Know Your Resources: How to Use Funding Data to Advocate for Global and Domestic Resources in the Critical Push towards the End of AIDS
A collection of resource tracking projects from The Henry J. Kaiser Family Foundation (KFF), Treatment Action Group (TAG), Funders Concerned About AIDS (FCAA), Center for Economic Governance and AIDS in Africa (CEGAA), National Alliance of State & Territorial AIDS Directors (NASTAD), Global Forum on MSM and HIV, HealthGap, and the Resource Tracking for HIV Prevention R&D working group
Know Your Resources What is resource tracking? Resource tracking is the exercise of determining what funding is made available by which entities, and how it is allocated and spent. In HIV, resource tracking provides the wider field with vital information to chart the course forward, revealing gaps but also opportunities to focus advocacy, policy, research and other necessary elements of a coordinated response. Understanding public, private and philanthropic investment priorities is crucial to ensure consistent and increased momentum toward ending AIDS.
Resource tracking: •
Promotes transparency and accountability;
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Informs policy making and government budgeting processes;
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Engenders data-driven advocacy agendas focused on gaps in the funding landscape;
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Increases the level and impact of international aid;
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Builds local understanding and capacity around budget issues
• “Measures of how much is being spent on health as well as information about how and what interventions funds earmarked for the health sector are being spent is an essential ingredient for effective advocacy by interest groups and policy champions both within and outside government.” • Health Resource Tracking: An Essential Ingredient for Improved Health Governance. USAID/HealthSystems 20/20. February 2012.
Synonyms for resource tracking include, but are not limited to: budget monitoring, mapping, resource flows, and financial flows.
Going beyond counting beans In an era of shifting donor priorities and an expanded focus on transitioning to country ownership of HIV programming, the importance of close and quality resource tracking becomes all the more amplified. Ensuring adequate allocation of available funding in what often remain strained macroeconomic conditions requires prudent and transparent budgetary and expenditure decisions, with meaningful input from all key stakeholders. Ending the HIV epidemic will not happen overnight; realistic targets for complex treatment and prevention modalities must be set, and effective country-level strategic programming is reliant on rigorous fiscal planning. Resource tracking efforts are essential to each of these processes. Keeping governments accountable to setting, reaching, and even exceeding productive targets, enacting good policy and ensuring funding flows are reaching historically marginalized populations remain the prerogative of resource tracking organizations and their partners.
Know Your Resources About this document The intent of this resource tracking guide is to provide an overview of resource tracking as a science, and highlight key resource tracking efforts that are linked to a broader agenda of advocacy and/or education for HIV. It was also created as a guide for an AIDS2016 session in July of 2016 in Durban, South Africa. A group was convened by session chairs AVAC and FCAA to discuss the resource tracking efforts highlighted in this document, including: TAG, FCAA, CEGAA, HealthGap, the Global Forum on MSM & HIV, and the Resource Tracking for HIV Prevention R&D working group. The document also spotlights additional organizations and resources, such as KFF, NASTAD, Stop AIDS UK, and others.
RESOURCE TRACKING ORGANIZATIONS The following list offers insight to organizations who conduct resource tracking related-efforts in the field. Please note, this is not an exhaustive list, but is meant to act as a beginning guide to resource tracking.
amfAR, the Foundation for AIDS Research amfAR has played a key role in advancing HIV research and policy since its inception. Its work identifies critical gaps in our knowledge of HIV/AIDS, and supports promising early-stage studies that often lack the preliminary data required by more traditional funders. Through its public policy office, amfAR tracks multilateral and bilateral funding for HIV programs and services for key populations – MSM, transgender individuals and people who inject drugs – globally. amfAR also produces rigorous analysis of research funding challenges, gaps, and opportunities, recently issuing a brief highlighting the broader health and economic benefits of AIDS research beyond HIV. http://amfar.org/publicpolicy.html
National Alliance of State and Territorial AIDS Directors NASTAD was founded in 1992 as a nonprofit association representing public health officials administering hepatitis and HIV care, prevention, education and support service programming in the United States and globally. Through strengthening both domestic and international public health systems through advocacy, capacity building, and social justice, NASATD aims to end the intersecting epidemics of HIV, viral hepatitis, and related conditions. NASTAD works with public officials to track and increase federal support for HIV and hepatitis. As part of its work it is an active member of the AIDS Budget and Appropriations Coalition (ABAC) and convenes the Hepatitis Appropriations Partnership (HAP). Both entities monitor and advocate for increased funding on behalf of statelevel and local health departments, community-based organizations, providers, research organizations and many others. www.nastad.org
Know Your Resources Centre for Economic Governance and AIDS in Africa (CEGAA) “Ongoing engagement with community stakeholders indicates that they now understand budget matters, demonstrated by the questions they ask in relation to health budgets and the richness of discussions at stakeholder meetings. The partner civil society organizations and their members are actively asking questions on budgets and expenditures to their target audiences.”
