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Linking NHA and NASA A country perspective - Rwanda

Linking NHA and NASA A country perspective - Rwanda. Agnès Binagwaho , MD, Paed Executive Secretary, National AIDS Control Commission.

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Linking NHA and NASA A country perspective - Rwanda

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  1. Linking NHA and NASAA country perspective - Rwanda AgnèsBinagwaho, MD, Paed Executive Secretary, National AIDS Control Commission

  2. National AIDS Spending Assessment (NASA), Generally conducted by NAC (with UNAIDS), to monitor the annual flows of funds used to finance the multisectoral response to HIV/AIDS National health accounts (NHA), Generally conducted by MOH (with WHO, USAID), to track expenditures on overall health care with particular attention of health sub accounts as HIV/AIDS NASA and NHA

  3. NASA and NHA UNAIDS

  4. NHA-NASA crosswalk NHA HIV/AIDS subaccount NASA – UNGASS table UNAIDS Implemented in Rwanda by MOH and CNLS team

  5. The teams of NACC and MOH worked together to harmonise the findings of the two exercises in one table only, with some difficulties: respondent fatigue given two sets of surveys (one for NASA and one for NHA) in some case estimates were conflicting inefficient use of human resources (two teams!) some gaps and inconsistencies were identified in the harmonization process Rwanda experience:Both NHA (for health and non-health) and NASA were carried out in 2007

  6. NHA treats all donor funding into one basket called “Rest of the World” while NASA/UNGASS requires distinction for each donor funding NHA had a non-health addendum, but not comprehensively addressed (insufficient to fill UNGASS matrix) – e.g. no data on income generating activities Current gaps and inconsistencies for harmonization Rwandan Experience

  7. With a small team of consultants and resources NASA exercise was only able to identify declared expenditure by funding agents and not to track funding flows down to the implementers to avoid double counting – NHA could do that (the team was bigger and with more resources) Expenditure for condoms distribution under NASA is totally attributed to HIV, while NHA makes a distinction with family planning (need to include data from the RH sub-account as well) Current gaps and inconsistencies for harmonizationcon’t Rwandan Experience

  8. It is very difficult for NACC with a small NASA team to collect data country wide. e.g. from private sector and for out-of pocket expenditure Current gaps and inconsistencies for harmonizationcon’t Rwandan Experience

  9. Refine (disaggregate) categories of expenditure for NHA to allow a better “crosswalk” with NASA (for UNGASS table) For NHA, maintain distinction across donors (who finance what for each category) in order to allow UNGASS reporting Better one complete exercise from the beginning than two parallel ones with “last minute” harmonization Keep all stakeholders at country level informed RecommendationsAt international level (UNAIDS, WHO, and USAID)

  10. One exercise only (one questionnaire only): NHA or NASA Need to know real expenditure by implementers in country (declared expenditure by donors is not sufficient) If using NHA, make sure it includes non-health information as well, it keeps each donor funding separate, and make sure representative from NAC are included into the MOH team Make use of existing data collection (e.g. information on expenditure by stakeholders at district level included into the CDLS database) – define “crosswalk” between existing database and NHA/NASA Recommendations cont’At country level

  11. Lessons learned: AIDS money is a catalyst for improvements in all sectors. Tool for making the money work: • With this exercise we had a better tracking of funds • We are improving our financial reporting • e.i: We gave evidence of 40% PEPFAR money, voted for Rwanda, missing in country reports This will lead to better allocation of funds and planning • We are applying the methodology to other sectors • A better tracking of other sectorial money will assure alignment to EDPRS and our vision 2020

  12. Malaria, HIV/AIDS, and RH in the context of general health expenditures 2006

  13. Financing Sources:Where do HIV/AIDS monies come from?

  14. Financing Sources:Where do HIV/AIDS monies come from?

  15. Providers:Where do PLHIV spend their money? = RWF 1,020,258,690 ($1,849,166) =RWF 950,475,493 ($1,722,687)

  16. Thank you to make our day to day work simple

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