TRAINING ON COSTING METHODOLOGIES AND TOOLS FOR HIV AND AIDS PROGRAMS

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1 TRAINING ON COSTING METHODOLOGIES AND TOOLS FOR HIV AND AIDS PROGRAMS A FACILITATOR S GUIDE AUGUST 2013 This publication was produced for review by the U.S. Agency for International Development (USAID). It was prepared by Nadia Carvalho, Consultant, and Margaret Reeves of the USAID Health Policy Initiative, Costing Task Order.

2 Suggested citation: Carvalho N, Reeves M Training on Costing Methodologies and Tools for HIV and AIDS Programs: A Facilitator s Guide. Washington, DC: Futures Group, Health Policy Initiative, Costing Task Order. The USAID Health Policy Initiative, Costing Task Order, is funded by the U.S. Agency for International Development under Contract No. GPO-I , beginning July 1, The Costing Task Order is implemented by Futures Group, in collaboration with Futures Institute and the Centre for Development and Population Activities (CEDPA), now part of Plan International USA.

3 TRAINING ON COSTING METHODOLOGIES AND TOOLS FOR HIV AND AIDS PROGRAMS A FACILITATOR S GUIDE AUGUST 2013 The views expressed in this publication do not necessarily reflect the views of the U.S. Agency for International Development or the U.S. Government. i

4 TABLE OF CONTENTS Acknowledgments... III Acronyms and Abbreviations... IV Introduction... 1 Using this Guide... 2 Workshop Components... 3 Module A: Introduction to Costing and Economic Evaluation... 4 Module B: Overview of Costing Models... 5 Module C: Estimating the Demographic Impact of HIV and AIDS Introduction to the Spectrum Package of Models: AIDS Impact Module (AIM)... 6 Module D: Strategic Planning... 8 Module E: National AIDS Spending Assessments (NASA)... 9 Module F: Resource Needs Model (RNM) Module G: WHO Costing Tool Module H: Decision-Makers Program Planning Tool (DMPPT) for Male Circumcision Module I: GOALS Model Module J: Results-Based Management Annex A. Sample Workshop Agenda Annex B. Additional/Optional Sessions Annex C. Additional Material and Resources ii

5 ACKNOWLEDGMENTS This manual was developed through the use of presentations, handouts, exercises, and other material developed by the USAID Health Policy Initiative (Task Order 1) and the Costing Task Order (Task Order 6), and partnering UNAIDS Technical Support Facilities (Eastern Africa, Southern Africa, South Asia, and South-East Asia & Pacific) for use at several workshops convened from 2011 to Also included in the training are the World Health Organization s (WHO) Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) Proposal Costing Tool, and the Asian HIV/AIDS Resource Needs Estimation and Costing Model developed by UNDP, UNAIDS and ADB. We would like to thank USAID, UNAIDS, PAHO and the Bill & Melinda Gates Foundation for their generous funding to support the regional and country-level workshops. We also recognize the support provided by USAID through the USAID Health Policy Initiative Task Order 1 and Costing Task Order 6 that funded staff time for workshop organization and participation. Several entities were responsible for the design and implementation of the HIV Costing Tools and Methodologies workshops conducted from 2011 to 2013, on which this publication was based. These include: USAID Health Policy Initiative Costing Task Order This project supports the President s Emergency Plan for AIDS Relief (PEPFAR) and Global Health Initiative (GHI) by working with policymakers and program managers to develop new tools, approaches, and analyses that help them to more accurately estimate the cost and impact of their HIV programs and other public health responses. The project is implemented jointly by Futures Group, Futures Institute and the Centre for Development and Population Activities (now part of Plan International). UNAIDS The Joint United Nations Programme on HIV/AIDS, UNAIDS, is an innovative partnership that leads and inspires the world in achieving universal access to HIV prevention, treatment, care and support. The UNAIDS Regional Support Teams and Technical Support Facilities played a key role in the workshops. Regional Support Teams provide timely and effective support to UNAIDS Country Offices, while working with regional partners to coordinate and provide programming and technical support to strengthen national responses. Technical Support Facilities small management teams with the purpose of building national and regional capacity to effectively respond to AIDS. They provide experienced, quality-assured consultants to help country partners design programs and solve problems in the area of strategic and operational planning, Global Fund proposal development and grant implementation, institutional development, resource mobilization and tracking, monitoring and evaluation, and management. The Global Fund to Fight AIDS, Tuberculosis and Malaria A unique, public-private partnership and international financing institution dedicated to attracting and disbursing additional resources to prevent and treat HIV and AIDS, tuberculosis, and malaria. iii

