Finance and Resource Mobilization and PER

2007/08

Tanzania Commission for AIDS

HIV/AIDS - Technical Review October 2008

HIV/AIDS- Financial status

Total budget for HIV/AIDS has decreased by 3% this year.

Total of Tshs.568.2 billion was planned to be spent in 2007/08.

In the year 2008/09 we expect to spend total of Tshs. 549.2 billion.

Of the funds available, 95% is supported by donors and 5% by the Government.

Of the 95% of donor support, only 26% is captured by the government budget.

Financial gap and Forecast

• The gap is getting bigger as we go.

• We almost got it right in 2006/07 (PEPFAR)

• Assumptions are to reach population in need.

• Increase in population increase in resource needs.

• We are left with a gap of more than 300mn USD in 2 yrs.

Financial forecasts

Commitment made for Care and treatment demands from 60% to 72% of the total resources for the next five years.

Prevention demands from 10% to 13% of the resources in next five years.

Mitigation has stabilized at 8% to 9% in next five years.

Government ContributionGovernment contribution to the National response has been between 22 to 25 billion per year since last review.

Of the Government contribution 50% to 60% is for health sector response.

6% of the Government contribution is been spent at the Regional level.

Ministries, Department and Agencies resource allocation from the Government account for 38.5%.

Government contribution…

2005/06 2006/07 2007/08 2008/09

Health and Social Welfare

3.5 16.1 11 12.1

TACAIDS 4.0 3.8 3.6 3.7

Other MDAs 14.9 5.5 7.7 6.9

Government contribution…

GOT Allocation in 2008/09

Contribution by development partners

The major supporters of HIV/AIDS National response are the US Government (PEPFAR) and the Global Fund.

The two donors support total of 86% of the National response.

According to surveys conducted care and treatment uses 64% of the contribution by the above to donors.

Development Partners – Trend

Development Partners – Trend ...

Donors not reflected in the chart above are contributing to General budget support (GBS).Part of the government contribution to HIV/AIDS reflects GBS.Donors supporting GBS are indirectly supporting health sector and other non health MDAsSome of the donors provides technical assistance.

HIV/AIDS Resource Allocation 2008/09

Major programs and

fund flow

Major Programs in TZUSG- Presidential Emergency Plan for AIDS

Relief

USG- Presidential Emergency Plan for AIDS

ReliefThis program reaches prime partners of about 351 and also prime partners have implementing partners of not less than 10 each.

The program is implemented throughout the country.

UNITED STATES GOVERNMENTUNITED STATES GOVERNMENT

Major Programs in TZ – Global Fund funded

The program is implemented by total of 103 implementers including MDAs, LGAs and CSOs.

TNCM – Tanzania National Coordinating Mechanism is in charge of planning and decisions.

Programs areas are selected through this committee.

The Committee is represented constitutionally.

Global Fund

Strengthen health

services and HIV/AIDS

Strengthen HIV/AIDS

Treatment and OVC

Fund Flow-3

Fund Flow-4

Major Programs in TZ - TMAP

Funds from this project is accessed by all partners from agreed arrangement.

Civil Society access funds through agencies.

Total of 2,057 implementers including 43 MDAs, 2,000 CSOs and other umbrella bodies.

Tanzania Multi-sectoral AIDS Project

TMAP

TMAP - Fund Flow

HIV/AIDS Fund It is a pooled arrangement to support NMSF

It is the GOT current financing modality of prioritizing the HIV/AIDS response as per country needs.

Have been used to strengthen District response

Currently supported by CIDA only, others to join.

HIV/AIDS Fund …

Development partners support

HIV/AIDS Fund …Since 2006/07 all LGAs and Regions have been supported for HIV/AIDS interventions through this support.

We established a block grant formula for funds to LGAs:

Population count

Poverty Count

Prelance rate (regional)

Service route (borrowed from health)

Achievements –HIV FundImproved coordination between TACAIDS, PMORALG and MOFEA.

Strengthened LGAs planning process, linking O & OD, NMSF, Councils strategic plans and minimum package on HIV/AIDS.

Some ideas were brought up from LGA level on improving TOMSHA project.

UN JOINT PROGRAMME

Led by a Steering Committee.

Steering Committee involves stakeholder from various sectors, including various UN Agencies.

Steering committee plan and make decision for the program.

Various interventions are implemented including technical capacity building.

UN JOINT PROGRAMME…

UNDP

TACAIDS

Ministries, Departments, Private Sector, Civil Societies

UNAIDS, WHO, WFP, UNICEF, UNFPA

Steering Committe

e

Rapid Fund Envelope (RFE)

Total of 90 CSOs were reached since the establishment of RFE in 2002.

It is a pooled funding arrangement managed by the private sector to support HIV/AIDS in TZ.

It is very competitive arrangement of accessing funds by the CSOs.

