5 broad areas
addressed, role of Ministries and other addressed, role of Ministries and other sectors sectors
National Policy on HIV/AIDS for Education National Policy on HIV/AIDS for Education Sector enactedSector enacted
2003 - External mid-term review of MTPII2003 - External mid-term review of MTPII 2003 – ARV programme launched2003 – ARV programme launched
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NACOP managed by different structures – NACOP managed by different structures – three committees at central levelthree committees at central level
National AIDS Committee (NAC)National AIDS Committee (NAC) National Multisectoral AIDS Coordination National Multisectoral AIDS Coordination
Committee (NAMACOC)Committee (NAMACOC) National AIDS Executive Committee (NAEC)National AIDS Executive Committee (NAEC) Regional AIDS Coordination Committees Regional AIDS Coordination Committees
(RACOCs) – regional level(RACOCs) – regional level Public-private partnerships – NCCI and then Public-private partnerships – NCCI and then
NABCOA launched in 2003, NANASO NABCOA launched in 2003, NANASO umbrella welfare body of HIV/AIDS NGOs, umbrella welfare body of HIV/AIDS NGOs, churches churches
Structures and InstitutionsStructures and Institutions
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Structure and Degree of Structure and Degree of decentralisationdecentralisation
1997, policy of decentralisation slowly being 1997, policy of decentralisation slowly being implemented – public service delivery and implemented – public service delivery and economic developmenteconomic development
MoHSS realigned its organisational structureMoHSS realigned its organisational structure Regional management team manages 13 regionsRegional management team manages 13 regions 34 public health districts providing a package of 34 public health districts providing a package of
essential servicesessential services 3 main providers of health services – the 3 main providers of health services – the
government (88%), church missions (7%), private government (88%), church missions (7%), private sector (5%)sector (5%)
Over 80% of the population live within 10km of the Over 80% of the population live within 10km of the nearest health facilitynearest health facility
Health care is financed by government Health care is financed by government Fees collected from patients go to central Fees collected from patients go to central
governmentgovernment
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The budgetThe budget Budget presented in 2 parts:Budget presented in 2 parts: Recurrent or operational budget Recurrent or operational budget
(Estimates of Revenue and Expenditure) - (Estimates of Revenue and Expenditure) - MoFMoF
Development budget – NPCDevelopment budget – NPC MoF introduced three-year rolling MoF introduced three-year rolling
development budgetdevelopment budget Medium-term expenditure frameworkMedium-term expenditure framework Performance & Effectiveness Management Performance & Effectiveness Management
Programme (PEMP) being implementedProgramme (PEMP) being implemented
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CIRCULARDEVELOPED
PRESENTATIONBY MIN OF FINANCE
BUDGETARYFRAMEWORK
AND MTEF
COMPILEDBUDGETING
ADJUSTMENTS
PRESENTATIONS
CONSULTATIONS
The budget processThe budget process
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1010
Intergovernmental fiscal Intergovernmental fiscal transfers for HIV/AIDStransfers for HIV/AIDS
Funds planned for utilisation under MTPII – Funds planned for utilisation under MTPII – 20% at national level, 20% at regional level, 20% at national level, 20% at regional level, 60% at constituency level60% at constituency level
NACOP receives funding through 2 channels NACOP receives funding through 2 channels – MoHSS (recurrent budget) and receives – MoHSS (recurrent budget) and receives funds from the development budget funds from the development budget (through NPC)(through NPC)
Individual ministries budget for HIV/AIDS Individual ministries budget for HIV/AIDS activities in recurrent budgetsactivities in recurrent budgets
There is monitoring and accountability to There is monitoring and accountability to the NPC of the development budget funds the NPC of the development budget funds onlyonly
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1111
Donor Funds for HIV/AIDSDonor Funds for HIV/AIDS NPC – coordinates donor funding (only NPC – coordinates donor funding (only
through dev budget)through dev budget) Allocations published in the three-year rolling Allocations published in the three-year rolling
Development BudgetDevelopment Budget Information on HIV/AIDS is not always Information on HIV/AIDS is not always
specified by line item for each Ministry - specified by line item for each Ministry - problematicproblematic
Donor community plays a major role in Donor community plays a major role in HIV/AIDS programmesHIV/AIDS programmes
No detailed database available on all donor No detailed database available on all donor funding going to HIV/AIDSfunding going to HIV/AIDS
High reliance upon donor aid for HIV/AIDS High reliance upon donor aid for HIV/AIDS (outside SRF = 80% by 2005/06)(outside SRF = 80% by 2005/06)
GFATM – 27% of requested amount was GFATM – 27% of requested amount was approved – none had been disbursed to date.approved – none had been disbursed to date.