6 ACRONYMS AND ABBREVIATIONS AIDS AIM ART Asia Model CAA DMPPT GFATM HIV MARP NASA OVC RBM RNM PMTCT TO TSF UNAIDS USAID WHO acquired immune-deficiency syndrome AIDS Impact Model antiretroviral treatment Asian HIV/AIDS Resource Needs Estimation and Costing Model Commission on AIDS in Asia Decision-Makers Program Planning Tool Global Fund to Fight AIDS, Tuberculosis and Malaria human-immunodeficiency virus most-at-risk population (key population) National AIDS Spending Assessment orphans and vulnerable children results-based management Resource Needs Model prevention of mother-to-child transmission of HIV Task Order Technical Support Facility Joint United Nations Programme on HIV/AIDS The United States Agency for International Development World Health Organization iv

7 INTRODUCTION As countries aim for the long-term effectiveness and sustainability of their HIV and AIDS programs, collecting, understanding, and utilizing cost information is of critical importance. First, data on the costs of HIV/AIDS programs can be combined with data on coverage goals to project the resource requirements of an HIV/AIDS strategic plan, or specific HIV/AIDS programs. When combined with epidemiological data, cost data can help to inform governments on how they can achieve program goals and how they can align their resource allocations with the country s epidemic. Knowing the costs of a country s response can then be used for budgeting, or for supporting proposals for donor funding. Additionally, an understanding of the key cost-drivers of a program can shed light on implications of scale-up and can identify opportunities for increasing efficiencies. As the USAID Health Policy Initiative undertook its work to assist countries to use timely and accurate data for evidence-based decision-making, it noted a lack of costing capacity among implementing partners, consultants, and research institutions in Africa and Asia. This lack of local expertise left stakeholders in these regions struggling to secure staff or consultants with technical expertise in this area, and hard pressed to obtain the cost information required to effectively plan HIV and AIDS interventions. As part of its mission, to support truly sustainable health solutions, the USAID Health Policy Initiative works to develop a cadre of local and regional costing experts able to get reliable, country-relevant cost data into the hands of decision-makers now and into the future. When decision-makers have consistent access to these costing and evaluation skills, it is more likely that these important analyses will be ingrained as part of a complete process of evidence-based, data-driven decision-making. The workshops presented in this guide were designed to help develop this cadre of local costing experts. To strengthen in-country costing expertise, the USAID Health Policy Initiative (Task Order 1 and Costing Task Order 6) organized regional training workshops on costing methodologies and tools, as well as country-level trainings requested by select national AIDS programs. The workshop materials were developed by the USAID Health Policy Initiative (Task Orders 1 and 6) and partnering UNAIDS Technical Support Facilities (Eastern Africa, Southern Africa, South Asia, and South-East Asia and Pacific). Between 2011 and 2013, over 200 individuals from more than 40 countries were trained at these regional and country workshops throughout Asia, Sub-Saharan Africa, and the Caribbean. The workshops focused on both theoretical and practical aspects of economics and modeling. The goal of each workshop was to strengthen skills in costing and modeling for HIV and AIDS programs, to build the technical capacity of consultants and country partners as costing experts. At the end of the workshop, the objective was for participants to be better able to: Understand the importance of economic evaluation, and how to measure cost-effectiveness Undertake costing of a variety of HIV strategies using widely accepted costing tools Understand and utilize cost data related to HIV interventions Learn about the importance of strategic planning in making policy decisions Use the Resource Needs Model for planning HIV/AIDS programs Understand how to use the WHO GFATM Proposal Costing Tool to budget for GFATM proposals Use the Decision-Makers Program Planning Tool (DMPPT) to cost male circumcision Use the GOALS model to understand what HIV/AIDS models can be implemented given current funding Understand the importance of Results-Based Management in HIV/AIDS planning 1

