National AIDS Spending Assessment Conceptual overview
description
Transcript of National AIDS Spending Assessment Conceptual overview
NASA 2008
National AIDS Spending Assessment
Conceptual overviewNASA TRAINING
September 2008
Economic and Financing Division -Resource Tracking and Projections Unit
UNAIDS EXO/EVA
NASA 2008
NASA Methodological introduction
Part I
NASA 2008
1. What is NASA?
2. NASA Objectives
3. NASA Attributes
4. Sources of information
5. NASA and NHA
6. Approximate time: 30 min
Outline
NASA 2008
NASA
?
NASA 2008
English: National AIDS spending Assessment (NASA)
Spanish: Medición de Gasto en SIDA (MEGAS)
French: Évaluation des Flux de Ressources et des Dépenses nationales contre le Sida (EF-REDES)
Portuguese: Medição do Gasto em SIDA (MEGAS)
Acronyms:
NASA 2008
NASA is:
A methodology to measure and track resources of the national responses to HIV. It is used to estimate HIV
expenditure.
Compared with Resource Needs reflects possible financing Gaps
National Aids Spending Assessment
NASA 2008
NASA is not:
A Software.
Resource Needs.
Economic impact.
National Aids Spending Assessment
NASA 2008
Resource Needs Model (RNM)Resources requirements
(Future)
FuturePast
NASA vs. RNM:
National Aids Spending Assessment (NASA)
Resources consumed (Past)
NASA 2008
NASA (I):
NASA does tracks resources of health services, social mitigation, education, labour, justice and other sectors to embody the multi-sectoral response.
National Aids Spending Assessment
Social MitigationHealth
Human Rights
HIV
Labour
Education
NASA 2008
Objectives:
National Aids Spending Assessment
NASA describe the financial flows, actual disbursements and
expenditures for HIV/AIDS by identifying:
who pays and who purchase? (F. Sources & F. Agents)
who benefits? (Beneficiary Populations)
who provides the services? (Providers)
what was provided? (Aids Spending Categories)
$ MoF
NGO
OVC OVC
Clinic
NASA 2008
To describe the AIDS health and non-health financial flows and expenditures according to three dimensions and six vectors:
FINANCING: 1) Sources; 2) Agents
PROVISION: 3) Providers; 4) Production Factors
USE: 5) AIDS Spending categories; 6) Intended Beneficiary Populations
NASA Dimensions and vectors:
NASA 2008
National AIDS Spending Assessments – Resource Tracking
Financing Sources
Financing Agents
Providers
Production Factors
AIDS Spending Categories
Intended Beneficiary Populations
FINANCING:
PROVISION:
USE:
NASA 2008
• Sources (Public, Private, International)– Financing Agents (to decide the use of the funds)
• Providers of services and goods – (e.g. hospitals, ambulatory services, pharmacies,
NAP, MoH, other Ministries, etc.)• Functions: (Health, Health Related, Non-health)• Beneficiary Populations (or beneficiaries; vulnerable
and at-risk epidemiologically defined populations): MSM, CSW, IDU; Accessible groups: military, school children; Recipients of treatment: PLWH, PLWA
• Production Factors (budgetary items): salary of health personnel, non-health personnel, material and equipment, administration, etc.)
Classifications Classifications
NASA 2008
1. Prevention2. Treatment and care3. Orphan and vulnerable children4. Programme management5. Human resources for AIDS6. Social protection7. Enabling environment &
community development8. Research: AIDS related
Categories of Spending
NASA 2008
Objectives:
NASA can also be used for monitoring of global objectives such as the Millennium Development Goals (MDG).
NASA facilitates the finding of real or potential gaps in the nations public policies.
NASA is a tool for policymakers to determine if funds are being spent as intended and in line with national AIDS strategic plans.
National Aids Spending Assessment
NASA 2008
Objectives:
NASA is an information system that tracks the use of financial resources.
NASA is used to monitor HIV services and interventions which change over time.
NASA analyses the activities local governments and of bilateral aid, multilateral programmes and private households as part of the HIV response.
National Aids Spending Assessment
NASA 2008
NASA:
A tool /method to measure and track resources of the
national responses to HIV.
