An overview of the NASA
methodology
Teresa Guthrie
Centre for Economic Governance and AIDS in Africa
Overview of this Presentation
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UNAIDS’ aim
Introduction to resource tracking & NASA
Purposes of NASA
NASA relationship to NHA
NASA methodology
Ghana NASA objectives - expectations
Anticipated process
NASA requirements
Low- and middle-income countries
reporting on domestic expenditure for
the review of the DoC. March, 2006
Resource Tracking: Purposes
• To provide indicators of the financial
country response to HIV/AIDS or health
• To support monitoring resource
mobilization
• To obtain information in order to
improve decision- making
• To define priorities regarding the
distribution of resources
• Not an auditing process
National AIDS Spending
Assessment
NASA is a generic term currently used for
all country’s HIV/AIDS resource tracking
activities.
It provides a framework and tools for
undertaking a comprehensive analysis of
actual expenditures for HIV/AIDS - which
can be applied to any HIV/AIDS activity
(health and non-health).
NASA data usefulness
• Measurement of Spending
– Total Domestic Public (e.g. UNGASS indicator)
– Inflows by donors (e.g. GF additionality)
– Private – OOPE, business, NGO
• Usefulness as input in the AIDS planning cycles
– Complimentary with the NSP categories
– Complimentary with Resource Needs
• Provides the base data to undertake further analysis:
Equity, beneficiary analysis, Efficiency, Bottlenecks,
Absorptive capacity, Allocative efficiency, etc.
NASA’s contribution
• Well developed methods and tools – userfriendly, internationally comparable stds
• Skills transfer and capacity building of
NAC, UNAIDS & consultants
• Contribute to the development of financial
information systems for the ongoing
monitoring by NAC
Complimentarity to the
Resource Needs Model
• NASA and the RNM use the same
classification for HIV/AIDS activities
• This makes analysis of the financing gap
between current expenditure and the
projected resource needs more useful for
Programme managers
Use of NASA Results: Work in progress
aimed at supporting better spending in
countries
• Efficiency: Bottlenecks and absorptive
capacity
• Additionality – GF projects
• Improved tracking of non-health
expenditures: Expanded response
• Timeliness of data: opportunity to
influence policies
• Allocative effectiveness – funding for
the right interventions
• Equity – funding for the right populations
NASA Framework for HIV/AIDS
NASA is not limited to health expenditures
for HIV/AIDS, but emphasizes the
tracking of non-health expenditure such
as social mitigation, education, labour,
justice and other sectors’ expenditure
related to HIV/AIDS
Captures according to categories similar to
the NSPs - more useful to NACA
HIV
AIDS
Health
Systems
National
AIDS
Accounts
NHA
HIV/AIDS
Subanalysis
State AIDS
Budget
Analysis
Idasa - ABU
Adjusted
from PHR+ presentation, Feb 04. PHR+.
12
PHRplus
SIDALAC
The Development of the 3 Approaches
for HIV/AIDS Funds
Govt
Budgets
NASA Relationship to NHAs
• Same accounting procedure
• Same data produced with more
disaggregation of activities/ functions
• Data for non-health expenditure
• NASA is compatible and comparable with
NHA (HIV sub-analysis), but provides
greater detail for NSP usefulness
Coverage of AIDS Resource Tracking
NAA
NHA-AIDS
Personal
services
Public
Health
Memorandum
Items
Care and
Treatment
Prevention
and Public
Health
Non-health
Non-health
(memorandum
items.)
Differences on
personal services with
Public Health
implications, e.g. STI.
NASA
Care and
Treatment
Prevention
and Public
Health
• Orphan & VC
• HR (incentives)
• Social
mitigation
• Community
development
• AIDS related
research (not
OR)
NASA Spending Categories/ Priorities
Proportional Spending Priorities 2005
100%
FN 8..HIV- and AIDS-Related Research
FN 7..Community Development &
Enhanced Environment
80%
FN 6..Social mitigation
60%
FN 5..Human Resources for HIV and
AIDS activities
FN 4..Prog.Devmt & HSS strengthening
40%
FN 3..Orphans and Vulnerable Children
(OVC)
20%
FN 2..Treatment and care components
Total
0%
FN 1..Prevention Programmes
Public sector
Internat.Orgs
NASA Treatment Components
PUBLIC Treatment Expenditure 2005
Antiretroviral therapy.