8 This guide was designed as a resource for trainers conducting similar regional or country-level workshops on costing methodologies and tools for HIV and AIDS programs. It provides trainers with example agendas, PowerPoint presentations, exercises, and handouts to create and conduct a Costing Methodologies and Tools for HIV/AIDS Programs workshop. The number of days, and modules included in the workshop, can be altered to fit the particular needs of the trainer and audience. Because this guide does not provide any basic training on the software and tools for trainers, trainers planning to facilitate these workshops should already be familiar with the costing software and tools presented. The typical audience for these workshops includes a broad set of individuals involved in developing strategic plans and budgets and contributing to resource allocation decisions related to HIV, including: technical experts (e.g., finance, costing, health economics, demography, policy advocacy, and public health), HIV and AIDS program planners, and government officials. While this material has been used in Asia, Sub- Saharan Africa, and the Caribbean, the curriculum can easily be adapted to meet the specific priorities and needs of countries and participants. USING THIS GUIDE This guide has been divided into various Modules. The full set of modules can be used together for a comprehensive workshop on HIV costing methodologies and tools (see Annex A for a sample 5-day workshop agenda), or the modules can be used individually based on the specific needs of a country or group. Trainers should consider the length of each Module, as well as the material and skills required for each Module, when organizing the agenda and determining the flow of the workshop or training session. Regardless of the content of the workshop, trainers and organizers may find the following tips helpful: At the start of the workshop or training, organize a welcome/introduction session to: o Share the workshop objectives with participants o Familiarize participants with the workshop agenda Familiarize facilitators and participants with each other, their backgrounds, and experiences. For any workshop that takes place over several days, it is helpful to spend 15 minutes at the start of each day to recap the information presented the previous day. Having participants complete an evaluation at the end of each day is a good way to collect feedback that can be used to adjust the facilitator s approach or the information presented to better meet the needs of participants. Evaluations forms are provided in the Handouts folder that accompanies this guide, as is a final workshop evaluation. For a shorter workshop, workshop organizers might want to consider adapting these evaluation materials for the specific Modules being used. 2

9 WORKSHOP COMPONENTS Module A Module B Module C Module D Module E Module F Module G Module H Module I Module J Introduction to Costing and Economic Evaluation Overview of Models Estimating the Demographic Impact of HIV and AIDS Introduction to Spectrum: DemProj and AIDS Impact Module (AIM) Strategic Planning National AIDS Spending Assessment Resource Needs Model WHO GFATM Proposal Costing Tool Decision-Makers Program Planning Tool (Male Circumcision) Goals Model Results-Based Management 3

10 MODULE A: INTRODUCTION TO COSTING AND ECONOMIC EVALUATION Total Time: 1 hour, 15 minutes Purpose: This module can be used to help educate participants about what economic evaluation is, its importance in HIV program evaluation, and how and when to use it. It will provide participants with an overview of economic evaluation methodologies, and when to use the appropriate method. This module will also help participants understand the limitations to economic evaluation methodologies. Learning Objectives: At the end of this session, participants should be better able to: Understand why economic evaluation is conducted Describe the various economic evaluation methodologies Understand the limitations to economic evaluation methodologies Understand how to measure cost-effectiveness PowerPoint: Introduction to Principles of Costing and Economic Evaluation Flipchart and markers, tape 1. This presentation will introduce participants to the principles of costing and economic evaluation. 2. Ask: Why should we evaluate HIV programs? Write answers on flipchart and display. 3. Start PowerPoint presentation (this should take 1 hour). 4. Summarize the presentation with the following take-home messages: Economic evaluation is a useful tool in determining an intervention with the greatest possibility of improvement in the quality of life per resource spent. There are four types of economic evaluations: cost analysis, cost effectiveness, cost-utility analysis, and cost-benefit analysis (this is the most complex). There is limited information available about what programs should or do cost. One of the main challenges in economic evaluation is that of uncertainty. Economic evaluation uses estimated values for many parameters, and these estimates carry with them a level of uncertainty that must be accounted for if the economic evaluation is to be of any use. Sensitivity analyses are used to deal with uncertainty. In some cases, cost-effectiveness/utility criteria must be complemented by other important considerations, such as ethics, equity, etc. Cost-benefit analysis represents a theoretically appealing, but practically difficult approach to economic evaluation of health programs. 5. For the remaining 15 minutes, discuss any questions that participants might have. 4