As a regional civil-society organization, the CEGAA has focused on attaining effective, rights-based and developmental health financing in Africa to enable a comprehensive response to HIV/AIDS since 2006. CEGAA’s strong team of health economists and public finance experts focuses on building capacity of African states and civil society to monitor budgets and track expenditures to ensure adequate and transparent expenditures in health and HIV/AIDS. CEGAA brings crucial in-depth understanding and skilled analysis to the field of HIV/AIDS costing providing their partners authoritative insight into the regional context of the health landscape. Through its work, CEGAA contributes to the full and active involvement of citizens, civil society representatives, research agencies, parliamentarians and local government authorities in fiscal policy and economic governance issues. This is vital for the acquisition, utilization and management of limited resources for HIV/AIDS and TB programs and health in general. http://www.cegaa.org/
Resource Tracking for HIV Prevention R&D working group “In a financial climate with increasingly limited resources, tracking investment in HIV R&D provides the field with vital information to chart the course forward. As later-stage and follow-on trials move forward, understanding and evaluating research in the context of public, private and philanthropic funding is increasingly important to ensure continued movement down the path towards ending AIDS.”
For 15 years, the Resource Tracking for HIV Prevention R&D working group (formerly the HIV Vaccines & Microbicides Resource Tracking Working Group) has employed a comprehensive methodology to track trends in research and development (R&D) investments and expenditures for biomedical HIV prevention options, including HIV vaccines, microbicides, pre-exposure prophylaxis (PrEP), treatment as prevention (TasP), medical male circumcision (VMMC), female condoms, prevention of vertical transmission (PMTCT) and HSV-2 vaccines. In 2016, the working group has tracked over US$17 billion in investments towards HIV prevention R&D, and has contributed policy analysis and critical data for advocacy to the prevention landscape. The Working Group consists of AVAC: Global Advocacy for HIV Prevention, the International AIDS Vaccine Initiative (IAVI), the International Partnership for Microbicides (IPM) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). www.hivresourcetracking.org
Know Your Resources The Kaiser Family Foundation (KFF) www.kff.org A leader in health policy analysis and health journalism, the KFF is dedicated to filling the need for trusted information on national health issues. KFF is a non-profit organization focusing on national health issues, as well as the U.S. role in global health policy. We serve as a non-partisan source of facts, analysis and journalism for policymakers, the media, the health policy community and the public. KFF, in collaboration with the Joint United Nations Programme on HIV/AIDS (UNAIDS), has been tracking donor government assistance for AIDS in low- and middle-income countries for more than a decade. The most recent report launched on July 2016 revealed that donor nation funding in 2015 for HIV in low- and middleincome countries fell for the first time in five years, to ecreasing from US$8.6 billion in 2014 to US$7.5 billion. The annual report associated with this collaboration is based on analysis of data provided by donor government members of the Organisation for Economic Cooperation and Development (OECD)’s Development Assistance Committee (DAC) and the European Union (EU). It includes their combined bilateral assistance and contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and to UNITAID. www.fcaaids.org/resourcetracking Funders Concerned About AIDS (FCAA) Funders Concerned About AIDS (FCAA) mobilizes the leadership, ideas, and resources of funders to eradicate the global HIV/AIDS pandemic and to address its social and economic dimensions. Our goals are to: Increase philanthropic resources dedicated to ending HIV/AIDS; catalyze a dynamic and sustained philanthropic response to HIV/AIDS with special attention to its underlying drivers; influence key public and philanthropic funders to align HIV/AIDS resources for greatest impact; amplify the leadership voice of FCAA and its members For more than a decade, FCAA has tracked the field of HIV/AIDS-related philanthropy. Its annual report Philanthropic Support to Address HIV/AIDS represents the most comprehensive resource available on private philanthropic giving from organizations based in the U.S., E.U. and the global South. In 2015 FCAA updated its methodology, moving from an aggregate survey tool to analysis of individual grant lists, as well as online research and data collaboration efforts with the U.S. Foundation Center, the International Human Rights Funders Group, and Funders for LGBTQ Issues. In 2015, FCAA received 96% of its data in the form of detailed grant lists submitted directly by funding organizations. The latest report was published in 2015 and revealed that global private funding for HIV was up 8% from 2013 to 2014, with funders contributing US$618 million in 2014. Private funding has been holding a flat trend for the past eight years, hovering between US$600-$650 million during this time. FCAA recently published a searchable, online map (www.aidsfundingmap.org) that offers private HIV funding levels by country, region, and U.S. State.