6%
Prophylaxis for Opportunistic
Infections - mainly IPT
37%
Treatment of Opportunistic
Infections.
Hospital treatment and care.
40%
Palliative care (incl. HBC)
1%
16%
NASA Beneficiaries of Spending
Beneficiaries by Agent (2005)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Public sector
Private sector
International Orgs.
PLWHA
Most at Risk Pops.
Vulnerable Groups.
Accessible Pops.
Gen.Pop (non-targeted)
Other Pops.
NAAs ~ HIV/AIDS per capita
expenditures LAC and selected African
countries. PPP-USD$, 2002/3. (Pre-GF)
PPP$ 15
Zambia
Ghana
Burkina Faso
Kenya
Rwanda
PPP$12
PPP$10
PPP$ 8.12
PPP$ 7.79
Honduras
Uruguay
Argentina
Haiti
Costa Rica
Nicaragua
Panamá
Brasil
Perú
R Dominicana
El Salvador
Paraguay
Chile
México
Guatemala
Bolivia
0.00
Q4
Q3
Q2
Q1
2.00
4.00
6.00
8.00
10.00
12.00
NASA Classifications
R.T.
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aims to collect comprehensive data regarding:
Sources – who pays
Agents – who manages the funds
Service Providers – who provides the services
Functions/activities – what is provided
Beneficiaries – who benefits
Objects of expenditure – what are the components of
expenditure
The primary responsibility of the resource tracking team is
to ensure that the classification scheme used is made
of mutually exclusive and exhaustive categories within
each of the classifications.
Assessment Along 3 Dimensions
• 3 dimensions and 6 vectors
• Financing:
– (1) Sources
– (2) Agents
• Provision:
– (3) Providers
– (4) Production factors
• Consumption
– (5) Activities
– (6) Beneficiary groups
Triangulation
Purchasers
Providers
Factors of
production
Sources
Commodities
Consumption
Beneficiaries
Financial Source
Entity which generates the funds and
makes the decision for assigning
resources to functions, or agents
e.g. Ministries of Finance/ Treasury
- Global Fund
- World Bank
Financial Agent
Intermediary flow in the context of health
financing.
If a financial agent assigns resources to
confront AIDS, for NASA purposes,
becomes a financial source as well
e.g. Ministry of Health, National AIDS
Commission
Provider
Entity responsible for delivering goods or
services in response to HIV/AIDS or
health
e.g. Blood bank
- Ambulatory care center (OPD)
- Hospital
Activities/ Spending Categories
All the interventions, services and
activities undertaken/ provided in
response to HIV/AIDS.
They are comparable across resource
needs and resource tracking – i.e. must
be standardised across studies and
between countries for comparison
purposes.
NASA Spending Categories for
HIV/AIDS
Classified for eight HIV/AIDS programmatic areas
• Prevention - Mass media, condoms, HRPs etc.
• Treatment & care – ARVs, OI Rx, palliative care etc.
• Orphans and vulnerable children – education, family support,
nutrition etc.
• Programme development & strengthening health care systems for
HIV/AIDS – program management, monitoring, training,
upgrading/new buildings etc.
• Human resources for HIV/AIDS activities – monetary incentives
• Social mitigation – social/financial support, human rights etc.
• Community development and enhanced environment – institutional
development, IGAs, women’s programmes etc.
