Periodic Review ccm request template
Yüklə 2,41 Mb.
|
- Bu səhifədəki naviqasiya:
- 4.3 Programme Effectiveness
- 4.3.2 Equity
- 4.3.3 Value for Money
|
* 2010 Results based on 10182 infants sampled * 2011 Results based on 10106 infants sampled
The HIV sentinel surveillance data has helped to map the epidemic and monitor HIV infection trends in the country and has served as an advocacy tool, resulting in the mobilization of partners, resources and development of innovative approaches by the national response to HIV and AIDS. The HIV epidemic in South Africa has in the last 6 years shown stabilization, particularly among antenatal care first time bookers in their current pregnancy served in public health sector clinics. In 2011, a total of 33 446 first time antenatal care attendees participated in the survey. This was a representative sample at National and Provincial level and in all 52 Health Districts. The estimated 2011 national antenatal HIV prevalence was 29.5%, showing a slight drop of 0.7% from 2010 prevalence. HIV prevalence of 29.5% in 2011 is in line with the prevalence observed in the previous four years. To avoid a resurgence of the HIV and AIDS epidemic in South Africa, HIV prevention efforts need to be urgently strengthened and sustained. Furthermore, ecological correlations between the trends in HIV prevalence, and behavioural changes that will focus on reducing the incidence of infection exposure factors, especially in districts that record more than 30% HIV prevalence, is warranted. Further in-depth epidemiological investigations on what could be causing the variation between the districts and between provinces in the identified epicentres could assist in understanding the different patterns of the transmission potential of the virus. Do you consider the Programme is making progress towards the goals and objectives of the proposal? If not, provide justification and explain how you intend to address the issues. Yes. South Africa has made important progress towards reaching the treatment target goal of 80% coverage, classified by the WHO as universal access. In mid-2011, following the launch of the HCT campaign in early 2010, the number of people on antiretroviral treatment increased significantly from 923 000 in February 2010 to 1.4 million in May 2011. In October 2012, the country is said to have reached the target of universal access to treatment as the total number of people receiving treatment reached 2 million (or 80% of all in need of treatment). Moving towards a tier 3 health information system will help validate these numbers. While the chosen impact/outcome indicators above show positive change this point in time, the key mortality indicators estimates and MTCT rate above show the effect of the SDA interventions and that South Africa is making progress in improving the health status of the nation. There have been sustained improvements in mortality of young adults and child mortality, largely due to the rollout of ART treatment and PMTCT. In the absence of clearly defined M&E framework or costing of the research, monitoring and evaluation, existing M&E systems have not been well coordinated. Reporting between public and private sector has been inconsistent, making it difficult to utilize the data to improve or evaluate processes. Indicators that were used did not differentiate between outcome and process. The NSP 2012-2016 includes a clear M&E framework with clear recommendations on data flow. In addition, the country is moving towards standardization of indicators through the NIDS.
Did you discuss within the CCM how to improve the aid effectiveness of implementation arrangements of GF financing? Yes If yes, was the process inclusive of key stakeholders, including those involved in donor coordination activities in your country? Please indicate the key stakeholders who participated in the discussion. Please comment on the main findings. The NDOH launched its Aid Effectiveness Framework for Health in South Africa in January 2011 (AEF). The Minister of Health requested development partners to work according to the framework to support South Africa to reach the goals of the NSDA for Health. The AEF provides a blueprint for collectively implementing the NSDA and to attain the Millennium Development Goals (MDGs). The NDOH assumed a leadership role in this process, by taking ownership of the strategies, action plans and review mechanisms. Focus will now be on results, linking activities to outputs, ensuring clear and unambiguous expectations, as well as facilitation of the process of alignment and coordination. The intention of the framework is to forge a collaborative partnership between the DOH throughout its various levels, its development partners representing bilateral donors, multilateral organisations, private sector business entities and civil society organisations (CSOs). The five key principles of the AEF, modelled on the Paris Declaration on Aid Effectiveness, guide coordination and efficacy within the health sector in South Africa:
The AIDS and Health Development Partners Forum (AHDPF) is the group tasked with realizing the AEF principles. The AHDPF convenes a quarterly meeting with other partners quarterly to identify ways to enhance aid effectiveness. Chaired by the Director General for Health, this quarterly meeting is called the ODA meeting and its participants include:
ODA members have developed several documents and requested the development of the Annual Planning Tool (APT) to help guide coordinated planning and greater value for money of investments. With the help of the APT and other tools, South Africa has mapped the efforts of the development partner to ensure activities and funds are directed to areas where they are most needed. This high level coordination mitigates duplication of efforts, improves coordination of development partner inputs and enhances accountability. With this structure, SA has effectively implemented the recommendations from the Accra Agenda Agreement and the Paris Declaration on Aid Effectiveness. Hence the Annual Planning Tool is an essential element in improving aid effectiveness and the effectiveness and value for money for both government and donor funding. The objective of the APT exercise is to collect health sector wide expenditures and budget information from government and development partners, to assess the level and scope of all domestic and external support. This annual process will fit within, and inform the broader resource allocation and decision making process led by NDOH and Treasury. Ultimately, the exercise will help to answer how Development Partner Funding will be coordinated and organized in relation to government priorities and spending, to generate greater efficiency and value for money. Based on your discussion did you identify any major risks? If so, please describe them and how you plan to address and monitor each in the next Phase/Implementation Period. Previously, multiple attempts to collect data have caused fatigue in the donor community and have resulted in highly variable and incomplete results (e.g. NDOH Questionnaire 2009, EU/KPMG 2009, AIDS 2031 2010, NASA 2010 and annual Treasury data collection). Some of the underlying challenges with these data collections include:
It is important that South Africa adopts a routine system for collection of past expenditure and future commitments from all actors in the HIV, AIDS and TB field. It is planned that through the SANAC Monitoring and Evaluation Framework and the work of the technical task teams that (1) costing, budgeting and expenditure tracking is improved and (2) the NSP Quarterly reports will be done and distributed widely. These processes will require ground work to establish appropriate collection tools, data verification processes, data reporting channels, adequate databases and timeous co-operation and collaboration of multiple government and non-government stakeholders.