11 MODULE B: OVERVIEW OF COSTING MODELS Total Time: 1 hour Purpose: This section is intended to help educate participants about the various models available to help cost out programs. Participants should have a better idea of the models available to them to help make policy decisions, and in what situations they should apply the models. Learning Objective: At the end of this session, participants should be better able to: Describe some of the costing models, including how they have been used to answer key policy questions related to HIV/AIDS resource allocation. PowerPoint: Models Overview Handout - Overview of Costing Models 1. Start PowerPoint by explaining that participants will now learn about a few frequently used HIV costing models, and that short examples will also be provided regarding how the models have been used. 2. Summarize the presentation using the following points: Demand exists for tools designed to determine AIDS treatment costs and various models are currently available, but there is still no consensus on the best approach. Existing models are increasingly integrated, yet rapidly evolving. To ensure that the most appropriate model is used to meet a country s needs, it is important that all parties involved have a clear understanding of what questions the model can and cannot help answer, the input data required for a tool, and resources necessary to collect, input and analyze the data. Additional information on the AIM, Goals, RNM, and DMPPT models can be found on the Futures Group website ( For more on the GFATM Proposal Costing Tool go to and for more on the Asian Costing Model go to Expanded training is still required to build full competency capacity in using these models. 5

12 MODULE C: ESTIMATING THE DEMOGRAPHIC IMPACT OF HIV AND AIDS INTRODUCTION TO THE SPECTRUM PACKAGE OF MODELS: DEMPROJ AND AIDS IMPACT MODULE (AIM) Total Time: 2 hours, 45 minutes Purpose: This session will provide participants with an overview of the Spectrum Suite of Models, and in particular familiarize them with the DemProj and AIDS Impact Modules. Because a demographic projection is the basis for all types of modeling, participants will learn more about the DemProj Module, and also delve deeper into the AIDS Impact Module (AIM), which helps to generate population information for a country about those who are living with HIV, people who are treatment eligible, and orphans and vulnerable children. At the end of this session participants should better understand how the Spectrum Suite of models can be used and have experience applying the DemProj and AIM modules to complete an exercise. Learning Objectives: At the end of this session, participants should be better able to: Describe how to estimate the demographic impact of HIV and AIDS using DemProj and the demographic impact of treatment using AIM Understand how to extract population information from Spectrum Be able to understand how to use the data produced by the model PowerPoint: Spectrum: AIDS Impact Module Handout - Spectrum Exercise: AIDS Impact Model Flipchart and markers, tape Introduction to Spectrum Focus on DemProj and AIDS Impact Model (AIM) (1 hour) 1. Explain that this presentation will introduce the Spectrum Package of Models: The Package includes DemProj, AIM, RNM, Goals, Lives Saved Tool (LiST), and RAPID. The Package is a unique tool that builds on the demographic and HIV epidemiological projection in a country to estimate the number of HIV infections, new HIV infections, AIDSrelated deaths, persons needing treatment, and number of orphans due to AIDS. 2. Begin the Spectrum PowerPoint 6

13 Spectrum Exercise: AIDS Impact Model (AIM) (1 hour 45 minutes) 1. Distribute Spectrum Exercise Handout. Explain that this exercise will help participants learn how to extract population information from Spectrum. 2. Assist participants to download Spectrum. 3. Ask participants to work on Questions 1 and Any time remaining can be used to download the other costing modules that will be used during the workshop. 7

14 MODULE D: STRATEGIC PLANNING Total Time: 1 hour Purpose: This module is intended to help participants learn how to create a strategic plan, to recognize the importance of understanding the HIV epidemic within their country to plan for resource allocation, and how to use results to adjust the strategic plan. Learning Objectives: At the end of this session, participants should be better able to: Explain the meaning of strategic planning Understand the importance of knowing the epidemic within their country Define the phases of strategic planning using the Results Cycle PowerPoint: Introduction to Strategic Planning 1. Explain that strategic planning is about using evidence to inform decision-making, and is focused on results that address the realities of the HIV epidemic. 2. Discuss the various types of strategic plans, and ask participants to talk about their experience with strategic plans. 3. Begin the PowerPoint: Introduction to Strategic Planning. 4. Summarize the session with the following points: A strategic plan is a living document. It can and should be revised as needed during implementation, according to monitoring data and research findings. Strategic planning is not a linear process. It involves a series of phases, as shown in the Results Cycle, which overlap. Information is more likely to be used when results are analyzed and findings are synthesized and reported. By using evidence, the strategic planning process creates demand for high-quality information. Strategic planning is about using evidence and focuses on results that address the realities of the epidemic. 8