• It is used to estimate HIV expenditure•National
•Regional
National Aids Spending Assessment
NASA 2008
Use of NASA results Support in-country policy and decision making process,
specifically for AIDS Provide indicators on the financing of AIDS
Annual estimates of Financing Sources and Functions
Comparison – Financial Gaps: resources available
(PAST) and (FUTURE) resource needs
Monitoring of Declaration of Commitment (e.g. UNGASS) International Comparability Utilization of data for country defined purposes by AIDS
program managers/policy and decision makers
NASA 2008
Results and cross-tabulation system
This methodology is based on double entry tables –matrices- – Represent the origin and the destination of
resources– Help to avoid doubling counting of expenditures.
A NASA report typically includes matrices, summary tables, auxiliary tables and synthetic indicators to facilitate the situation analysis and exposition to selected audiences.
NASA 2008
Matrix
NASA uses double entry tables or Matrix to cross information on its vectors and dimensions.
National Aids Spending Assessment
NASA 2008
• Comprehensive: An inventory of all resources addressed to
HIV/AIDS
• Internally consistent: Totals must add-up and be congruent
across different variable dimensions and tables.
• Internationally comparable accounts: The breakdown of
tables, the content of categories and the methods of
calculation must be harmonized (e.g. use of compatible
classifications)
• Compatible with upper-level or aggregated systems
– NHA and SNA. Systems developed during the last 30 years.
Mainly OECD based. Producers guide for NHA: WHO
Characteristics of NASACharacteristics of NASA
NASA 2008
One of the most important characteristics of a classification scheme is assuring that the categories are mutually exclusive and exhaustive.
Using standardized classifications for Resource Tracking allows both international comparisons and comparisons at country level in time trends.
The classifications scheme must answer to politically relevant questions in order to help monitoring the national strategic action plans.
Characteristics of NASACharacteristics of NASA
NASA 2008
Sources of InformationSources of Information
Sources of information (1): -Records of external funding of the public sector- Budget execution reports from each entity-Budget execution reports from entities executing HIV/AIDS programs -Budget execution reports from medical care programs -Reports of services contracted for HIV/AIDS patients-Budget execution reports from the largest organizations in each main type of provider / service function-Reports on resources channeled towards HIV/AIDS non for- profit organizations by external agencies or by government sources
NASA 2008
Sources of InformationSources of InformationSources of information (2): -Reports on services provided and claims for HIV/AIDS coverage from private insurance and private social insurance-Business survey by type of productive branch- Households surveys: out-of- pocket expenditures -HIV/AIDS service provider survey-· Pharmaceutical sector: importation and expenditures on condoms, anti-retroviral medication and other medical supplies related to prevention and treatment-Secondary source: Home health expenditure surveys-Interviews with people living with HIV/AIDS-Providers Surveys
NASA 2008
P1
Source 1 Source 2
Agent 1
P2 P4P3
Agent 2 Agent 3
ASCi ASCi ASCi ASCi ASCi ASCi ASCiASCi
P5 P6
NASA – Resource Tracking
NASA: we analyze data “Bottom up” & “Top down”
NASA 2008
NASA & National Health Accounts:
Is NASA overlapping with NHA?
No, because the methodologies are complementary, as the peruse different
objectives….
NASA 2008
Objective:
NHA are designed to capture the full range of information contained in these resource flows and to reflect the main functions of health care financing: resource mobilization and allocation, pooling and insurance, purchasing of care, and the distribution of benefits. NHA enable stakeholders to identify policy concerns and to simulate the impact of solutions to the problems monitored.
NHA address four basic sets of questions:
I) where do resources come from II) where do they goIII) what kinds of services and goods do they purchase and IV) whom do they benefit?
National Health Accounts (NHA)
NASA 2008
NASA divergence with NHA:
NASA does not confine itself to health expenditures and the sector boundary overlaps with other sub-accounts (i.e.: Reproductive Health, Education…)
National Aids Spending Assessment
General NHA
NASA
Health portion of HIV/AIDS expenditures
Nonhealth portion of HIV/AIDS expenditures
NASA- NHA Crosswalk
Health related
NHA HIV/AIDS subaccount (represents health and health related portions of HIV/AIDS expenditures)
General NHA
NASA
Health portion of HIV/AIDS expenditures
Nonhealth portion of HIV/AIDS expenditures
NASA- NHA Crosswalk
Health related
NHA HIV/AIDS subaccount (represents health and health related portions of HIV/AIDS expenditures)
NASA 2008
NASA Methodological Introduction
Part 2
NASA TRAINING
15 - 19 September 2008
Zagreb, Croatia
NASA 2008
• Resource Tracking & Transactions
• NASA Dimensions & Vectors
• What do we understand by “expenditures”?