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Health SpendingHealth Spending
MoHSS – pivotal role in HIV/AIDSMoHSS – pivotal role in HIV/AIDS 2001/02 – 2004/05, total expenditure 2001/02 – 2004/05, total expenditure
has annual growth rate of 7.8% has annual growth rate of 7.8% (nominal terms)(nominal terms)
Remains at 13% of total recurrent Remains at 13% of total recurrent budgetbudget
Health- specific expenditure = 9.4% of Health- specific expenditure = 9.4% of the total recurrent budgetthe total recurrent budget
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Health Spending as proportion Health Spending as proportion of total government recurrent of total government recurrent
budgetbudget
0%
2%
4%
6%
8%
10%
12%
14%
16%
2001/02 2002/03 2003/04 2004/05
Sh
are
of
To
tal
SR
F E
xpen
dit
ure
MOHSSbudget asshare of totalexpenditure
Total Health-SpecificExpenditure/TotalExpenditure
Sources: Republic of Namibia, Estimates of Revenue & Expenditure, 2001/02–2003/04.
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Grants and Welfare Grants and Welfare SpendingSpending
MWCW – Social allowances and welfare MWCW – Social allowances and welfare programmes Division caters for grants – 56% programmes Division caters for grants – 56% of the Ministry’s total budgetof the Ministry’s total budget
2000/01 to 2001/02 budget increased by 2000/01 to 2001/02 budget increased by 133.54%, 2001/02 to 2002/03, budget 133.54%, 2001/02 to 2002/03, budget increased by 206.47% - cater for AIDS increased by 206.47% - cater for AIDS orphans and responsibility shifted to the orphans and responsibility shifted to the Ministry from MoHSSMinistry from MoHSS
MWCW accounted for 0.88% of recurrent MWCW accounted for 0.88% of recurrent budgetbudget
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HIV/AIDS allocations under recurrent budget HIV/AIDS allocations under recurrent budget not includednot included
No specific budget line for HIV/AIDS No specific budget line for HIV/AIDS expenditureexpenditure
Such expenditures are lumped together with Such expenditures are lumped together with other costs under Health and Social Services other costs under Health and Social Services budget vote e.g. salaries of NACOP staff, budget vote e.g. salaries of NACOP staff, training and condom suppliestraining and condom supplies
Therefore can only present allocations in the Therefore can only present allocations in the development budget and therefore figures development budget and therefore figures are an underestimation of total HIV/AIDS are an underestimation of total HIV/AIDS spendingspending
HIV/AIDS allocations in the HIV/AIDS allocations in the Namibian BudgetNamibian Budget
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1616
HIV/AIDS in the Three-Year HIV/AIDS in the Three-Year Rolling Development BudgetsRolling Development Budgets
Development budget organised by Development budget organised by projects under each voteprojects under each vote
Projects are funded either ‘inside SRF’ or Projects are funded either ‘inside SRF’ or ‘outside SRF’‘outside SRF’
HIV/AIDS-related projects fall under Vote HIV/AIDS-related projects fall under Vote 13: Health and Social Services13: Health and Social Services
HIV/AIDS accounts for almost 4% of total HIV/AIDS accounts for almost 4% of total development expendituredevelopment expenditure
HIV/AIDS projects first coded in a separate HIV/AIDS projects first coded in a separate HIV/AIDS sector in 2003/04-2005/06HIV/AIDS sector in 2003/04-2005/06
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Increasing HIV/AIDS projects in the Increasing HIV/AIDS projects in the development budgetdevelopment budget
Namibian Development HIV/AIDS Budget (1998/99-2005/06) Nominal N$'000