• Research – biomedical, social, psychological, behavioural, vaccine…
Target Group or Beneficiaries
Population of interest addressed by / benefiting from
the activities:
• People living with HIV and AIDS
• Most at risk populations
• Vulnerable groups
–
–
–
–
OVCs
Migrants
Refugees
Men who have sex with men (MSMs)
• Accessible populations
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–
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STI clinic patients
Women – reproductive health clinics
Police, military, truckers, sailors
Children at school
• General populations
Object of Expenditure
Production factors purchased to produce a good or deliver
a service, under any determined production function
e.g. Current expenditure
– Wages/ salaries/ non-wage income
– Pharmaceutical products (ARVs, other drugs)
– Reagents, materials, supplies
– Condoms
– Services
• Transport
• Training of staff
• Consultant services
• Administrative
• Capital
– Buildings, equipment, vehicles, capital transfers
Tracking the Transaction
Is the basic unit of the financial flow, that
describes the transit of resources from a
source to a provider, who purchases
objects of expenses to develop one or
more functions benefiting target groups,
specified or not.
Flow of resources from origin to end users:
reconstruction of transactions
Source
Provider
Functions
A
C
B
Objects of Expenditure
Non
Specific
Target Groups
Sources of Data for NASA
• Top-down: from sources of funds eg donor
reports, commitment reports, government
budgets etc.
• Bottom-up: service provides’ expenditure
records, facility level records, governmental
dept. expenditure accounts.
• Missing data: costing techniques are used to
estimate actual expenditure
Flow of resources from origin to users:
reconstruction of transactions (“Top Down”)
Sources
Financing
Agents
Financing
Providers of
services
Provision
Production Factors
Functions
(Health or non-Health)
Use
Beneficiaries
- Specific Target
Groups
- Or unspecified
Reconstruction of transactions (“Bottom Up”) to
reconcile with flows from sources (ceiling)
Financial
Sources
Financing
Financing
Agents
Functions
Providers of
services
(Health or non-Health)
Beneficiaries
Provision
Production Factors
Use
REPORTING TO UNGASS
Expenditure on HIV and AIDS
MANDATORY (as agreed in the UNGASS DoC)
RECOMMENDED (Components of the total figure to be reported)
OPTIONAL
ORIGIN OF THE SOURCES by FINANCING AGENT
PUBLIC
INTERNATIONAL
Functions
TOTAL
1.
Prevention
2.
Care and Treatment
3.
Orphans and Vulnerable
children
4.
Program Management costs
5.
Incentives for Human
Resources
6.
Social Mitigation
7.
Community development and
enhanced environment
8. Research
Multilaterals
Development
Development Bilaterals
Central
SubBanks Grants
Bank
UN GF
Total (National) national
(nonReimbursable
USD $
reimbursable)
PRIVATE
Corporations
Out-ofpocket
Challenge of estimating information
not easily accessible
• There are several components for which the
information is not easily accessible
– e.g. unlikely to be reported and leave “administrative trail”
• Example: Treatment of Opportunistic Infections in
public settings
– Part of the hospital budget
– Need to use costing tools to provide the best possible
estimations
Costing Techniques for Estimations
• Internationally accepted costing methods and
standards used to retrogressively measure past
actual expenditure
• Ingredient and step-down costing is used for
direct and shared expenditure for HIV/AIDS
• Shared costs are allocated on the most
appropriate utilization factor
• Donated goods and in-kind servicies are valued
at their valve in the year of consumption
• Capital goods costs are annualised and adjusted
for inflation (where appropriate)
NASA process/ timeframe
• Planning & training – week 1
• Key stakeholder meeting – end of week 1
• Identification of key sources of data & appointment
setting – 1-5days
• Obtaining permissions, letters of access – 2/3weeks
• Data collection (interviews, site visits) – 4-5weeks
• Data capturing in the software – ongoing. 2weeks.
• Data analysis – 1/2 weeks
• Draft 1 of report – 1/2 weeks
• Validation meeting – prelim findings to stakeholders
• Editing and improving report – 1 week
• Finalisation of report
NASA Team Requirements
• Permissions – letters to key sources of data – especially
Moh, MoE, MoLG (SS), district level services
• Comprehensive database of all sources, agents,
providers in Ghana
• Assistance with sample selection & site visit preps
• Secondary data (refer to list)
• Access to expenditure records et al – electronic and hard
copies
• GAC & UNAIDS representatives, ISSER team
• Data capturers (?)
• Transportation & accommodation for site visits
• Printing of docs etc.
Thank you!
Teresa Guthrie
Centre for Economic Governance and AIDS in Africa
[email protected]