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Monitoring HIV/AIDS financial flows from global initiatives - Tracking Results or Advancing Political Agendas: Multi-country results

Tania Dmytraczenko, PhD, International Health Division, Abt Associates, 4800 Montgomery Lane, Suite 600, Bethesda, MD 20814 and Susna R. De, MSc, MPH, International Health Area, Abt Associates Inc., 214 Stanley Drive, Waterloo, ON N2L 1H4, Canada, 519 342 7948, susna_de@abtassoc.com.

Unprecedented increases in funding to fight the HIV/AIDS pandemic in recent years have largely flowed through new global and bilateral initiatives such as the Global Fund, the World Bank's MAP and the US President's Emergency Plan. Although there is a global effort to harmonize M&E efforts through the Three One's Initiative, and capture strategic information, each initiative has developed its own M&E framework for reporting by grant recipients. Additionally, national AIDS strategies often set their own targets and countries are encouraged to report on core indicators for implementation of the UNGASS Declaration of Commitment.

The international classification of health accounts—a methodology vetted through over 30 years of use in more than 50 countries—is adapted to track the flow of HIV/AIDS funds. The origins of funds are identified as well as allocation to specific program and service delivery components of interest to global and bilateral initiatives, and national strategic plans. Estimates of spending by program/ treatment categories are presented for 7 countries—with generalized and concentrated-epidemics—across 3 regions. Put in the years, this is critical to make sure that reviewers are clear of the timeframe the data represent.

In most cases, funds were not allocated according to the spending priorities established in national strategic plans. Further, though the principal of additionality has been met in many countries, increases in government spending on HIV/AIDS are relatively small, as is the reduction of the burden of financing on households. Meeting bilateral and global output targets would require significant increases in funding, improvement in the effectiveness of country-level disbursements in reaching vulnerable populations and in the accountability of governments to provide evidence-based information of their expenditures.

As HIV/AIDS funds increasingly flow from external sources to NGOs, the ability of government to exercise stewardship over prevention and care is challenged. As demonstrated by the experiences of the governments of Kenya, Malawi, Rwanda, Ukraine, Vietnam, Zambia and Zimbabwe, developing systems to track the flow of resources against program objectives can be a powerful tool in guiding HIV/AIDS policy and approaches to programming.

Learning Objectives:

Presenting author's disclosure statement:

Not Answered

Evaluating the Impact of Our Work: From the Global Fund to Patient Interactions

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA