The political will to achieve universal access of HIV services by 2015 juxtaposed with a decline in HIV donor funding requires HIV programs to rethink efforts to sustain scale-up of quality HIV services. This presentation provides insights into recurring HIV programing sustainability issues that have emerged from use of the HIV/AIDS Program Sustainability Analysis Tool (HAPSAT). Presenter: Itamar Katz, Wendy Wong December 2011

1. Tackling the Decline in HIV Resources:
Lessons Learned from HAPSAT
Itamar Katz, PhD, MPhil
Wendy Wong, BS
John Osika, MD,MPH,MHMPP,CCST,FFPH
December 2011
Abt Associates Inc.
In collaboration with:
I Aga Khan Foundation I Bitrán y Asociados
I BRAC University I Broad Branch Associates
I Deloitte Consulting, LLP I Forum One Communications
I RTI International I Training Resources Group
I Tulane University’s School of Public Health

2. Health Systems 20/20
 Health Systems 20/20 is the USAID
flagship project for strengthening health
systems worldwide
 55 countries, US$125 million
 Health Systems 20/20 developed the
HIV/AIDS Program Sustainability Analysis
Tool (HAPSAT) in 2008
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3. Outline
 Decline in financial resources
 Sustainability analysis
 HAPSAT-Plus
 Three lessons learned
 Capacity building
 Summary

4. HIV Funding: Donor and
Estimated Need
25
22 22
Billion US$
Estimated need 21 21 21
20 20
20 19
HIV donor funding 18
17
15
10
8 8 7
5
5 4 4
3
1 2
0
2002 2005 2008 2011 2014 2017 2020
Source: UNAIDS and Kaiser Foundation, 2011; Schwartländer, et al, 2011
Figures are rounded 4

5. Sustainability Analysis
What goals can be
achieved with the current
and potential capacity of
the program?

6. Sustainability Analysis: Example
$250
$200
$200
$150
Million US$
$150
$100
$80
$50
$-
Cost of scaling up to Cost of scaling up based Available funding
Universal Access on past performance

7. HIV/AIDS Program Sustainability
Tool (HAPSAT) is …
 Sustainability study/tool
 Provides evidence for decision-making and
target setting
 Comprehensive and flexible costing approach
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8. Evolution of HAPSAT
 Original HAPSAT:
 Gap analysis
 Recommendations for efficiency
 The “plus” in HAPSAT-Plus:
 Recommendations also on prioritization
 Based on stakeholder priorities
 HAPSAT 2.0 software - simplified, flexible, user-friendly
 Knowledge hub for sustainability
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9. HAPSAT 2.0 Workflow
Understanding need for HIV services in the country
Defining HIV interventions
Quantifying unit costs and human resources unit cost of HIV interventions
Defining policy scenarios (target setting)
Quantifying financial and human resources policy scenarios
Gap analysis: Comparing resources required to resources available
Resource Mobilization Efficiency Prioritization

10. HAPSAT Experience
Prioritization
of services
HRH solutions
Domestic resource
mobilization
• Benin • Guyana • Sierra Leone
• Cote d’Ivoire • Haiti • South Sudan
• DR Congo • Kenya • Vietnam
• Ethiopia • Nigeria • Zambia

11. Lesson Learned 1: Efficient Use
of Existing Resources
 Guyana:
 Interim, efficient solution for data flow
 Revisiting belief of shortage in health workers
 South Sudan: Avoiding costly HIV-prevention
facilities
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12. Lesson Learned 2: Integration,
Integration, Integration
 Extent of integration of HIV services varies by
country, yet need to examine:
 Integration into the wider health services
 Integration into social services
 Integration for resource mobilization
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13. Unit Cost of ART
Drugs
8%
8% Supply Chain Logistics
36%
Training
21% Laboratory Tests
Labor
4% Facility Overhead
2%
Central-Level Overhead
22%
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14. Lesson learned 3: Prioritize and Set
Realistic Targets
 Need to prioritize interventions
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15. Billboard vs. Radio for HIV
Awareness in South Sudan
Cost per
Context Priority
exposure
Radio ads
Major information source for
and talk- US$ 0.003 High
Southern Sudanese
shows
Low literacy levels limit its use,
Billboards US$ 0.05 Low
potentially useful in urban areas

16. Lesson Learned 3: Prioritize and Set
Realistic Targets
 Need to prioritize interventions
 Frequently unrealistic targets are formulated:
 Commitment to reach international targets
 Mobilizing more resources:
• Over-ambitious targets to justify more resources
• Under-ambitious targets to ensure achieving targets in
performance-based mechanisms
 Lack of data prevents setting ambitious, yet feasible, targets
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17. Target Setting
80% Number of people on ART: past 80%
performance
Projected scale-up based on past
60% Reaching universal
performance (proxy to capacity)
coverage requires
Scale-up towards universal access efforts beyond
apparent capacity
40%
35%
20%
20%
11% Both are costed for
stakeholders to decide
on their scale-up
0%
2007 2008 2009 2010 2011 2012 2013 2014 2015

18. Target Setting in HAPSAT 2.0
Software
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19. Target Setting in HAPSAT 2.0
Software
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20. Capacity Building
 Country level:
 Engaging implementers in sustainability approach
 Training on the HAPSAT 2.0 software
 Regional level: Training two regional research
institutions
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21. Capacity Building of Regional
Institutions
 Advantages  Challenges
 Regional capacity  Teaching a flexible
building approach
 Increased scalability of  Ensuring standardization
HAPSAT  Building capacity:
 Potential cost reduction • Technical
• Managerial
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22. HAPSAT Take-aways
 Targets need to be realistic
 Resource mobilization strategy needs to be
aligned to targets
 Participatory approach promotes country
ownership
 Helps policymakers to think through
sustainability issues
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23. Country-level Results
 Kenya: Developing an innovative financing
mechanism
 South Sudan: Avoiding expensive ineffective
prevention activities
 Guyana: Changing thinking on shortage of health
workers
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24. Thank you
For more information…
hapsat@abtassoc.com
www.healthsystems2020.org/hapsat
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