• Budget and Budget Execution
• Donors: Pledge, Commitments, Disbursements
• Accrual method
• Stocks, purchases and actual spending
• Approximate time: 45 min
Note: Ask questions at any time.
Outline
NASA 2008
Resource Tracking &Transactions
Resource tracking is based on a methodology to reconstruct all the financial transactions related to the National Response to HIV and AIDS epidemic.
A transaction is a transfer of resources between different economic agents.
It follows the money from sources to mobilization to provision and factor tracking to consumption (final use).
NASA 2008
Transaction: the basic unit of the financial flow, that describes the transit of resources from a source to an agent, who purchases from a provider one or more ASC benefiting beneficiary populations, specified or not, and produced consuming production factor.
Tracking the TransactionTracking the Transaction
NASA 2008
(Ministry of Finance)
(Ministry of Health)
$ M F
Hospital
MoH
(Hospital)
NASA (I):
Source
Agent
ProviderBeneficiary Population
Aids Spending Categories
NASA 2008
To describe the AIDS health and non-health financial flows and expenditures according to three dimensions and six vectors:
FINANCING: 1) Sources; 2) Agents
PROVISION: 3) Providers; 4) Production Factors
USE: 5) AIDS Spending categories; 6) Intended Beneficiary Populations
NASA Dimensions and vectors:
NASA 2008
Financial Flow
Consumption Flow
Financial and Expenditure Flows:Transactions
Provider
Production Factors2
ASC1
F. Source
Activities or ASC
Beneficiary Populations2
F. Agent
ASC2
ASC3
PF1
BP1
PF3
Bp3
NASA 2008
Triaxiality
• Capturing value: a triaxial information approach
• Three dimensions (axes) sought : * Financing
* Provision
* Final use
• Agents : * Financing intermediaries ) transact
* Providers ) «from »
* Beneficiaries ) « to »
National Aids Spending Assessment
NASA 2008
T account T account
All the revenues in one side and all the expenditures on the other side, produce a balance and reduce error
Information systems and book keeping on expendituresProof of purchase, bills, charges, debits, invoices, statements
Revenues Expenditures
NASA 2008
TriangulationTriangulationGathering, compiling and cross checking information Gathering, compiling and cross checking information
from three sourcesfrom three sources
Provision
Con
sum
ption F
inanci
ng
Citizen
PoolingPurchaser
Provider
Three party transactions
NASA 2008
The agents’ triangulation
Fina
ncin
g
Fina
ncin
g Provision
Provision
ConsumptionConsumption
====
==Fi
nanc
ing
Sour
ces
Fina
ncin
g So
urce
s
& F
inan
cing
Age
nts
& F
inan
cing
Age
nts
Providers &
Providers &
Production Factors
Production Factors
Aids Spending Categories & Beneficiary PopulationsAids Spending Categories & Beneficiary Populations
Sources
Purchasers Providers
Factors of production
Commodities Beneficiaries
NASA 2008
∑ Activities or ASC: $ 10
Financial and Expenditure Flows & Agent’s Triangulation
Provider
Production Factors2
ASC1
F. Source
ASC
Beneficiary Populations2
F. Agent
ASC2
ASC3
PF1
BP1
PF3
BP3
$ 10 $ 10
Example: ($ 10 -VCT)
∑ PFi: $ 10
Fina
ncin
Fina
ncin
gg
Provisio
Provisio
nn
ConsumptiConsumptionon
====
==
∑ BPi: $ 10
NASA 2008
HIV SpendingHIV Spending
HIV expenditures: Good and services delivered to a Beneficiary Population.
Beneficiary Population
Antiretroviral therapy BP.1 People living with HIV
Good and Services:
AIDS Spending Categories
Social Change Communication
BP.5 General Population
NASA 2008
Antiretroviral in a warehouse in the MoH…
+ MoH
Actual Expenditure
Is not an ASC = Not captured by NASA
(It is captured once it is delivered to patients)
NASA 2008
ASC.2.3 Antiretroviral therapy ASC.2.1.05 Specific HIV-related laboratory monitoringASC.1.03 - Voluntary counselling and testing ASC.1.17 PMTCT
PS.1.1.1 - Public general hospitalsPS.1.2.1 - Public outpatient care centres
Actual Expenditure
ARV delivered, tests done...