Know Your Resources 3. Define gaps and opportunities: The Beyond 2015 Campaign (focused on the SDGs) http://www.beyond2015.org/ 1. Hold donors accountable for their 4. Embrace “what works” on social media commitments: One Campaign: 10 staggering AIDS report stats—in HealthGap: “PEPFAR WATCH – Tools for Civil Society” GIFs http://www.healthgap.org/pepfarresources https://www.one.org/us/2015/12/02/10-staggering2. Break down a complex issue and establish clear aids-report-stats-in-gifs/ advocacy goals 5. Help define successes amfAR: “Hepatitis C in the United States: A Hidden and Stop AIDS UK: “They made the momentum real” An Growing Epidemic” evaluation of the contribution made by STOPAIDS to http://www.amfar.org/Articles/On-Thethe £1 billion UK Global Fund pledge. (April 2014) Hill/2015/Hepatitis-C-in-the-United-States--Ahttp://bit.ly/29vkiOI Hidden-and-Growing-Epidemic/
5 ways to Use Resource Tracking for Effective Advocacy
“Ten years of data collected by Treatment Action The Treatment Action Group (TAG) Group (TAG) show that funding shortfalls for TB
research and development (R&D) are serious and chronic. It is imperative to break out of this stagnation in funding, political commitment, and popular attention to go somewhere new in our response to TB. Repetition of past failures holds a firm and frustrating grip on the fight against TB. As we imagine the next 10 years, there is an urgent need to remember what we learned from the last decade and to let this memory spur us to secure the funding, political will, and public pressure that can prevent us from repeating past mistakes.”
TAG is an independent AIDS research and policy think tank fighting for better treatment, a vaccine, and a cure. TAG works to ensure that all people with HIV receive lifesaving treatment, care, and information. TAG are science-based treatment activists working to expand and accelerate vital research and effective community engagement with research and policy institutions. TAG catalyzes open collective action by all affected communities, scientists, and policy makers to end AIDS. For nearly a decade, TAG has tracked funding streams and allocations of both private and public investment in R&D funding for tuberculosis across six key areas of research such as treatments, diagnostics, vaccines, pediatrics, operational research and infrastructural projects. Currently TAG has released a supplemental policy and advocacy brief analyzing US government funding of R&D for tuberculosis. TAG tracks and adjusts annual investments in T&B research and has developed a decade of data. The recent TB R&D brief calculations are done by applying measures of inflation from the Biomedical Research and Development Price Index (BRDPI) to the data collected. This index measures the average change in prices of research-related goods and services (e.g., personnel, supplies, and equipment) purchased with the NIH budget. The annual change in the BRDPI indicates how much research spending must change to maintain purchasing power at the previous year’s level. http://www.treatmentactiongroup.org/tb/tbrd-usg
Know Your Resources
ADVOCACY ORGANIZATIONS The following two examples highlight organizations that employ the use of funding/resource tracking data into their advocacy and accountability-focused efforts, as well as conduct/publish their own publications. Please note, this list is not exhaustive, but hopefully points you to effective strategies to guide your own work. The box “5 ways to Use Resource tacking for Effective Advocacy�, above, provides a number of additional examples.
HealthGap www.healthgap.org
HealthGap is an organization of AIDS and human rights activists, people living with HIV/AIDS, public health experts, fair trade advocates and concerned individuals who campaign against policies of neglect and avarice that deny treatment to millions and fuel the spread of HIV. The organization campaigns for drug access and the resources necessary to sustain access for people with HIV/AIDS across the globe. We work with allies in the global South and in the G-8 countries to formulate policies that promote access, mobilize grassroots support for those policies, and confront governmental policy makers, the pharmaceutical industry and international agencies when their policies or practices block access. HealthGap has a specific programmatic focus on funding the fight against global AIDS, which includes monitoring and advocacy on bilateral and multilateral aid. In particular, Health GAP works with developing country activists to identify bottlenecks to effective use of PEPFAR funds or to highlight detrimental effects of reduced funding at the local level. We then pressure U.S. elected officials and the Administration to increase support and work to undo bottlenecks. Health GAP also works to identify problems with the Country Operational Plans that provide guidance to countries on how to use PEPFAR funds.