Did you conduct an equity assessment, or was an equity assessment conducted by the national Programme or other stakeholders, in the current Phase/Implementation Period? Yes If no, please explain why an assessment was not conducted. If yes, please comment on the process for developing the equity assessment The District Health Barometer (DHB) is an annual report published by the Health Systems Trust which measures the degree of equitable provision of primary health care services in South Africa. The National Treasury also does its own evaluation of equity which is then used to determine the funding allocations to provinces. Together these two reports provide a comparative assessment of the strength of primary health care (PHC) systems. Although inequities in health result from the social conditions that increase health risk factors, the quality and accessibility of healthcare can improve or worsen the situation, particularly in connection with the provision of PHC services. The DHB examines a selected set of socio-economic and health care indicators in PHC by socio-economic quintiles, highlighting inequities that exist between the most deprived and the least deprived districts in the country. As such, the DHB works as a tool to monitor the equitable provision of PHC in SA. The size of an individual province’s global budget is determined by a complex formula devised by the Treasury to estimate differential needs among provinces. Hence, the global budget is often referred to as the province’s equitable share. Among other factors, the equitable shares formula (used for the first time in 1998/99) considers the estimated population in each province with and without private health insurance to determine funding for public sector health services and (those without insurance are weighted four times more than those with insurance)70. The formula is reviewed annually to ensure an appropriate balance of factors. Please comment on the main findings of the assessment and include additional data, if available, which supports your findings (e.g. disaggregated data by relevant population groups for key indicators, findings from qualitative research, grey literature, etc.). The per capita expenditure (PCE) on PHC measures the amount of money, excluding expenditure on hospitals, which each district spends annually per person not covered by medical insurance. The average PCE for SA increased from R410 in 2008/09 to R514 in 2010/11, after adjusting for inflation. The resource allocation for PHC remains inequitable as the more deprived the district the greater the need for health care. Ideally the ratio of PCE should be in favour of districts that are most deprived71. Provincial PCE ranged from R430 in the Free State and KwaZulu-Natal to R631 in the Western Cape, with North West lying close to the national average at R519. The extreme variation in per capita expenditure within the Northern Cape has increased further in 2010/11 to a difference of R711 between Namakwa and Siyanda. Both districts are geographically large, sparsely populated (=2 persons/km) and fall into the wealthiest quintile. The PCE was fairly uniform across Integrated Sustainable Rural Development Programme (ISRDP) districts, except for the substantially higher value in Central Karoo. The average expenditure for the metro districts was R569 in 2010/11. The PCE ranged from R500 in eThekwini (KZN) to R826 in Nelson Mandela Bay (EC). The PCE was tightly clustered around R530 in the three Gauteng metros (Ekurhuleni, Tshwane and City of Johannesburg). The PCE for Nelson Mandela Bay Metro was substantially higher than the other metros after having risen sharply during the current year from R494, due to increased expenditure by local government. District rankings from the Deprivation Index (DI) and the South African Index of Multiple Deprivation (SAIMD) 2007 show much greater deprivation for Gauteng, KwaZulu-Natal, Limpopo and Mpumalanga, with lower levels found in the Northern Cape and, to a lesser extent, Free State and the Western Cape72. To better address above inequities, the SAG has done the following:
Based on your discussion did you identify any major risks (e.g. gaps in data availability or data use to assess equity, inequities in service coverage and impact/outcomes, gaps or weaknesses in planning, programming or implementation, or structural barriers)? The NASA process encountered several weaknesses in the financial information systems in SA, which are limiting the ability of all actors to be transparent and accountable. Hence several key recommendations have been made for improving the expenditure tracking systems and linking these to routine M&E systems, so as to institutionalise this process as routine data collection, rather than one-off, expensive survey-style collections in future. Only by increasing the openness, transparency and accountability of all actors in South Africa, not only in the HIV and TB fields, but for all development efforts, can we strengthen health care systems and strive to achieve zero transmissions of HIV and zero mortality due to AIDS, by ensuring the maximum impact of all available resources, in a coordinated and harmonised manner.73
Yüklə 2,41 Mb. Dostları ilə paylaş:
|