…should be reflected in a NASA
NASA 2008
UN
AID
S/G
.PIR
OZ
ZI
Resources allocated, resources committed, resource needs…
… are usually not equal to Budget executed, or actual expenditures…
• …NASA tracks actual expenditures on the HIV Response.
Budget vs. Actual Spending Budget vs. Actual Spending
NASA 2008
Execution ratio = Budget executed / Budget
Interventions by type 2007 - Budget 2007 - Executed %
I Prevention 6.400.000 6.010.456 94%
II Treatment and Care 2.010.850 1.786.532 89%
III Other 1.987.000 1.237.890 62%
Total - USD 10.397.850 9.034.878 87%
Budget vs. Budget Executed Budget vs. Budget Executed
NASA 2008
Budgets usually have important differences with Budget execution…
Budget execution does not reflects total HIV expenditure: some expenditures are not HIV Budgeted (i.e.: Human resources in OI, STI, ARV, etc, and some drugs are not reflected in HIV budgets since they are not HIV specific).
Budget, Budget Executed & HIV expendituresBudget, Budget Executed & HIV expenditures
NASA 2008
Donors - SourcesDonors - Sources
Terminology…
Pledge: a promise to give resources.
Commitment: contract on resources to give.
Disbursement: resources available for the recipient of the funds.
Budget: An itemized summary of estimated or intended expenditures for a given period along with proposals for financing them
NASA 2008
Source
Agent
Provider
DonorsDonors - DisbursementsDisbursements
+ MoH
resources available for the recipient of the funds
(not necessarily spent)
NASA 2008
Source
Agent
Provider
DonorsDonors - Actual SpendingActual Spending
Actual Spending: Good and Services delivered to a Beneficiary Population Beneficiary
Population
+ MoH
NASA 2008
Donors Donors
Usually:Only Budget figures available
Sometimes:No data availability in budget nor in actual
expenditures
Solution: Get data from recipients of the funds (Agents and Providers)
NASA 2008
Stocks Vs. Actual SpendingStocks Vs. Actual Spending
+ MoH
2007 2008
Ministry of Health ARV Acquisitions / Warehouse
USD 500,000 USD 300,000
NASA 2008
+ MoH
2007 2008
USD 500,000 USD 300,000
USD 400,000 USD 400,000
MoH ARV Acquisitions
(Stock)
ARV Spending
=
ARV delivered
NASA 2008
Accrual Method Accrual Method Accrual Method: Accounting method that records revenues and expenses when they are incurred, regardless of when cash is exchanged. Income and expenses are recorded as they occur, regardless of whether or not cash has actually changed hands.
(Accrual accounting is opposed to cash basis accounting. Cash Method: Income is recorded when it's received, and expenses are reported when they're actually paid, whenever cash has actually changed hands.)
UNGASS Indicator No. 1 and NASA: Accrual Method.
Resource trackers will encounter a variety of accounting practices in their data sources, some accrual and others cash. Their job is to convert everything to an accrual basis, to the extent possible.
NASA 2008
Accrual Method Accrual Method
E.g.: A patient receives a consultation on a private Clinic on December 2007, but pays for the consultation on January 2008:
2007 2008
Clinic
Accrual Method: The outpatient services must be accounted for 2007.
NASA 2008
Accrual Method ExerciseAccrual Method Exercise
E.g.: An NGO receives condoms from a Donor valuated in USD 100,000 by the end of 2007. The NGO distributes 10% of the condoms in 2007 and the rest in 2008.
For the Donor the USD 100,000 is a 2007 disbursement
For the NGO the USD 100,000 is a 2007 donation…
…How to account it in NASA and UNGASS indicator NO. 1?
NASA 2008
Accrual Method ExerciseAccrual Method Exercise
Accrual Method: 10 % of the condoms should be accounted for the NGO and the Donor as 2007 expenditures, and the other 90% as 2008 expenditures.
NASA: USD 10,000 are a 2007 expenditure and USD 90,000 are a 2008 expenditure.
NASA 2008
Accrual Method Accrual Method
2007 2008
USD 100,000
Don
or
disb
urse
men
t
2007 2008
NG
O c
ondo
m
Dis
trib
utio
n
USD 10,000 USD 90,000
NASA 2008
1. Follow Accrual method as possible
2. Pledge, Commitments, Disbursements are not actual spending
3. Actual spending are good and services delivered to a population
4. Budget figures do not represent expenditures. Budget executed!.
5. Some HIV expenditures are not reflected in HIV budgets.
Recap:
NASA 2008
?
Thank You…