Global Forum on MSM & HIV (MSMFG): MSMGF advocates for equitable access to effective HIV prevention, care, treatment and support services for gay men and other men who have sex with men, inclusive of those living with HIV. MSMGF also works to promote the health and human rights of gay men and other MSM worldwide. MSMGF acts as a global watchdog for public health policies and funding trends, working to ensure policy, programming, and investment are aligned with the epidemiological burden of HIV faced by gay men and other MSM. As such, MSMGF also conducts their own mapping efforts, include a past report commissioned by the Global Fund to Fight AIDS, Tuberculosis, and Malaria to help understand how HIV investments target MSM and transgender people in low-and middle-income countries. A report released in 2011 revealed a widespread lack of disaggregated tracking and public reporting of investments for MSM and transgender people by major bilateral, multilateral and private philanthropic donors. www.msmgf.org
Know Your Resources
Additional Resources & Essential Reading Health Policy Project (HPP) works in partnership with in-country experts and other associates to sustain commitment to, and ownership of, policy responses supporting improvements in family planning and reproductive health, HIV, and maternal health. HPP contributes to improved health outcomes through strengthening the efficiency, effectiveness, and equity of health systems by; designing and implementing health programming analysis tools; building in-country capacity to generate, interpret, and utilize accurate economic, costing and budgeting data for interventions; working with key stakeholders to identify resource restraints and gaps; and encouraging the integration of accurate economic analysis into planning and resource allocation. As part of its work it produces spectrum of publications related to sustainable financing on multiple axes. Institute for Health Metrics and Evaluation produces an annual report on global health financing, inclusive of HIV/AIDS financing in the context of development assistance for health. UNAIDS has a number of resources/divisions that support resource tracking efforts. The Resource Mobilization Division tracks and reports on public sector/donor government spending related to global health targets, including the annual “Financing the Response…” publication with the Henry J. Kaiser Family Foundation; National AIDS Spending Assessment (NASA) reports provide indicators of the financial response to AIDS by country and supports the monitoring of resource mobilization; AIDSinfo provides analysis based on available financing information. World Bank Global AIDS Economic Resources. The International AIDS Transparency Initiative (IATI) is a voluntary, multi-stakeholder initiative that seeks to improve the transparency of aid, development, and humanitarian resources in to increase their effectiveness in tackling poverty. IATI brings together donor and recipient countries, civil society organisations, and other aid experts who are committed to working together to increase the transparency and openness of aid. The Center for Global Development. (2013). More Health for the Money: Putting Incentives to Work for the Global Fund and Its Partners.Provides an in-depth analysis of how the Global Fund and other major health funders can maximize the health impact of every dollar spent in environments of austerity, within the framework of the Global Fund grant-making cycle. Funders for LGBTQ Issues. (2016). 2014 Tracking Report: Lesbian, Gay, Bisexual, and Transgender Grantmaking By U.S. Foundations. “The 2014 Tracking Report (2016) explores the scope and character of foundation funding for LGBTQ issues in the calendar year 2014. The report analyzes 4,552 grants from 313 foundations, making it the most comprehensiveness assessment of LGBTQ funding available.” PATH. (2014). The Role of Research and Innovation for Health in the Post-2015 Development Agenda: Bridging the Divide Between the Richest and Poorest Within a Generation. Washington, DC: COHRED, Global Health Technologies Coalition, International AIDS Vaccine Initiative, PATH. Makes the investment case for all countries to make research and innovation for health in low and middle-income countries a central component of the post-2015 development agenda. Resch, S., Ryckman, T., & Hecht, R. (2015). Funding AIDS programmes in the era of shared responsibility: an analysis of domestic spending in 12 low-income and middle-income countries. The Lancet Global Health, 3(1), e52-e61. Proposes a system of metrics to determine scenarios of possible future domestic investment in HIV/AIDS in 12 countries in sub-Saharan Africa. Findings show almost all of the 12 countries fall short on funding needed to meet proposed expenditure benchmarks. UNAIDS. (2016). Fast-Track Update on Investments Needed in the HIV/AIDS Response. Elaborates the need to fully fund and front-load investment in comprehensive HIV responses and intensify focus on populations and locations in greatest need.