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

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

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

44

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

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

66

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

77

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

88

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

99

CIRCULARDEVELOPED

PRESENTATIONBY MIN OF FINANCE

BUDGETARYFRAMEWORK

AND MTEF

COMPILEDBUDGETING

ADJUSTMENTS

PRESENTATIONS

CONSULTATIONS

The budget processThe budget process

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

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.

1212

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

1313

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.

1414

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

1515

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

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

1717

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)

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)

1919

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

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

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

2222

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

2323

THANK YOUTHANK YOU

Authors of the reportAuthors of the reportHopolang Phororo (ILO) - Hopolang Phororo (ILO) - phororo_ADD@ilo.orgphororo_ADD@ilo.org

Rosa Endjala (NEPRU)Rosa Endjala (NEPRU)Ndeutalala Haimbodi (NEPRU) - Ndeutalala Haimbodi (NEPRU) -

NdeutalalaH@nepru.org.naNdeutalalaH@nepru.org.na

Teresa Guthrie (IDASA) – Teresa Guthrie (IDASA) – teresa@idasact.org.zateresa@idasact.org.za