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Tanzania Public Expenditure Review Multi-Sectoral Review: HIV-AIDS 2005 Update

Smithson, P. (2005) Tanzania Public Expenditure Review Multi-Sectoral Review: HIV-AIDS 2005 Update. UNSPECIFIED. (Unpublished)

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Abstract

The latest national blood donor statistics indicate that that HIV prevalence in Tanzania has at last begun to decline – after 15 years of increase. Particularly encouraging is the reduction in prevalence among the 15-24 age group, which is indicative of recent HIV infection. Nonetheless, because of the long incubation period, the burden of AIDS will continue to grow. Assuming an 8-10 year period between infection and death, the current burden of AIDS morbidity and mortality is likely to double over the next decade, even if prevalence begins to decline. There is no room for complacency. HIV must stay at the top of the policy agenda.The national sero-prevalence survey provided the first nationally representative figures on HIV prevalence. Adult prevalence rate (7%) is rather lower than earlier official estimates. However, this average masks significant variations. Prevalence rates vary markedly across geographic areas. Male infection rates peak at 12.3% in the 40-44 year age group. Female infection rates peak at 12.9% in the 30-34 year age group. Applying the prevalence data to the population age structure, we find that an estimated 1.1 million people were HIV-infected in 2004, of whom 57% were female, 43% male.Total planned expenditure on HIV/AIDS for FY2004/5 has reached T.Shs 80.7 billion. This includes 12.6 billion aid to NGOs. Taking the government portion alone (domestic and aid-financed), the total has risen from 41.6 billion to 68.1 billion. This represents an increase of 64% over the previous year. All of the increase has come from aid resources. Domestic financing for HIV has remained
flat, at 14.6 billion after having doubled the year before.The new “Z” coding of HIV budget/expenditure has been a great help in tracking resource deployment for HIV across government. A considerable improvement has been made also in capturing aid resources for HIV in the budget. This “narrow” definition of HIV expenditure is certainly an under-estimate. Direct and indirect expenditures in the health sector, mostly represented by hospital care for HIV patients, would increase the total by at least 65 illion.About 15% of all HIV spending is through NGOs, the remainder through government. Most NGO spending is funded by direct project grants. Only a fifth of the total is channelled through the Rapid Funding Envelope. The Community AIDS Response Fund (CARF) is in its infancy but is expected to grow rapidly.In spite of the centrality of local government in the National Multi-sectoral Strategic Framework, the vast majority of government expenditure on HIV is incurred by central ministries. The 10% or so spent by local government is almost entirely aid-funded. Given recent capacity developments at the local level, a sharp increase in funding for the local government level is desirable.Among central government votes, Health (36%), TACAIDS (55%) and Education (5%) make up the vast majority of budgeted funds (domestic and aid combined). The TACAIDS figures is significantly inflated by funds channelled through it to other government departments. None of the other votes exceeds 1%. Higher levels of expenditure should be expected in selected MDAs with a prominent role in executing the National Multisectoral Strategic Framework. In particular, we would expect to see significant increase in future years for: Vote 46 (Ministry of Education and Culture), Vote 69 (Science Technology and Higher Education) , Vote 28 (Police Force) Vote 29 (Prisons Service),Vote 38 (Defense), Vote 32 (President’s Office – Public Service Management) Manual analysis of selected MTEFs indicates that 56% of budget was for multipurpose activities, 35% for care and treatment, 8% for prevention, and 1% for impact mitigation. A similar analysis of development assistance showed 59% to be multi-purpose or unclassified, 25% for care and support, 14% for prevention, and 2% for impact mitigation. The sharp increase in funds allocated for Care and Treatment (up from close to zero two years ago) looks set to continue as PEPFAR, Global Fund and other donor resources come on stream. This should not crowd out Prevention - either by displacing funding, or by shifting policy attention. Social and economic support to people affected by AIDS (PLWHA, their carers and families, orphans) might absorb very significant levels of resources once policies and modalities have been determined. Budget execution rates for domestic HIV funds are good. Disbursement rates for projects are undoubtedly much lower, although comprehensive data on aid actuals are not available.Three donors presently account for between two thirds and three quarters of total aid for HIV. This leaves Tanzania with a high level of dependency and uncertainty. New aid resources will come on stream next year, bringing about a rapid increase in aid for HIV. In theory, it could rise to as much as T.Shs 190 billion. Discounting
by 40% for delays and under-disbursement suggests a more realistic estimate of 100 billion. Most of this increase is for care and treatment. A preliminary estimate of “full funding” requirements presented here suggests an annual requirement in the region of $160 million. The prospective resource gap therefore stands at about $50 million. These estimates are highly sensitive to assumptions on the actual costs of scaling up ART, and on the level of aid that actually materialises. More generally, the absence of suitable modalities for channelling aid resources is hindering their effective utilization. The vast majority of donor funding is projectised, and very little flows through the Exchequer System. There is a strong case for devising streamlined, multi-donor funding mechanisms for HIV-AIDS that will channel resources through the Exchequer system. As part of this assignment, options for such a fund were set out for consideration. A decision will need to be reached by MOF, TACAIDS and other stakeholders on the preferred option.Recommendations of the report are set out in the final section, at page 33.

Item Type: Other
Keywords: Muti-Sectoral Public Expenditure; HIV infection;HIV Prevalence;Tanzania
Subjects: HIV > Surveillance
Divisions: Tanzania Commission for AIDS
Depositing User: Mr Joseph Madata
Date Deposited: 14 Jan 2013 06:51
Last Modified: 14 Jan 2013 06:51
URI: http://ihi.eprints.org/id/eprint/618

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