National AIDS Spending Assessment (NASA)
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Date
2019-09-20
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Abstract
Zanzibar consists of two main islands, Unguja and Pemba and a number of smaller islands. According to 2012 Population and Housing Census projections, by 2018 Zanzibar had a total population of 1,579,849 inhabitants (768,528 males and 811,321 females). It has an annual population growth rate of 2.8% and a population density of 400 people per square kilometre (km2). More than half of the inhabitants (53.7%) live in urban areas and the rest (46.3%) in rural areas.
The large part of the population is the youth (0 - 17 years) which forms 47% of the total population.Being one of the countries that form the United Republic of Tanzania (URT), Zanzibar is committed to implement national and international responses to HIV & AIDS. While guided by the 3-ones principles, the response has been led by the Zanzibar AIDS Commission (ZAC). This is a legal entity mandated to provide strategic leadership and coordination of the national response. ZAC has developed and coordinated the implementation of the first, second and now the third National Multi-sectoral Strategic Framework (ZNSPIII) for Zanzibar that inform and guide the implementation of the national response. In addition, the health sector has been mandated to implement and oversee the health sector component of the national response through the Zanzibar Integrated HIV, Hepatitis, Tuberculosis and Leprosy Program (ZIHHTLP) which is a Department under the Ministry of Health (MoH).
The national response is informed in-country by the global strategies that are guided by existing and new evidences. The united Republic of Tanzania has joined the world by committing to bold targets in the Sustainable Development Goal (SDG) of ending the AIDS epidemic by 2030. The country has adopted and is monitoring the reduction of new infection as guided by UNAIDS, in its Fast-Track commitments on HIV Combination Prevention strategy.
An effective and long-term response to HIV & AIDS in any developing country must have a primary financial commitment from the national resources. As countries prioritize HIV & AIDS through increased budget allocation and development of multi-sectoral plans and work actively to involve government departments outside the health sector in the fight against HIV & AIDS, the role of budgeting and expenditure tracking to the success of these programs is of paramount importance. Thus, monitoring public expenditure for HIV & AIDS in Zanzibar is vital for several reasons:
i. More than looking at policy or legislation, a country’s budget is the clearest, most reliable and telling indicator of a country’s prioritization of the epidemic.
ii. The national budget is the key to sustainability of any government program and in ensuring reliable availability of human workforce
iii. With the current noticeable fluctuation in availability of donor funds to many African countries [such as those from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the Presidential Emergency Plan for AIDS Relief (PEPFAR)], it is important for public and non-public structures to track these funds, as well as advocating for increased in country funds allocation.
iv. With the announcement of many African countries to roll-out Anti-retroviral (ARV) programs to all HIV-positive citizens, it is necessary to monitor the funds
allocated for care, treatment and support services as part of ensuring continuum of care.
v. Sustainable financing of HIV & AIDS programs is a critical element in achieving the UNAIDS' 90-90-90 goals in line with national and regional policies.
On understanding this, ZAC in collaboration with UNAIDS launched a study to track expenditures on HIV & AIDS related interventions starting from the source of funds to beneficiaries level with the aim of establishing whether what has been allocated to providers reached the intended beneficiaries through appropriate interventions. The study employed the National AIDS Spending Assessment (NASA) Tools and principles developed and supported by UNAIDS.