PROVINCIAL COUNCIL ON AIDS MEETING 25 AUGUST 2010

KZN HIV and AIDS Spending Assessment: Preliminary Findings

Presented by Dr F. NdlovuOFFICE OF THE PREMIER

.

PROVINCIAL COUNCIL ON AIDS MEETING

25 AUGUST 2010

Outline

Methodology Total HIV and AIDS spending in KZN (public,

external & private but business limited) Sources Agents Activities Providers Beneficiaries

DOH spending on HIV and AIDS DOH voted funds for HIV and AIDS DOH CG for HIV and AIDS

Objectives of NASA in KZN To identify all the sources of financing for HIV and AIDS and

TB in KZN, for the years 2007/08 and 2008/09. To measure all the public, external and private financial

resources allocated/ committed and spent for HIV and AIDS and TB activities in KZN, for the years 2007/08 and 2008/09.

To identify the providers of the HIV and AIDS and TB services in KZN, for the years 2007/08 and 2008/09.

To identify the activities on which the funds were spent, according to the NASA classifications and the PSP priorities, for the years 2007/08 and 2008/09.

To identify the beneficiaries of the spending on HIV and AIDS and TB activities in KZN, for the years 2007/08 and 2008/09.

To make recommendations for the improved targeting of funds and efficiency of spending, according to the provincial priorities.

Methodology Aimed to include data from all sources, from all

agents and from sampled service providers. All DOH & PPSD & NHLS expenditure by activity and

service provider – from BAS records Verified with small sample of clinics / hospitals /

pharmacists / NGOs receiving DOH and /or DSD grants DOE – provided detailed expenditure of lifeskills CG DSD – did not provide BAS expenditure, so had to use

the audited expenditure amounts from budget documents and split between OVC, HBC, M&E, planning & coord, training, social services – excludes the payments made on grants (national level analysis).

Methodology cont. Other govt departments were interviewed: agriculture,

OP, treasury – they were unable to provide any HIV-specific spending.

Public wellness programme - there was no HIV-specific spending in the study years, they are creating it currently.

External sources – data obtained from EU, GF & donors to DOH only.

Missing all other external partners since they indicated that their expenditure would be obtained from Head Offices.

Missing private medical aid & insurances indicated that their expenditure would be obtained from Head Offices.

Missing: spending of most municipalities, mortuaries & C. Sections.

Methodology cont. Business sector – only DCC & SABCOAH & McCarthy

provided data, many did not respond and some indicated that their Head Offices would have to provide the data.

NGOs: were sampled from 911 database – many were not contactable, and eventually only about 60 provided data.

Research institutions – contacted: MRC, HSRC, HST, HEARD, HIVAN, RHRU, PASCA, McCord Hospt, Nelson Mandela Med.School – only got data from MRC & HEARD.

To be collected at national level – blood safety, condoms (the numbers of condoms distributed were not obtained from HAST so could not be estimated), correctional health services, private medical insurances, businesses & external funders.

DRAFT - DO NOT DISSEMINATE.

Methodology cont Data collection through interviews &

expenditure record verification. Data triangulation to ensure correct actual

expenditure. Also avoided double counting through

triangulation & creating transactions. Data cleaned and captured in Excel. Exported to NASA RTS where aggregated

and matrices produced. All analysis & graphs generated in excel.

Total Spending on HIV and AIDS in KZN

All public, external & some private (business limited)

Total Funding & Sources for HIV and AIDS in KZN


Sources of all HIV spending in KZN – further disaggregated 2007/08 & 2008/09

Funding Levels & Sources in the SADC Region and 1 West African Country

Source Data: individual Country NASA reports, complied by Guthrie, 2009.

Comparison with Spending in SADC

Source Data: individual Country NASA reports, complied by Guthrie, 2009.

Multilateral AID for HIV and AIDS in KZN 2007/08 & 2008/09

0

20

40

60

80

100

120

140

160

2007/08 2008/09

ZAR

mill

iions

WHO

UNAIDS

Global Fund

European Commission

Bilateral AID For HIV and AIDS in KZN 2007/08 & 2008/09

External Foundation AID for HIV and AIDS in KZN 2007/08 & 2008/09

Agents of Spending The managers of funds – receive and send on

to providers. Decide programmatic spending. Eg. GF – CCM assumed principal recipient is

the agent But for EU funds, EU is the agent


Financing Agents of HIV spending 2007/08 & 2008/09


Public sources by Agents for HIV and AIDS spending 2007/08 & 2008/09


External Sources by Agents for HIV spending in KZN 2007/08 & 2008/09


HIV and AIDS Spending Activities NASA classifications:

Prevention Treatment and care OVCs Policy, management and coordination Human Resources Social services & Protection Enabling environment Research

Each have several sub-components

Total KZN HIV and AIDS Spending Activities

Comparison with Activities in SADC

Public Spending Activities

Private Spending Activities

External Spending Activities

Prevention Activities

Treatment Activities


OVC Spending


Programme Management etc.


HIV and AIDS Service Providers – 2007/08 & 2008/09


Beneficiaries of Total HIV and AIDS Spending


Beneficiaries of HIV and AIDS Services 2007/08


Beneficiaries by Activity (2008/09)


MARP SpendingMARPS in KZN (2007/08)

OVCs & Vulnerable Groups

Access.Pops.