15 MODULE E: NATIONAL AIDS SPENDING ASSESSMENTS (NASA) Total Time: 1 hour Purpose: This module will teach participants about the National AIDS Spending Assessment (NASA), which is a tool used to look at past resources consumed by HIV/AIDS programs to help policymakers determine where the gaps are in resource allocation and the flow of resources. Participants will learn how to use the tool, where to find data to put into the tool, and how information from NASA can be used to guide decisions by funders and policymakers. Learning Objective: At the end of this session, participants should be better able to: Understand the National AIDS Spending Assessments Know how to use the tool Understand how information from the tool can be used PowerPoint: National AIDS Spending Assessment Handout NASA Additional Resources 1. Begin the PowerPoint: National AIDS Spending Assessment, and explain that it will provide: a. Additional information about what the National AIDS Spending Assessment (NASA) is b. Objectives of NASA c. Attributes of NASA d. Sources of information 2. Distribute the Handout with additional NASA resources, and summarize the session, by reminding participants that NASA: Is a term used for country HIV and AIDS resource tracking activities Provides indicators of the country s financial response to HIV and AIDS, and to support the monitoring of resource mobilization Provides information relevant for decision-makers by answering questions such as: Who finances? Who manages the funds? Who provides the services? What is being provided? Who benefits? and How is it being produced? When the actual expenditure obtained through NASA is compared with resource needs estimates, a possible financing gap is revealed, which is useful to assess adequacy of funding, or need for additional resources. NASA has three phases of data collection, processing and reporting: (1) total public spending from central, sub-national, local and municipal governments, as well as government managed funds; (2) international aid from bilateral and multilateral agencies; and (3) private expenditures. Key dimensions and vectors constituting the NASA framework include financing (sources of resources and financing agents), provision (providers and factors of production), and consumption (AIDS Spending Activity and beneficiary population groups). 9

16 MODULE F: RESOURCE NEEDS MODEL (RNM) Total Time: 9 hours, 15 minutes Purpose: The Module will help participants understand the Resource Needs Model (RNM), which is used to look at resources that are needed for prevention and/or care and treatment of HIV/AIDS. Participants will understand the importance of estimating resource needs for prevention and treatment within the country, and identifying resource gaps to help plan for the future. Participants will also be able to understand how to use the model, and what data are needed to produce necessary information. Learning Objectives: At the end of this session, participants should be better able to: Describe the use of the Resource Needs Model Describe the type of estimates that the RNM can generate Describe how the RNM can be used to determine the resources required for HIV prevention programs Understand how to assess the resources needed to reach most-at-risk populations (MARPs or key populations), deliver key services, and provide health care prevention strategies Describe the elements within the care and treatment component of RNM Understand how to use RNM s Care and Treatment and HIV Treatment components Use the unit cost component of AIM to extrapolate ART unit costs at the national level Define and develop unit costs for OVC programs Demonstrate how to input coverage and unit costs into the RNM Mitigation (OVC) component Analyze results from the RNM Mitigation (OVC) component Use the RNM Summary Sheet to analyze total resources required and the resource gap Understand and discuss resource gap implications Session 1: Determining Resource Needs: Using RNM (30 minutes) PowerPoint: Determining Resource Needs: Using RNM 1. Begin PowerPoint: Determining Resource Needs Using RNM. 2. Summarize with the following points: The RNM estimates resource requirements for specified interventions in order to achieve a given level of coverage of a given target population at the given unit costs, based on national policies and plans. The RNM is a useful tool for budgeting and strategic planning. 10

