Costing human rights and gender equality commitments in the context of HIV
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Costing human rights and gender equality commitments in the context of HIV
- 1. Costing human rights and gender equality commitments in the context of HIV UNAIDS Human Rights Costing Tool (HRCT) Lina Nykänen-Rettaroli Human Rights, Gender and Community Mobilization Adviser UNAIDS Argentina, Chile, Paraguay and Uruguay
- 2. Global HIV Commitments • UN General Assembly Special Session on HIV/AIDS 2001 Declaration of Commitment on HIV/AIDS • UN High Level Meeting on HIV/AIDS 2006 Political Declaration on HIV/AIDS • UN High Level Meeting on HIV/AIDS 2011 Political Declaration on HIV/AIDS, Intensifying Our Efforts to Eliminate HIV/AIDS ALL THESE DECLARATIONS INCLUDE COMMITMENTS ON HUMAN RIGHTS AND GENDER EQUALITY
- 3. 3 2011 Political Declaration Targets and Elimination Commitments Sexual transmission Drug injection Children Treatment Tuberculosis Systems integration Travel restrictions Stigma, discrimination Gender inequalities Resources
- 4. In the Political Declaration on HIV/AIDS (2011), Countries committed to: “…eliminate gender inequalities and gender-based violence, increase the capacity of women and adolescent girls to protect themselves from the risk of HIV infection, …, ensure that women can exercise their right to have control over, and decide freely and responsibly on, matters related to their sexuality, including their sexual and reproductive health, free of coercion, discrimination and violence, in order to increase their ability to protect themselves from HIV infection, and take all necessary measures to create an enabling environment for the empowerment of women and to strengthen their economic independence, and, in this context, reiterate the importance of the role of men and boys in achieving gender equality”.
- 5. In the Political Declaration on HIV/AIDS (2011), Countries committed to: “…national HIV and AIDS strategies that promote and protect human rights, including programmes aimed at eliminating stigma and discrimination against people living with and affected by HIV, including their families, including through sensitizing the police and judges, training health-care workers in non-discrimination, confidentiality and informed consent, supporting national human rights learning campaigns, legal literacy and legal services, as well as monitoring the impact of the legal environment on HIV prevention, treatment, care and support”. Commitment not on human rights outcome only, but also on the process to get there!
- 6. VISIONZERO NEW HIV INFECTIONS. ZERO DISCRIMINATION. ZERO AIDS-RELATED DEATHS.
- 7. UNAIDS Strategic Directions Treatment, care & support Access to effective treatment when people need it Strong national & community systems Access to care, support & social protection HIV prevention Political commitment to why people are getting infected Communities demand transformative change Resources directed to hotspots and what works Advancing human rights & gender equality Protective social & legal environments enable access Equitable service provision reaches people most in need HIV-related needs and rights of women and girls addressed and realised
- 8. Investment Approach to HIV SYNERGIES WITH DEVELOPMENT SECTORS Social protection; Education; Legal Reform; Gender equality; Poverty reduction; Gender-based violence; Health systems (incl. treatment of STIs, blood safety); Community systems; Employer practices. CRITICAL ENABLERS Social enablers • Political commitment & advocacy • Laws, policies & practices • Community mobilization • Stigma reduction • Mass media • Local responses, to change risk environment Programme enablers • Community-centered design & delivery • Programme communication • Management & incentives • Production & distribution • Research & innovation Care & treatment Male circumcision Keeping people alive BASIC PROGRAMME ACTIVITIES Key populations Children & mothers Condoms OBJECTIVES Stopping new infections Behaviour change
- 9. 0 5 10 15 20 25 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 USD (Billions) The UNAIDS investment framework Focus on what makes a difference Basic Programme Activities Critical Enablers Synergies
- 10. Are countries fulfilling their HIV-related human rights and gender commitments? • Almost all countries report including human rights in their national strategies for HIV (89% in UNGASS 2010) • However, UNAIDS Assessment (2009) of the level of inclusion of human rights and gender equality activities, indicators and budgets in national strategic plans for HIV and major funding proposals showed that: o Human rights and gender equality mentioned as guiding principles or cross-cutting strategies o Some concrete activities included o BUT most drop off in budgets and M&E frameworks
- 11. Moving from human rights as guiding principles to concrete action
- 12. Seven key programmes to reduce stigma and discrimination and increase access to justice 1. Programmes to reduce stigma and discrimination 2. HIV-related legal services 3. Programmes to reform and monitor laws relating to HIV 4. Legal literacy programmes (“know your rights and laws”) 5. Human rights training for health care workers 6. Training and sensitization of law enforcement agents on HIV and human rights 7. Programmes to promote the rights of women in the context of HIV
- 13. Challenges in costing of HIV–related human rights programmes Lack of clarity on the definition of the human rights and gender programmes Absence of literature and data on costs of HIV-related HR programmes Little experience in costing and budgeting human rights - Existing tools do not refer to HR in detail Cross-cutting vs. stand alone approach to human rights Differences in knowing your rights affects demand