2007/08

2008/09

DOH HIV and AIDS Spending in KZN

DOH Comprehensive Conditional Grant for HIV and AIDS


Total DOH ES & CG for HIV and AIDS (2007/08-2009/10)

DOH Absorption of ES & CG Funds (07/08)


KZN DOH CG Spending by Activity 2007/08 & 08/09


KZN DOH Spending on ART (2007/09 – 2009/10)

0

200

400

600

800

1,000

1,200

2007 2008 2009

ZAR

Mill

ions

Other

Food and nutrients

Reagents and materials

Medical & surgical supplies

Other medicines (excl ARVs)

Antiretroviral drugs

Pensions & Social contributions

Wages

DOH Programme Costs in ART Delivery

0

2

4

6

8

10

12

2007 2008 2009

ZAR

Mill

ions

Equipment not disagg.

Rental & Leases

Staff Training & Dev.

Logistics of events, including catering services

Housing & S&T

Transportation & travel services

Publishing materials

Mainten. & repair services

Admin services

Uniforms/ clothing

Public ART Unit Costs in KZN


2007/08 2008/09 2009/10Total spending by DOH on ART delivery (ZAR) 629,691,367R 742,797,541R 1,088,443,426R Total number of active ART patients 143,526 208,168 319,015Average Unit Cost (per patient per annum) ZAR 4,387.30R 3,568.26R 3,411.89R Average Unit Cost (per patient per annum) US$ 585$ 476$ 455$

KZN DOH Voted Funds for HIV and AIDS


KZN Total Voted Funds by Activity, 2007/08 & 2008/09

DRAFT - DO NOT DISSEMINATE.-

100

200

300

400

500

600

700

2007/08 2008/09

ZAR

mill

ions

Palliative care

Training

VCT

TB/HIV COMB MGMT

Step Down care

Prog Mgmt

Prev STIs

POLICY/ SYSTEMS DEV

PMTCT

OPEP&PEP

HTA

HBC (H/BAS COMHLTH WK) (HO/BASED CARE)

Communication / Prev

ARV Nutrition

ARVs

KZN Voted Funds Service Provider (2008/09)


KZN District Service Delivery Voted Funds for HIV and AIDS (%) (2007/08-2008/09)


KZN Hospitals Voted HIV Spending by Activity (%) 2007/08 & 2008/09


KZN Public Clinics Voted HIV and AIDS Spending (%)


KZN DOH Voted Funds to NGOs & Mission Hospitals by Activity 2007/08, 2008/09


KZN DOH CG for HIV and AIDS


DOH CG HIV and AIDS Spending Activities


KZN DOH CG Service Providers (2007/08)


KZN DOH CG Service Providers (2008/09)



KZN HAST HIV CG Spending (2007/08 & 2008/09)


-50

-

50

100

150

200

250

300

350

Hospitals 07/08 Hospitals 08/09

ZAR

mill

ions

VCT

Step Down care

Prog Mgmt

PMTCT

PEP& OPEP

HTA

HBC

Communications/ Prev

ARV Nutrition

ARVs

KZN Hospital HIV CG Spending (2007/08 & 2008/09)


KZN Clinic HIV CG Spending (2007/08 & 2008/09)

-

10

20

30

40

50

60

70

80

90

Clinics 07/08 Clinics 08/09

ZAR

mill

ions

VCT

Step Down care

Prog Mgmt

PMTCT

PEP& OPEP

HTA

HBC


ARV Nutrition

ARVs


-

5

10

15

20

25

30

35

NGOs 07/08 NGOS 08/09

ZAR

mill

ions

VCT

Step Down care

Prog Mgmt

PMTCT

PEP& OPEP

HTA

HBC


ARV Nutrition

ARVs

KZN NGO HIV CG Spending (2007/08 & 2008/09)

Currently the response in KZN is dominated by spending by DOH - Greater inter-sectoral effort required

More funds needed for prevention activities such as BCC, community mobilisation, male circumcision, PMTCT, youth interventions and VCT, and potentially microbicides

Prevention efforts increased for MARPs, while also attempting to address SA’s key modes of transmission

TB prophylaxis roll-out important with greater integration of TB and HIV and AIDS services

Other priority areas: OVC, Social mitigation, Enabling environment, Research – underfunded

Increased implementation of workplace wellness programmes

Additional resources for infrastructural development


Key Points & Recommendations (1)

Key Points & Recommendations (2) Voted DOH funds should continue to target other important

interventions i.e HBC, BCC,STI prevention and VCT because CG is devoted to ART

If KZN is reducing its ES for HIV and AIDS, then the CG must also cover these important interventions other than ART

More funds needed for HBC, step-down care & palliative care – best provided through NGOs

Greater treatment efficiencies in spending – lower tender drug prices, task shifting, step-down, clinic level delivery

Skilled and professional health workers required at the district level, but require adequate recompense to retain their skills


NGOs & CBOs play important roles and could be strengthened and expanded

DSD & DOH need to increase & standardize stipends to HBC volunteers

Financing and reporting requirements for NPOs need to be harmonized

Greater collaboration between provincial managers and district officials required in budget planning processes

An integrated Performance Budget System would greatly enhance planning, implementation & monitoring

Capacity building in data management, analysis and utilization of data in planning processes needed at district level


Key Points & Recommendations (3)

Thank you


PROVINCIAL COUNCIL ON AIDS MEETING 25 AUGUST 2010

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