Tackling the Decline in HIV Resources:       Lessons Learned from HAPSATItamar Katz, PhD, MPhilWendy Wong, BSJohn Osika, M...
Health Systems 20/20 Health Systems 20/20 is the USAID  flagship project for strengthening health  systems worldwide   5...
Outline   Decline in financial resources   Sustainability analysis   HAPSAT-Plus   Three lessons learned   Capacity b...
HIV Funding: Donor and               Estimated Need               25                                                      ...
Sustainability AnalysisWhat goals can beachieved with the currentand potential capacity ofthe program?
Sustainability Analysis: Example               $250                             $200               $200                   ...
HIV/AIDS Program Sustainability Tool (HAPSAT) is … Sustainability study/tool Provides evidence for decision-making and  ...
Evolution of HAPSAT Original HAPSAT:   Gap analysis   Recommendations for efficiency The “plus” in HAPSAT-Plus:   Rec...
HAPSAT 2.0 Workflow               Understanding need for HIV services in the country                            Defining H...
HAPSAT Experience                                                   Prioritization                                        ...
Lesson Learned 1: Efficient Use  of Existing Resources Guyana:   Interim, efficient solution for data flow   Revisiting...
Lesson Learned 2: Integration,Integration, Integration Extent of integration of HIV services varies by  country, yet need...
Unit Cost of ART                             Drugs             8%        8%                   Supply Chain Logistics      ...
Lesson learned 3: Prioritize and SetRealistic Targets Need to prioritize interventions                                   ...
Billboard vs. Radio for HIV    Awareness in South Sudan             Cost per                                    Context   ...
Lesson Learned 3: Prioritize and SetRealistic Targets Need to prioritize interventions Frequently unrealistic targets ar...
Target Setting80%          Number of people on ART: past                                 80%             performance      ...
Target Setting in HAPSAT 2.0Software                               18
Target Setting in HAPSAT 2.0Software                               19
Capacity Building Country level:   Engaging implementers in sustainability approach   Training on the HAPSAT 2.0 softwa...
Capacity Building of Regional   Institutions Advantages                    Challenges   Regional capacity             ...
HAPSAT Take-aways Targets need to be realistic Resource mobilization strategy needs to be  aligned to targets Participa...
Country-level Results Kenya: Developing an innovative financing  mechanism South Sudan: Avoiding expensive ineffective  ...
Thank youFor more information…hapsat@abtassoc.comwww.healthsystems2020.org/hapsat                                   24
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Tackling the Decline in HIV Resources: Lessons Learned from HAPSAT

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The political will to achieve universal access of HIV services by 2015 juxtaposed with a decline in HIV donor funding requires HIV programs to rethink efforts to sustain scale-up of quality HIV services. This presentation provides insights into recurring HIV programing sustainability issues that have emerged from use of the HIV/AIDS Program Sustainability Analysis Tool (HAPSAT).

Presenter: Itamar Katz, Wendy Wong

December 2011

Published in: Health & Medicine
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  • Resources increased, than decreased; funding increases Round 11
  • Sustainability study/tool Gap analysis  solutions Provides evidence for decision-making and target setting Data based and various scenarios Comprehensive and flexible costing approach
  • Triangulation of costing Does not accept a cost as is Target setting for multiple scenarios
  • Data sources Does not accept a cost as is
  • Change map – do not differentiate Note that the bolded countries were countries in which the HAPSAT-Plus methodology was refined (Kenya, S. Sudan) or applied (S.L., Guyana). Mention that the institutions we are building HAPSAT capacity in were trained on the new tool; ISED (trained in May) will carry out a HAPSAT in Benin under HS20/20 guidance, and HEARD (being trained next week) will carry out a HAPSAT in a yet to be determined Anglophone African country.
  • Here examples encountered in HAPSAT The prevention facility - No always work
  • Do not refer to HAPSAT
  • Do crispy
  • Sierra Leone = strategy and operational plan
  • Formulation of targets: Denominator/need Data for formulating the denominator Data for measuring the coverage
  • Still not enough to meet the demand
  • Short and sweet, easy transfer to last slides Provide examples Reduce BCC from 6m to 2.7m Reduce testing from 10m to3.2m Justify costs – e.g., show ART unit cost is low
  • Do crispy
  • Tackling the Decline in HIV Resources: Lessons Learned from HAPSAT

