Thailand National Aids Account 2000-2003

1. Thailand National Aids Account2000-2003 Waranya Teokul* Walaiporn Patcharanarumol** Chitpranee Vasavid** Pornpimol Cheewacheun* Viroj Tangcharoensathien** * National Economics and Social Development Board, Office of Prime Minister ** International Health Policy Program-Thailand 5 September 2005

2. Outline for presentation • Background and HIV/AIDS situation in Thailand • Objectives • Methodology • Results: HIV/AIDS expenditure by • Financing agencies • Healthcare functions • Healthcare function and financing agencies • Policy implication • Recommendation

3. Background • GDP per capita was 2,060 US$ or 7,010 PPP US$ (2002), with a growth rate of 2.9% (average for 1990-2001). • HDI in 2002 was 0.768; rank 76th (Human Development Report 2004) • 2001 achieved Universal Health Care Coverage • NHA well-established, 3 dimensional matrix for 1994-2001 areavailable • Current Health Expenditure (CHE) • High burden from HIV/AIDS: Disable Adjusted Life Year (DALY) loss = 17% among men and 9% among women in 1999

4. HIV/AIDS situation in Thailand Estimated cumulative numbers of HIV/AIDS in the year 2002 • PMTCT covered 85% of HIV pregnancies, pediatric HIV 98% and breast milk substitution 88% (Dept of Health 2004) • ART: 350 US$ per patient year, target = 5-60,000 pt in 2004 Source: 1 Thai Working Groups on HIV/AIDS Projection 2001 2 Children on the Blink 2002, UNAIDS

5. Objectives • To develop methodological approaches for the construction of NAA. • To construct NAA for four years, 2000-2003, in order to estimate total HIV/AIDS expenditure by finance agencies and healthcare functions. • To provide policy recommendations on financing HIV/AIDS.

6. Conceptual Framework • Based on the principle ofThailand National Health Account (NHA)which was adapted from OECD’s System of Health Account • Tracking HIV/Aids expenditure flow on two dimensions • Financing Agencies (FA) • Healthcare Function (HC) • The third dimension of health care provider (HP) was dropped, as most of HIV/AIDS services were provided by public providers

7. Sources of Financing Agencies • 5 Government agencies • Ministry of Public Health • Other ministries • Local Government • Civil Servant Medical Benefit Scheme (CSMBS) • Social Security Scheme (SSS) • 2 Non Government Agencies • Out of Pocket Payment • Rest of the World (ROW)

8. Categories of Healthcare Function • Current Health Expenditure • Curative Services e.g., OI treatment, STI treatment, ART • Preventive Services e.g., PMTCT, VCT, safer sex practices, blood safety • Healthcare Related Expenditure • Education and Training • Research and Development • Capital Formation on AIDS program can be inserted here (Dropped from this version) • Memorandum Items • Impact mitigation of AIDS (care for orphan, protecting rights of PLWA and social supports) • Social research

9. NAA matrix (FA x HC)

10. Methodology • Scope • Actual expenditure – not budget figures • Only recurrent expenditure included, capital investment excluded. • Data source • Secondary data collection on actual expenditure where available • Government agencies report on the use of budget • Where 2nd data is not available • Estimate based on PQ approach • Unit cost of services • Total services rendered

11. Existing database • The weekly Epidemiological Surveillance Report (WERS) • Covers almost all public health facilities • OI incidence and profile • PMTCT program • PMTCT enrolees and program outcome • By Department of Health of the MOPH • Government budget in all concerned ministries on HIV/AIDS activities, several years • Comptroller General Department (CGD) • The annual sero-sentinel and sex behaviour sentinel • Updated HIV prevalence among different groups • Bureau of Epidemiology, several years

12. Key Findings from NAA in Thailand 2000 - 2003

13. Selected indicators on HIV/AIDS expenditure (current year price)

14. HIV/AIDS expenditure by financing agencies • Public source through MOPH, other ministries and local govt played a major role (60-74%) • CSMBS and SSS was small and stable (~2-3%) • Household OOP spending played a substantial role (16-26%) • ROW played an increasing role when GF stepped in in 2003 (13.5%)

15. HIV/AIDS expenditure by healthcare functions • Spending on OI and ART take major share to total current spending • Trade off between OI and ART • OI 48.6% - 32.8% (2000 - 2003) • ART 19.3% - 45.6% (2000 - 2003) • Decreasing trend of spending on preventions

16. HIV/AIDS expenditure by healthcare functions

17. Public and Household Spending on OI treatment • Household expenditure on OI was then significantly reduced • UC in 2001  no financial barrier to access health care services • 30 Baht (0.75 USD) per visit or admission for any treatment including OI was very minimum to household income.

18. Financing ART program by sources of financing agencies • Households shouldered a significant proportion of expenditure on ART. • The universal ART program started with naive PHA (the inexperienced cases) where the first line regimen was provided free. • The financing of the ongoing ART patients (the experience cases) was more expensive as most of them were on the second line regimens, and not fully provided by the National ART program.

19. AIDS expenditure, selected Countries, 2003 • Thailand spending on HIV/AIDS was considerable low compared to the first leading Burden of Diseases attributed to HIV/AIDS and unsafe sex practices. • The larger part was spent on ART and OI treatment • Compared to other countries, Thailand spending on prevention was the lowest (10%) and household shouldered the highest portion. Sources, UNAIDS (2004) selected countries

20. Policy implication • NAA • Invaluable information on resource tracking • The stepping stones for future investment and financial re-orientation of national AIDS program • To renew prevention efforts • Universal ART  Increasing investment in VCT • To ensure safe sex among those not yet infected. • To identify asymptomatic HIV for early recruit for better clinical outcome and survival • To ensure adherence to ARV • Effective program of monitoring ARV resistance requires • financial support and high skill human resources

21. Recommendation • To develop NAA in country • Consensus on dummy table, • Starting with a simple two dimension matrix (FA and HC) • FA: Public and Donor Expenditure (the major share of total spending) • The process of NAA development • Local initiative to ensure ownership • Capacity strengthening of local scientists to maintain and routine update • Technical supports from international agencies such as WHO, UNAIDS and others • A regional collaboration can be one of the entry points to stimulate and support such development

22. Acknowledgments • We wish to acknowledge the following • The predecessors who contributed to the development of NHA in Thailand whereby NAA lends itself on their experiences. • Researchers and partners inside and outside the MOPH for their contributions towards the development of NAA. • Long term institutional grant to IHPP by Thailand Research Fund • UNAIDS supports to this Project • Peer reviews by UNAIDS, WHO and SIDALAC

23. Thank you very much