Mapping HIV Spending in Central America

Washington D.C., USA, 22-27 July 2012www.aids2012.org

Mapping HIV Spending in Central America

And the need of renewing the policy agenda

Ricardo Valladares–CardonaRegional M&E Systems Advisor, USAID - PASCA



Central America35 Million Inhabitants220 thousand squared milesUSD 25 billion GDPUSD 283 per capita Health ExpenditureUSD 5.05 per capita HIV AIDS Expenditure

Country HDI RankOut of 169 countries

Life Expectancy at birth

Years of schoolingadults

GNI per capita

Panama 58 76.1 9.4 6,970

Costa Rica 69 79.3 8.3 6,810

Belize 93 76.1 8.0 NA

El Salvador 105 72.2 7.5 3,380

Honduras 121 73.1 6.5 1,870

Nicaragua 129 74.0 5.8 1,110

Guatemala 131 71.2 4.1 2,740


Central America• Poverty, hunger, migration• Youth population• Effective health coverage: low in most countries• Sex tourism, human traffic, child exploitation• PWA, SW and MSM face stigma, discrimination,

violence and prosecutionAdult HIV Prevalence (UNAIDS Estimates, 2009)

Country2009

Female 15-24 yr Male 15-24 yr Total 15-49 yr Total 15-24 yrBelize 1.8 0.7 2.3 1.3Costa Rica 0.1 0.2 0.3 0.2El Salvador 0.3 0.4 0.8 0.3Guatemala 0.3 0.5 0.8 0.4Honduras 0.2 0.3 0.8 0.3Nicaragua 0.1 0.1 0.2 0.1Panama 0.3 0.4 0.9 0.3LAC Region 0.2 0.2 0.4 0.2


USAID PASCA

Mapping HIV Spendingin Central America

• Expected Result• Strategy Elements

Sub-Intermediate ResultImproved policies implemented.

Lower Level Result C“Surveillance Systems Developed and Used for Strategic Planning, Resource Allocation and Program Evaluation”

National AIDS Spending Assessments for Central

America 2010 comparable and policy relevant.

• Key research questions• Common reporting tools• Support on data collection• Database audits• Results validation• Use for high level policy dialogue

Harmonized resource tracking baseline for 2010 at regional level


Funding Gap

Key Findings

Are we spending too much or too little on the national response to HIV AIDS?

Belize

Panamá

Nicaragua

Costa Rica

Honduras

Guatemala

El Salvador

03

24

25

31

36

46

50

Total HIV AIDS Spending by Country

Central America, 2010In USD Million

USD 214.6


Funding Gap

Key Findings

Are we spending too much or too little on the national response to HIV AIDS?

Guatemala

Nicaragua

Honduras

Costa Rica

Panamá

El Salvador

Belice

0tan2a56602

12tan3a56603

24tan3a56603

24tan5a56605

12tan6a56606

36tan7a56607

36tan8a56608

HIV AIDS Per Capita Expenditures by Country

Central America, 2010USD

CENTRAL AMERICA

Per capita spending 2010HIV AIDS = USD 5

Carbonated BeveragesUSD 114

Alcoholic BeveragesUSD 447

USD 214.6


Vulnerability

Key Findings

At regional level, the weight of external funding

is 27%.

Some countries urgently need to find ways of

reducing dependency in the short term.

How catastrophic would be a drastic reduction in external funding for HIV AIDS?

Panamá

Costa Rica

El Salvador

Región

Guatemala

Honduras

Belice

Nicaragua

65%

81%

77%

63%

62%

44%

51%

39%

30%

12%

2%

10%

10%

12%

0%

5%

6%

7%

21%

27%

28%

43%

49%

56%

Source of HIV AIDS Funding by CountryCentral America, 2010

Public Private External


Vulnerability

Key Findings


Costa Rica

El Salvador

Belize

Guatemala

Region

Honduras

Nicaragua

99%

96%

96%

90%

88%

68%

46%

0%

0%

0%

0%

2%

7%

10%

0%

4%

4%

10%

11%

25%

45%

Sources of Funding for HIV AIDS Care and Treatment by Country in Central America,

2010Public Private External Most of the Central

American Countries have secured public funds for

HIV AIDS Care & Treatment.

In Nicaragua, a cut in C&T external funds would be

catastrophic.


Vulnerability

Key Findings


Costa Rica

Belize

El Salvador

Región

Guatemala

Honduras

Nicaragua

60%

71%

61%

47%

38%

35%

44%

30%

0%

4%

17%

25%

18%

6%

10%

29%

35%

37%

37%

47%

51%

Sources of Funding for HIV AIDS Prevention by Country in Central America, 2010

Públicas Privadas Internacionales

A third of HIV AIDS Prevention resources come from external

sources, and more than a half in some countries.