Rapid Fund Envelope

CIDA, Ireland, DFID, Finland, DANIDA, Netherlands, Norway, Swiss, Bernard Van Leer Foundation and USG

TACAIDS

Delloite and Touche

NGOs & FBOsAcademic Instit. CBOs

Steering Committe

e

Achievements - Resource Mobilization and

financingMainstreaming of HIV/AIDS in the National Budget Guidelines

Establishment of the HIV Fund

In process of developing AIDS Trust Fund

Some LGAs are now planning to support CPPs (output of RFAs work)

Budget mainstreaming at LGAs dept. level is at 40%, while other LGAs do plan under Community Development budget.

Issues - Resource Mobilization and

financingResources contributed by the private sector is missing from the analysis.

Resource Mobilization supports implementation of NMSF, hence operational plan and NMSF costing

Some of the LGAs do not use objective A for budgeting HIV/AIDS.

Some MTEFs are crowded with a lot of HIV/AIDS activities (over ambitious)

HIV/AIDS Public Expenditure

Review (PER) - 2007/08

IntroductionThe study covered review of budgets and actual expenditure of all MDAs including 18 Districts and

Review of Development partners who support HIV/AIDS

5 LGAs were visited for during this study.

Analysis of key sectorsMOHSW - 95% of the budget is for care and treatment, others are work place program and advocacy.

TACAIDS - 84% represent transfers to CSOs.

MOEVT 2bn shs., programs on prevention, building capacity in school colleges and VTCs, develop IEC and disseminate and strengthen HIV/AIDS database.

Defense- receive PEPFAR and Global Fund support for care and treatment.

Analysis of key sectors…Water – only workplace programs and HIV/AIDS IEC during Water week.

Agriculture – developed a strategy to support vulnerable households involving in agriculture, developed approaches to produce nutritional foods for PLHAs, implementation is by LGAs

MCDGC – Workplace programs, outreach program through 58 VTC in the country

LGAsSources of fund have been the GFATM, TMAP and CIDA

Health related expenditures are centrally supported.

Currently there’s no other support for multi-sectoral response than block grant, financed by CIDA

Global fund support to LGAs is for care and treatment.

LGAs MTEF include Block grant and health basket

Global Fund is not included in the MTEF.

LGAsPlanning is participatory in most of the LGAs, however, in most of the villages HIV/AIDS doesn't rank high as a priority.Villagers priority include economic and social support to OVC, PLHAs, home based care20% of the CMACs visited never met.A need to review a minimum package to improve it.

LGAs (block grant)

Most of the LGAs plans for trainings, sensitization, work with schools, youth groups, adult education, peer education, drama groups, Orphans, uniforms, fees, economic support to PLHAs and Home Based Care.

The block grant formula will need to be reviewed immediately after completion of THIS II.

NMSFNMSF has not been costed yet, costing will require development of operational plans.HSHSP requires USD 444 to 486mn per annum.Commitment by the GOT and donors is only shs. 540 to 590 bn per annum.This leaves only USD 104 for Non-health interventions in the NMSF.

Steps for NMSF road mapUse minimum package to give evidence based guidance - LGAs.

Allocate resource based on criteria of need (THIS II) - Prevalence

Ensure promised funds are made available in time.

Allow flexibility with LGAs

Pilot alternatives to RFAs for supporting CSOs

Identify gaps and channel resources towards them

RecommendationsThere should be a debate, on HIV/AIDS resources and the implications of levels and trends.

MDAs and LGAs be reminded of the definitions of the standard targets within Objective A.

Undertake a study on ‘donor expenditure review’ in HIV/AIDS

Recommendations…

The review should be done to re-consider TACAIDS recurrent budget decline.

DPG members to ensure that HQ staff responsible for GFATM are aware of Global Fund problems to Tanzania unpredictable and difficult to integrate within national plans and budgets.

Recommendations…

MOF should make a provision for the HIV/AIDS earmarked block grant in the GOT budgets each year without it being donor dependent.

Donors providing financial support for the HIV/AIDS block grant should negotiate with MOF for earlier and full release of the grant.

Recommendations…The LGAs minimum package should be reviewed and prioritised.

The minimum package should be supported with best-practice guidance

Regional capacity to support CHACS and CSOs be supplemented by sub-contracting institutional support functions to NGOs accredited to provide these services (and piloted).

Recommendations…

LGAs should be responsible for channelling financial support to CSO projects.

TACAIDS will facilitate detailed operational guidance covering fund flow, procurement, financial and physical monitoring.

Support to CSOs should include longer-term financing of programmes to support PLWHAs and OVCs.

Recommendations…

In the spirit of increased D by D, individual CSO projects should no longer go to TACAIDS centrally for approval, but should remain within the authority and accountability of the LGA, as an intrinsic part of the LGA budget.

Recommendations for NMSF operationalizationAdopt a decentralised approach

Allocate resources based on criteria of need

Ensure promised funds are made available in full and on time

Allow LGAs more flexibility on how to use them, within the scope of national strategy and the guidance provided.

 Pilot alternatives to the RFAs for supporting CSOs

 Promote the development of mutual learning networks at national and regional level

 Identify financing gaps, and develop regular institutional mechanisms for directing Government and donor resources towards filling them

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