better systems, better health
HIV/AIDS Program Sustainability Analysis Tool (HAPSAT) OVERVIEW
IMPACT
The recent decline in donor funding for HIV/AIDS poses particular challenges for low- and middle-income countries, which receive the bulk of their HIV/AIDS resources from international sources. How can countries maintain their HIV/AIDS programs in this time of belt-tightening? The first step is to evaluate HIV/AIDS program needs, look at available funding, and assess ways to reduce the gaps in financial and human resources.
HAPSAT has been applied in 14 countries, and the findings and recommendations have been used in many of these countries to inform the development of long-term national HIV program strategies, operational work plans, and funding proposals. In Zambia, HAPSAT was used to inform a successful application to the Global Fund. In Nigeria, HAPSAT findings spurred the government to commit to an increased budget allocation for HIV/AIDS interventions, and in Côte d’Ivoire, HAPSAT identified inefficiencies and helped maximize treatment funds.
Health Systems 20/20 created the HIV/AIDS Program Sustainability Analysis Tool (HAPSAT) in 2007, and further modified it in 2011. The HAPSAT approach aims to assist governments and donors develop strong and realistic HIV/ AIDS policies and implementation plans and consists of two major components:
In Guyana, stakeholders, including the National AIDS Program Secretariat, came to the HAPSAT process concerned about a lack of human resources to provide HIV/AIDS services. After estimating the number of health workers needed to deliver anti-retroviral (ART) and HIV testing, and analyzing schedules and patterns in patient appointments, HAPSAT found that the shortage of human resources was actually less
yy An Excel-based tool which estimates the gap in funding and human resources and which can be applied to more than one policy scenario; and yy A stakeholder-driven process to formulate recommendations on prioritization, efficiency, and resource mobilization to minimize the gap in resources.
acute than previously thought.
Gap Analysis: Comparing funding and human resources required to resources available Discussion with stakeholder on reducing the gap
Prioritizing
Efficiency
Resource Mobilization
The overwork reported by staff was due to the fact that most patients were arriving at health centers in the morning, causing bottlenecks. HAPSAT stakeholders devised a plan to set up an appointment system that scheduled clinic visits throughout the day. This solution allows the same number of patients to be seen by the same number of health workers in a much more efficient way. In addition, the number, distribution, and tasks of health workers providing HIV/TB services are being reexamined. Health Systems 20/20 continues to foster local ownership and build country capacity to use the HAPSAT tool. HAPSAT training has taken place at two regional research institutions: the Health Economics and HIV/AIDS Research Division (HEARD) of the University of KwaZulu Natal in South Africa and the Institut de Santé et Développement (ISED) of the University of Chiekh Anta Diop in Senegal. Both institutions are now leading HAPSAT processes themselves, with support from Health Systems 20/20, HEARD in Lesotho and Swaziland, and ISED in Benin.
FEATURES HAPSAT synthesizes data from many sources into a coherent and comprehensive framework that enables country policymakers, health economists, and health managers to understand the feasibility of establishing, expanding, and sustaining an HIV program. HAPSAT allows users to: yy Meet country needs to set and cost targets for any HIV/AIDS interventions yy Consider multiple policy scenarios yy Compare two cost estimate methods; if discrepancy is large, user is advised to reexamine the costing
Target-Setting Process Understand the epidemic and prioritize interventions
Assess the internationally agreed targets within the country context Set ambitious, yet achievable targets, toward universal access 1. Determine capacity by factoring in: past performance, financial resources, human resources, time dimension 2. Review how capacity can be strengthened to accelerate scale-up to taking necessary actions
Sustainability analysis is becoming a requirement in today’s resource-constrained environment. As countries struggle to provide HIV/AIDS services in a world where external funding is shrinking, they will need—more than ever—the kinds of analysis that HAPSAT can provide. Country HAPSAT reports, HAPSAT 2.0, a training exercise, and the document, Target-Setting for HIV Services, useful for HAPSAT users, can be downloaded at www.hs2020.org/hapsat. For further information, please email hapsat@abtassoc.com.
yy Quantify the number of health workers needed to provide HIV/AIDS services Health Systems 20/20 is USAID’s flagship project for strengthening health systems worldwide. By supporting countries to improve their health financing, governance, operations, and institutional capacities, Health Systems 20/20 helps eliminate barriers to the delivery and use of priority health care, such as HIV/AIDS services, tuberculosis treatment, reproductive health services, and maternal and child health care. Abt Associates leads a team of partners that includes: Aga Khan Foundation | Bitrán y Asociados | BRAC University | Broad Branch Associates | Deloitte Consulting, LLP | Forum One Communications | RTI International | Training Resources Group | Tulane University School of Public Health
DISCLAIMER:The author’s views expressed here do not necessarily reflect the views of the United States Agency for International Development or the U.S. Government. For more information about Health Systems 20/20 please contact: Health Systems 20/20 | Abt Associates | www.abtassociates.com 4550 Montgomery Avenue | Suite 800 North | Bethesda, MD 20814 | USA E-mail: info@healthsystems2020.org | www.healthsystems2020.org July 2012