- 14. UNAIDS Human Rights Costing Tool (HRCT) Objectives: •Conduct detailed activity based costing of human rights •Estimate average unit costs •Estimate resources needed to operationalize HR commitments
- 15. Steps to frontloading human rights programmes HRCT Source: Victor Steenbergen, a guide to Costing Human Rights, 2011
- 16. HRCT Strategic planning, costing landscape and the HRCT
- 17. Characteristics of the tool Excel Based Built over the 7 key programmes recommended by UNAIDS Flexible and adaptable Designed to be used at the provider level, i.e. at the facility The tool can be used by programme officers and financial officers when developing or extending existing human right programmes Complementary to existing costing tools
- 18. The HRCT approach: costing HR programmes in five steps Step 1: Defining programmes and activities Step 2: Reporting on outputs (or outcomes) of services achieved or targeted Step 3: Reporting on the cost of human resources directly associated to the implementation of the programmes Step 4: Reporting on indirect costs of the organisation (i.e. overheads) Step 5: Reporting on specific operational costs directly associated to each activity; i.e. inputs directly related to the implementation of an activity
- 19. Baskets of services for each of the 7 programmes HIV-related legal services Provision of legal information and referral Legal advice Legal representation Mediation between local service providers, communities, police, etc Strategic litigation Alternative forms of dispute resolution (e.g. village courts) Research and analysis Programmes to support the rights of women in the context of HIV Community mobilization and education Legal information, advice and representation Law reform (e.g. property, inheritance, custody, equality within marriage) Working with traditional leaders to address gender norms Life-skills at school Development of tools and guidance Research and analysis
- 20. Uses of the data generated by the HRCT • To estimate the funds required for operational planning or budget proposals • To inform development of the national strategic plan for HIV • To support the monitoring of these 7 key programmes • To evaluate past HIV response by using service unit costs as an input for cost-efficiencies and cost-effectiveness analyses • To provide key inputs for other normative costing tools focusing on national programmes or strategies • To support advocacy of the key programmes by producing strategic information on the cost and outcomes of these programmes; and • To help make decisions in the routine implementation and management of these programmes.
- 21. Piloted in 14 countries
- 22. HRCT currently being applied in Jamaica Indonesia Mozambique Argentina
- 23. Lessons learnt • Has helped identify the real costs, including indirect costs • Process of applying the tool allows broader discussion on what it takes to address human rights in the context of HIV • Places costing at the centre of defining the content of programmes (not at the end) • Has strengthened capacity of civil society in strategic planning and resource mobilisation
- 24. Challenges • Difficulty in classifying activities into the 7 key programmes • Better definition of activities needed • The tool needs to be applied in a large number of organisations implementing HR activities to be able to generate unit costs for planning at national level • Difficult to engage partners beyond National AIDS Programme and civil society working on HIV • Budgeting: whose budget is should be in?
Notes de l'éditeur
- Almost all countries report including human rights in their national strategic plans (89% in 2010). However, assessments of national strategic plans done by UNAIDS indicate that human rights are often mentioned as guiding principles but plans include very few concrete programmatic activities to support human rights. Even where activities were mentioned, these were often not costed or budgeted for. Nor were there many indicators included in the plans to monitor human rights and law issues. It appeared therefore that although there was increased political commitment at country level to promote human rights in the context of HIV, countries lacked understanding and capacity to translate the human rights commitments they had made into concrete actions. The UNAIDS Human Rights Reference Group as well as civil society at country and regional levels have called UNAIDS to concretise human rights. We have therefore responded to the demand out there to come up with a package of recommended human rights programmes as well as guidance and tools to help countries include these programmes in their national HIV responses.
- The main work of the Human Rights and Law Division focuses on targets 8 and 9.
- Start with some background
- Start with some background
- UNAIDS new strategy takes us towards our vision of zero, zero, zero
- Almost all countries report including human rights in their national strategic plans (89% in 2010). However, assessments of national strategic plans done by UNAIDS indicate that human rights are often mentioned as guiding principles but plans include very few concrete programmatic activities to support human rights. Even where activities were mentioned, these were often not costed or budgeted for. Nor were there many indicators included in the plans to monitor human rights and law issues. It appeared therefore that although there was increased political commitment at country level to promote human rights in the context of HIV, countries lacked understanding and capacity to translate the human rights commitments they had made into concrete actions. There was therefore a need to come up with a package of recommended human rights programmes as well as guidance and tools to help countries include these programmes in their national HIV responses.
- To support countries in translating commitments into concrete programmes that support human rights in the context of HIV, UNAIDS has done the following: Identified 7 key programmes to reduce stigma and discrimination and increase access to justice (through available literature and expert advice) Assessed the inclusion of these in national strategic plans, budgets, M&E frameworks and funding proposals Developed a series of guidance and tools to support their inclusion in NSPs and funding proposals
- Identified through literature and in consultation with the UNAIDS Reference Group on Human Rights and HIV
- Most countries acknowledge that HIV-responses will not be effective unless stigma and discrimination are reduced and key population are supported to access HIV services. Most NSPs therefore include some programmes to support rights and reduce stigma. However, these programmes are often not costed and budgetted for and therefore not implemented. There is currently little experience in costing these programmes. There is a wide range of literature and data referring to the cost of having one patient on treatment, or on the cost of providing VCT to a person, but there is no such information when it relates to human rights activities on a stand alone approach. This is why costing human right activities for NSPs will also require to produce unit service costs of different activities by costing existing programmes at the provider level. More complicated to assess cost-efficiency and cost-effectiveness. Challenge of costing human rights as cross-cutting vs stand-alone programmes. All HIV programmes should be planned and implemented through a human rights based approach. This may entail extra resources to be allocated, for example, to training personnel on non-discrimination, confidentiality and informed consent , to linking HIV services to other services (e.g. to gender based violence prevention, to legal services, etc.) All HIV responses should also include specific, stand-alone, programmes to support human rights, e.g. stigma and discrimination reduction in different settings, law reform, etc. Different approaches are needed for costing mainstreamed and stand-alone human rights activities. The demand can vary considerably from a country to another due to the epidemic and specificity of the country. However, with HIV-related human right programmes, the variation can be more important as the level of legal literacy (knowing your rights) can affect de demand for HR services. For example, if the persons in need are not knowledgeable of their rights and of the legal mechanisms to claim them, they will probably not be seeking legal services (legal advice, information, representation, etc.) It is difficult to apply a standardized approach to the HIV-related human rights response in the country due to specificities of the epidemic, of the legal systems in place, or in the cost of specific interventions. This requires flexibility in the implementation scale of each key programme and specific studies to capture the costs of key programmes nationally.
- Within the national strategic planning process, key human rights programmes need to be costed to ensure that sufficient resources are allocated to the programmes and activities. The costing process is usually done after the definition of the activities and the development of an operational plan . The results obtained will describe the resources required to implement the NSP and the Operational Plan. However, costing studies can also be carried out at other steps of the result cycle. Activities that have already been implemented can be costed to produce strategic information on the analysis of the response and to support decision makers when deciding on the strategic programmes and activities to be implemented. In a way, the tool also supports the planning and management of HIV-related human right programmes by detailing the programmatic components and activities under each programme as well as capturing the targeted outputs. However, it is to note that these elements are not done within the costing exercise; they are done before.
- Different approaches and different tools depending on the costing landscape. The absence of data on the cost of human rights programmes made it necessary to collect data at the provider level. Estimate the cost of a programmes through activity based costing (analytical costing) Estimate the average unit service cost (analytical costing) Support financial projections for National Strategic Plans or GF applications Cost efficiency and cost effectiveness studies Estimate the amounts required for future plans (normative costing) Estimate funds required for operational planning or budget proposals (e.g. GFATM) Support planning and monitoring of key human right programmes
- Data included in the costing tool General information and contacts Programmes and activities planned or implemented Outputs (achieved or planned) Human resources (permanent direct staff costs) Costs: indirect costs (rent, energy, capital, etc.) direct operational cost by activity and programme Different steps of the tool: Step 1: Reporting activities implemented under each programme Step 2: Reporting on outputs (results) of services achieved or targeted Step 3: Reporting on the cost of human resources directly associated to the implementation of the programmes Step 4: Reporting on specific operational costs directly associated to each activity; i.e. inputs and unit prices – directly related to the implementation of an activity (one sheet by Key Programme implemented) Step 5: Reporting on indirect costs of the organisation (i.e. overheads)
- Initial field testing in 5 organisations from Namibia and Malawi in February 2011 Piloting exercise in 25 organisations from Kenya, Burkina Faso, Senegal, Cameroun, Ghana, Thailand, Philippines, Morocco, Belarus, Jamaica, Dominican Rep and Mexico