National HIV Investment Plan (NHIP) – a new wine in old bottle: a case from Nepal
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National HIV Investment Plan (NHIP) – a new wine in old bottle: a case
from Nepal
This study aims to examine the value addition, if any, in using New Investment Framework as a tool to develop costed action or investment plan at the country level.
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Introduction and background
Search for an ideal method, tool or a model for resource allocation and projection – an on going process
Simple costing tools to more elaborated models are available
Various tools, models are being used depending on country context and capacity
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Introduction and background
This study is based on three premises1. New Investment Framework, (Schwartländer, et
al), www.thelancet.com.Vol 377 June 11, 2011)
2. Redefining AIDS in Asia - Commission Report 2008
3. National AIDS Spending Assessment (NASA) and other AIDS spending assessments
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The New Investment FrameworkIntroduced during the resource crunch period
Contributed in regaining global resource confidence
Intervention, allocation Investment
The term investment got into Global Fund dictionary more firmly
GF require NFM concept note based on investment case/plan
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(..contd): The New Investment Framework (4 pillars)
1. Basic Programme activities
Critical enablers
2. social enablers 3. Programme
enablers
4. Synergy with development sectors
Basic programmes Critical enablers Synergies with dev sectors
0
10
20
30
40
50
60
70
42.2
35.76
21.82
58.37
15.38
26.24
53.81
18.78
27.41
Resource needed for NIF (%)
2011 (16.5 bil) 2015 (22.1 bil) 2020 (19.7 bil)
Global resource need and return on investment for 139 LIC and MIC countries
Country specific use of model
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2. AIDS Commission Report (2008)
An independent body created by UN Secretary General
- Reviewed Asian epidemic- Analysed course and
impact of epidemic- provided region specific
recommendation- Estimated resources to
content the epidemic
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Investing in high impact areas
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NASA
• Monitor the resource mobilisation and utilisation
• Support in-country policy and decision making process,
• Promote accountability and transparency
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…..Introduction and backgroundNepal HIV Investment Plan –NHIP (2014-2016)
prepared in line with New Investment Framework-NIF (S. et.al, 2011)
In the past, country had prepared several costed strategies and national action plans (NAP)
Country had also conducted AIDS spending assessments in the past
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Country context
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Country contextTreatment cascade
45,000
40,000
35,000
30,000
25,000
20,000
15,000
10,000
5,000
-
40,700
Estimated people living with HIV (2013)
23,977
HIV diagnosed
(1988-2013)
8,866
On ART (December, 2013)
1,080
Suppressed viral load
(a)
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Methods retrospective analysis of
o AIDS spending reports (NASA 2007 and RTS 2010) and
o National Action Plan - NAP (2008-2011) allocations recalculated and regrouped the spending and
budgets according to four NIF pillars compared the results with NHIP (2014-2016)
allocations also reviewed the process followed during the
preparation of NAP and NHIP to examine if any significant departure existed in the process
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Methods
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ResultsProcess followed for preparing NAP (2008 -
2011) and NHIP (2014-2016) was similaro Consultations with KAP and key stakeholderso Epidemiological data reviewo Unit cost analysiso Active CCM engagement (New)
Two AIDS spending assessments – similar pattern in spending
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Key feature in NHIP (2014-1016)
KAP focused, disaggregation of MSM/TG for better targeting
Female sex workers who inject drugRapid scale of HIV testing and treatmentA robust eVT programme Community Test and Treat Competence
(CTTC)Hepatitis C/HIV co-infectionAcceptance of NHIP – up to higher level
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Basic Programme Program Enablers Social Enablers Synergies with dev sectors
0
2
4
6
8
10
12
14
16
18
20
0
20
40
60
80
100
120
140
160
180
200
8.60 2.22 2.61 4.22 9.72 6.05 3.40 1.28
89.17
17.18 17.19 4.48
103.16
29.94 2.30
5.42
AIDS investment/allocation and actual spending (US$ million)
NASA 2007 RTS 2009 NAP 2009-10 NHIP 2014
AID
S s
pend
ing
(mill
ion
US$
)
NAP
and
NH
IP
….Result:
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NASA 2007 RTS 2009 NAP 2009-10 NHIP 20140
10
20
30
40
50
60
70
80
90
100
48.72 47.53
69.65 73.26
12.5929.59
13.4221.26
14.79
16.6213.43
1.63
AIDS investment/allocation and actual spending (%)
Basic Programme Program Enablers Social Enablers Synergies with dev. sectors
%
• Similar pattern is seen in actual spending, NAP and NHIP• High spending and high allocation in Basic Programme• Similar pattern in programme Enablers• Social Enablers and Synergy with Dev Sectors received less
allocation than spending trend
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Conclusion
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0
10
20
30
40
50
60
0
5
10
15
20
25
30
35
40
45
52.83
20.74 19.63
6.80
42.42
21.82
35.76
0
Spending in AP region (2007-2009) and NIF es-timates for 2011 (%)
Total spending in AP countries (%)NIF estimates (%) 2011
Spen
ding
200
7 -2
009
NIF
Esti
mat
es (%
)
Source: UNAIDS 2010
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Conclusions Compared to spending data, a significantly higher
budget estimate/investment in NAP and NHIP is noted
despite different methods, different point of time, similar patterns of spending and resource allocation observed with Basic Programme as a priority followed by Programme Enabler.
Neither any significant departure is noticed in the process nor any major shift in allocation priorities in NHIP
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……Conclusion increase in volume of investment can be
attributed to one or more factorso programme expansion,o Unfolding realities, lessons from pasto introduction of new approaches, new technology o increase in international financing
Limited value addition is observed in using NIF as a tool for budget plan at the country level