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
2000/01 2001/02 2002/03 2003/04 2004/05 2005/06
N$'
000
Outside SRF
Inside SRF
Sources: Namibian Rolling Development Budgets (2000/01, 2001/02-2003/04, 2003/04-2005/06)
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1818
HIV/AIDS allocations as share of total Health & Social Services dev. budget
0%
5%
10%
15%
20%
25%
30%
35%
40%
2000/01 2001/02 2002/03 2003/04 2004/05 2005/06
Pe
rce
nta
ge
Sh
are
Sources: Namibian Rolling Development Budgets (2000/01, 2001/02-2003/04, 2003/04-2005/06)
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Composition of HIV/AIDS Composition of HIV/AIDS spendingspending
NDP2 gives indications/ guidelines of NDP2 gives indications/ guidelines of government intentions – (estimates but government intentions – (estimates but not actual budget allocations)not actual budget allocations)
Four focus areas: IEC, condom promotion, Four focus areas: IEC, condom promotion, care and support, sector organisation and care and support, sector organisation and managementmanagement
Care and support wasCare and support was to absorb almost the to absorb almost the whole budget in 2001whole budget in 2001
More funds should go towards recent ARV More funds should go towards recent ARV programmeprogramme
Global Fund submission, emphasis is on Global Fund submission, emphasis is on prevention and education programmes, prevention and education programmes, support and capacity buildingsupport and capacity building
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2020
Key sources of dataKey sources of data
Estimates of Revenue and Expenditure Estimates of Revenue and Expenditure (ERE)(ERE)
Development Budgets Development Budgets NDP2 covering 2001/02-2005/06NDP2 covering 2001/02-2005/06 MoHSSMoHSS MoFMoF National Planning CommissionNational Planning Commission MWACWMWACW
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2121
Key difficulties facedKey difficulties faced No comprehensive database on nationally No comprehensive database on nationally
sourced funds or donor funding sourced funds or donor funding Recurrent Budget documents do not Recurrent Budget documents do not
provide disaggregation of HIV/AIDS provide disaggregation of HIV/AIDS programmes programmes
No clear data on actual expenditure nor on No clear data on actual expenditure nor on the processes for devolution to the regionsthe processes for devolution to the regions
Difficult to study adequacy and efficiency Difficult to study adequacy and efficiency of HIV/AIDS spending of HIV/AIDS spending
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Conclusions and Key Conclusions and Key RecommendationsRecommendations
Government is committed to policy Government is committed to policy interventionsinterventions
Partners from private sector are involvedPartners from private sector are involved The lack of data impedes the monitoring and The lack of data impedes the monitoring and
evaluation of financial commitmentevaluation of financial commitment NACOP should administer HIV/AIDS budgeting NACOP should administer HIV/AIDS budgeting
at the national levelat the national level HIV/AIDS activitiesHIV/AIDS activities must be better coordinated must be better coordinated
and administered at national leveland administered at national level
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THANK YOUTHANK YOU
Authors of the reportAuthors of the reportHopolang Phororo (ILO) - Hopolang Phororo (ILO) - [email protected][email protected]
Rosa Endjala (NEPRU)Rosa Endjala (NEPRU)Ndeutalala Haimbodi (NEPRU) - Ndeutalala Haimbodi (NEPRU) -
[email protected]@nepru.org.na
Teresa Guthrie (IDASA) – Teresa Guthrie (IDASA) – [email protected]@idasact.org.za