    1. 1. Tackling the Decline in HIV Resources: Lessons Learned from HAPSATItamar Katz, PhD, MPhilWendy Wong, BSJohn Osika, MD,MPH,MHMPP,CCST,FFPHDecember 2011 Abt Associates Inc. In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University’s School of Public Health
    2. 2. Health Systems 20/20 Health Systems 20/20 is the USAID flagship project for strengthening health systems worldwide  55 countries, US$125 million Health Systems 20/20 developed the HIV/AIDS Program Sustainability Analysis Tool (HAPSAT) in 2008 2
    3. 3. Outline Decline in financial resources Sustainability analysis HAPSAT-Plus Three lessons learned Capacity building Summary
    4. 4. HIV Funding: Donor and Estimated Need 25 22 22 Billion US$ Estimated need 21 21 21 20 20 20 19 HIV donor funding 18 17 15 10 8 8 7 5 5 4 4 3 1 2 0 2002 2005 2008 2011 2014 2017 2020Source: UNAIDS and Kaiser Foundation, 2011; Schwartländer, et al, 2011Figures are rounded 4
    5. 5. Sustainability AnalysisWhat goals can beachieved with the currentand potential capacity ofthe program?
    6. 6. Sustainability Analysis: Example $250 $200 $200 $150 Million US$ $150 $100 $80 $50 $- Cost of scaling up to Cost of scaling up based Available funding Universal Access on past performance
    7. 7. HIV/AIDS Program Sustainability Tool (HAPSAT) is … Sustainability study/tool Provides evidence for decision-making and target setting Comprehensive and flexible costing approach 7
    8. 8. Evolution of HAPSAT Original HAPSAT:  Gap analysis  Recommendations for efficiency The “plus” in HAPSAT-Plus:  Recommendations also on prioritization  Based on stakeholder priorities  HAPSAT 2.0 software - simplified, flexible, user-friendly  Knowledge hub for sustainability 8
    9. 9. HAPSAT 2.0 Workflow Understanding need for HIV services in the country Defining HIV interventionsQuantifying unit costs and human resources unit cost of HIV interventions Defining policy scenarios (target setting) Quantifying financial and human resources policy scenarios Gap analysis: Comparing resources required to resources available Resource Mobilization Efficiency Prioritization
    10. 10. HAPSAT Experience Prioritization of servicesHRH solutions Domestic resource mobilization • Benin • Guyana • Sierra Leone • Cote d’Ivoire • Haiti • South Sudan • DR Congo • Kenya • Vietnam • Ethiopia • Nigeria • Zambia
    11. 11. Lesson Learned 1: Efficient Use of Existing Resources Guyana:  Interim, efficient solution for data flow  Revisiting belief of shortage in health workers South Sudan: Avoiding costly HIV-prevention facilities 11
    12. 12. Lesson Learned 2: Integration,Integration, Integration Extent of integration of HIV services varies by country, yet need to examine:  Integration into the wider health services  Integration into social services  Integration for resource mobilization 12
    13. 13. Unit Cost of ART Drugs 8% 8% Supply Chain Logistics 36% Training21% Laboratory Tests Labor 4% Facility Overhead 2% Central-Level Overhead 22% 13
    14. 14. Lesson learned 3: Prioritize and SetRealistic Targets Need to prioritize interventions 14
    15. 15. Billboard vs. Radio for HIV Awareness in South Sudan Cost per Context Priority exposureRadio ads Major information source forand talk- US$ 0.003 High Southern Sudanese shows Low literacy levels limit its use,Billboards US$ 0.05 Low potentially useful in urban areas
    16. 16. Lesson Learned 3: Prioritize and SetRealistic Targets Need to prioritize interventions Frequently unrealistic targets are formulated:  Commitment to reach international targets  Mobilizing more resources: • Over-ambitious targets to justify more resources • Under-ambitious targets to ensure achieving targets in performance-based mechanisms  Lack of data prevents setting ambitious, yet feasible, targets 16
    17. 17. Target Setting80% Number of people on ART: past 80% performance Projected scale-up based on past60% Reaching universal performance (proxy to capacity) coverage requires Scale-up towards universal access efforts beyond apparent capacity40% 35% 20%20% 11% Both are costed for stakeholders to decide on their scale-up0% 2007 2008 2009 2010 2011 2012 2013 2014 2015
    18. 18. Target Setting in HAPSAT 2.0Software 18
    19. 19. Target Setting in HAPSAT 2.0Software 19
    20. 20. Capacity Building Country level:  Engaging implementers in sustainability approach  Training on the HAPSAT 2.0 software Regional level: Training two regional research institutions 20
    21. 21. Capacity Building of Regional Institutions Advantages  Challenges  Regional capacity  Teaching a flexible building approach  Increased scalability of  Ensuring standardization HAPSAT  Building capacity:  Potential cost reduction • Technical • Managerial 21
    22. 22. HAPSAT Take-aways Targets need to be realistic Resource mobilization strategy needs to be aligned to targets Participatory approach promotes country ownership Helps policymakers to think through sustainability issues 22
    23. 23. Country-level Results Kenya: Developing an innovative financing mechanism South Sudan: Avoiding expensive ineffective prevention activities Guyana: Changing thinking on shortage of health workers 23
    24. 24. Thank youFor more information…hapsat@abtassoc.comwww.healthsystems2020.org/hapsat 24
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