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Evidence-based HIV/AIDS Programming: A Couple Examples

Evidence-based HIV/AIDS Programming: A Couple Examples. Ann Lion Health Systems 20/20 (a USAID funded HSS Project). PEPFAR Supported Research in HSS. SWEFs: Ethiopia HSAs: Nigeria, Vietnam, Namibia HRAs*: Kenya, Nigeria, Cote d ’ Ivoire, Egypt, Ethiopia, and Zambia

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Evidence-based HIV/AIDS Programming: A Couple Examples

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  1. Evidence-based HIV/AIDS Programming: A Couple Examples Ann Lion Health Systems 20/20 (a USAID funded HSS Project)

  2. PEPFAR Supported Research in HSS • SWEFs: Ethiopia • HSAs: Nigeria, Vietnam, Namibia • HRAs*:Kenya, Nigeria, Cote d’Ivoire, Egypt, Ethiopia, and Zambia • NHAs*: Over half of 100 NHAs. e.g.,: Kenya, Uganda, Mozambique, Yemen, Rwanda, Namibia • SPAs: Cote d’Ivoire, Nigeria • HAPSATs: Zambia

  3. Developing Empirical Evidence for HRH Planning: Four Steps • Assess current HRH situation • Availability, skills mix and distribution of HRH • Changes in the HRH stock (attrition and entry of new graduates) • Project future availability of HRH • Estimate future HRH requirements consistent with health targets (PEPFAR and MDGs) • Use findings to develop policy recommendations

  4. Nigeria: Projected and Required HRH The public health sector in Nigeria will not have sufficient number of health workers to reach the MDGs, at current rates of attrition and in-service training

  5. Strategies to Address HRH Shortages • Incentives to attract and retain health workers • Housing, in-service training and career development opportunities, subsidy for school fees and transportation, hardship pay for rural/underserved areas • Utilization of unemployed and retired health workers • Expanded hiring, contracting, in-service training • Scaling up and adjusting skills mix of pre-service training

  6. Resource Tracking:National Health Accounts • NHA describes the flow of funds through a health system. It reveals: • Who spends on health care • How much they spend • What types of health services/functions are purchased • Is inclusive of all financing actors in the public, semi-public, and private sectors • A tool for policymakers to make better informed decisions regarding health financing

  7. Who Pays and How Much for HIV/AIDS Health Care - Zambia Data Sources: National Health Account-HIV/AIDS subaccounts, Zambia

  8. Evidence of Higher Out-of-pocket Spending by PLWHIV informs policy actions Data sources: Country National Health Accounts Data; Rwanda, Zambia (5 yr GFATM eval), Tanzania (5 yr GFATM eval).

  9. Evidence to Inform Shift in Donor Funding to Increase Local Stewardship Rwanda HIV subaccounts 2006 NHA shows how the Rwandan National AIDS Commission (NAC) has strengthened its coordination role over time

  10. Use of NHA Data: Civil Society in Kenya Lobby Government for ART Line Item • Civil society had difficulties engaging in national debates, due to paucity of data to substantiate their claims/requests • 2002 NHA HIV/AIDS subaccount finding showed that: • The government did not contribute to ARV • The Spending was largely on prevention • Impact: • Kenya Treatment Access Movement (KETAM) used finding to lobby government for budget line-item for ARV • Public hearings ongoing and government is discussing how to introduce this budget allocation

  11. NHA and National AIDS Spending Assessment (UNGASS Reporting) Harmonized NHA Reproductive health All other health spending NASA/ UNGASS Crosswalk HIV/AIDS Malaria Subaccounts Developed at the international level and applied in Rwanda during the 2006 estimation

  12. Conclusions • PEPFAR research exemplifies “Positive Synergies” through broader health system impact: • research to guide decision making for programs • empirical evidence for national level planning and coordination among donors • Because of the diversity of the GHIs, program research needs to be comprehensive, coordinated, and useful to planners/policy makers

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