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
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Tackling the Decline in HIV Resources: Lessons Learned from HAPSAT
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
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
7
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
8
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
11
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%
13
14. Lesson learned 3: Prioritize and Set
Realistic Targets
Need to prioritize interventions
14
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
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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Notes de l'éditeur
Resources increased, than decreased; funding increases Round 11
Sustainability study/tool Gap analysis solutions Provides evidence for decision-making and target setting Data based and various scenarios Comprehensive and flexible costing approach
Triangulation of costing Does not accept a cost as is Target setting for multiple scenarios
Data sources Does not accept a cost as is
Change map – do not differentiate Note that the bolded countries were countries in which the HAPSAT-Plus methodology was refined (Kenya, S. Sudan) or applied (S.L., Guyana). Mention that the institutions we are building HAPSAT capacity in were trained on the new tool; ISED (trained in May) will carry out a HAPSAT in Benin under HS20/20 guidance, and HEARD (being trained next week) will carry out a HAPSAT in a yet to be determined Anglophone African country.
Here examples encountered in HAPSAT The prevention facility - No always work
Do not refer to HAPSAT
Do crispy
Sierra Leone = strategy and operational plan
Formulation of targets: Denominator/need Data for formulating the denominator Data for measuring the coverage
Still not enough to meet the demand
Short and sweet, easy transfer to last slides Provide examples Reduce BCC from 6m to 2.7m Reduce testing from 10m to3.2m Justify costs – e.g., show ART unit cost is low