Downsizing in prevention would be catastrophic in a

funding reduction scenario


Vulnerability

Key Findings


Belize

Costa Rica

El Salvador

Honduras

Guatemala

Nicaragua

Central America

69%

73%

79%

82%

85%

75%

78%

0%

10%

8%

2%

1%

1%

3%

31%

18%

13%

16%

14%

24%

19%

Sources of Funding for Program Management by country in Central America, 2010

External Private Public

Policy making, strategic planning, monitoring and

evaluation, financial management and

investment in HIV AIDS depend on foreign

funding in all Central American countries.


Efficiency

Key Findings

Are resources used to obtain the best value for money?- Palmer S and DJ Torgenson BMJ 1999 318(7191): 1136

Orphans and VC0%

Research1%

Social Protection1%

Enabling Environment1%

Human Resources3%

Program Management9%

Prevention38%

Care and Treatment47%

Composition of the HIV AIDS Funding in Central America, 2010

85% out of Total HIV AIDS Expenditures go to

Health Sector Activities.

Excluding Program Management, Multi-Sectoral interventions have a 6% share of the HIV AIDS Spending.


Efficiency

Key Findings

Are resources used to obtain the best value for money?- Palmer S and DJ Torgenson BMJ 1999 318(7191): 1136

Belice

Nicaragua

Honduras

Panamá

Región

Guatemala

El Salvador

Costa Rica

9%

23%

36%

43%

46%

53%

57%

57%

46%

38%

51%

49%

39%

36%

30%

37%

26%

25%

8%

2%

8%

8%

5%

2%

20%

15%

4%

6%

7%

3%

9%

3%

HIV AIDS Spending by Category and Country in Central America, 2010

Care & Treatment PreventionProgram Management Other categories Some countries allocate

more than a half of HIV AIDS resources in Care & Treatment Activities.

Program Management takes a large share in

countries where Care & Treatment Expenditures represent less than 25%.


Targeting

Key Findings

Does the resource allocation by human groups address key populations, i.e. the most affected, exposed and vulnerable

groups facing HIV AIDS?

Belice

Costa Rica

El Salvador

Guatemala

Honduras

Nicaragua

Panamá

Región

11%

56%

65%

55%

31%

23%

48%

48%

6%

3%

4%

7%

9%

8%

5%

6%

11%

3%

1%

8%

9%

4%

0%

4%

72%

37%

30%

30%

51%

66%

47%

41%

HIV AIDS Spending by Beneficiary Group in Central America, 2010

People with HIV AIDS MSM, CSW and IDUOther key populations Rest of the expenditures

The epidemic is concentrated in all Central American Countries and

fueled by unprotected sex among MSM.

However, 90% of the resources are directed to general population and

PWHA.


Targeting

Key Findings



Nicaragua

Guatemala

Costa Rica

Central America

El Salvador

Honduras

Panamá

Belice

029

011

001

014

010

016

015

032

022

033

043

048

059

076

081

089

Per capita spending in MSM and CSW by Country, in US Dollars

CSW MSM

In Central America, MSM have 33 times

probability of acquiring HIV than other men from

general population.

However, countries are more willing to

prevent HIV transmission during

paid sex.


Targeting

Key Findings



Belize

Honduras

Guatemala

Panamá

Region

Nicaragua

El Salvador

Costa Rica

471

723

899

1,317

931

1,123

791

1,285

065

285

412

585

587

817

945

1,756

Per capita spending in Antiretroviral Therapy and in People with HIV/AIDS (US Dollars)

PWA ART

Antiretroviral treatment cost per person varies from Belize to Panama.

CA is a USD 33 million marketplace of ART . There is room for bloc

negotiation and manufacturing.

Wherever spending per PWA is lower than ART per capita, it means poor ART coverage.


Targeting

Key points:

• Central America NASA 2010: 7 countries baseline• Key changes: increased funding, mainly from public sources• Domestic spending covers most of prevention and treatment expenditures• Multi sectoral components (management, research, enabling environment)

depend on external funding.• Main challenges :

– Reducing vulnerability– Improving allocation (interventions and populations)– Containing cost escalation– Taking stock of regional scale & mechanisms

• New policy agenda: address equity, transparency and sustainability.

• Central American Health Ministers Council, examining these results, resolved to commission the Regional Coordinating Mechanism to develop a sustainability strategy, with emphasis on improving spending quality, containing costs and mobilizing resources.


Thank youfor your attention

Mapping HIV Spending in Central America

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