17 Session 2: RNM Prevention Component (2 hours 30 min) PowerPoint: Overview of RNM Prevention Component Handout - RNM Prevention Exercise Overview of RNM Prevention Component (1 hour) 1. Begin PowerPoint: Overview of RNM Prevention Component. 2. Summarize by concluding that the prevention module within RNM calculates the resources required for HIV prevention programs for each MARP (key population) category, the resources needed for key service delivery, and the resources required for prevention within the health care settings. 3. Discuss the components of the prevention module. Demonstrate how this information is put into the HIV Treatment tab of RNM, and explain that this tab calculates unit costs based on these inputs, and uses them in the Care and Treatment section. Exercise: Developing RNM Estimates for Prevention (1 hour 30 minutes) Distribute RNM Prevention Exercise Handout and work with participants to complete the exercise. Session 3: RNM Care and Treatment Component (2 hour 30 min) PowerPoint: Overview of RNM Care and Treatment Component Handout - RNM Care and Treatment Exercise Overview of RNM Care and Treatment Component (1 hour) 1. Show PowerPoint: Overview of RNM Care and Treatment Component. 2. Summarize by highlighting: There are various costs within the care and treatment components of the RNM, including costs for ART drugs, laboratory tests, patient care, palliative care, psychosocial support, pre-art care, etc. The care and treatment component can be used to determine the cost per person receiving treatment. The care and treatment component has certain limitations (for example, cost inputs for the regimen mix, laboratory testing, and care schedule must be consistent across years). These unit costs can then be used to estimate national costs for the program, or if the user already has estimates, these can be input directly. Exercise: Developing RNM Estimates for Care and Treatment (1 hour 30 minutes) Distribute RNM Care and Treatment Exercise Handout and work with participants to complete. 11

18 Session 4: Modeling ART Costs Using Spectrum (45 minutes) Projector to display software: RNM HIV Treatment tab and Care and Treatment component 1. Lead a discussion about antiretroviral treatment (ART) coverage in specific countries represented at the workshop, and in the region. 2. Discuss the components of care and treatment in specific countries represented at the workshop, and in the region. 3. Demonstrate how users can enter the unit costs calculated in RNM, or existing unit cost estimates to Spectrum. 4. Give participants time to practice using the unit cost component of AIM to extrapolate unit costs to the national level. Session 5: Costing OVC Programs (1 hour 30 minutes) Projector to display software: RNM OVC component 1. Lead a discussion about programs for orphans and vulnerable children (OVC) in specific countries represented at the workshop, and in the region. 2. Discuss how to define orphans (e.g., maternal, paternal, and dual), and how these definitions can affect costing of OVC programs. Session 6: Using RNM to Estimate Mitigation (OVC) (1 hour 30 minutes) Projector: RNM Mitigation (OVC) component 1. Using the projected RNM Mitigation (OVC) component, walk through the module and explain various components to participants. 2. Give participants an opportunity to input coverage and unit costs into the Mitigation component. 3. Work with participants to analyze the results. 12

19 Session 7: Exercise: Policy and Program Support Costs (45 minutes) Projector to display software: RNM Policy and Program Support component Exercise: RNM Policy and Program Support 1. Use the projected RNM Policy and Program Support component to explain to participants that this is the final component of the RNM. Explain that it allows users to base costs as percentages of the overall already-defined program, and walk through the various components. 2. Distribute Exercise: RNM: Policy and Program Support, and work with participants to complete. 3. Lead a discussion with participants about their perspectives on priorities for the coming year, and specific policy issues to prioritize. Session 8: Using RNM to Estimate Total Resource Needs and Resource Gap (1 hour) Exercise: RNM: Total Resources Required and Resource Gap Projector to display software: RNM summary sheet 1. Distribute the Exercise: RNM: Total Resources Required and Resource Gap. 2. Using the projected RNM summary sheet, work with participants to analyze the total resources required. 3. Help participants to analyze possible implications of the resource gap, and discuss potential resource mobilization strategies, prioritization of interventions, and strategies/efficiencies that could be used to narrow the gap. 13

20 MODULE G: WHO GFATM PROPOSAL COSTING TOOL Total Time: 3 hours, 30 minutes Proposal: This Module will help participants prepare a budget for Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) proposals. Participants will learn how to use the WHO Costing Tool to create a budget that will work for their proposal. Learning Objectives: At the end of this session, participants should be better able to: Explain how the WHO Costing Tool can be used to cost GFATM proposals Use each component of the tool to cost GFATM proposals PowerPoint: WHO Costing Tool Exercise: GFATM Costing Tool Scenarios and Exercises Projector to display software: GFATM Costing Tool 1. Use the PowerPoint: WHO GFATM Proposal Costing Tool to describe the WHO Costing Tool and explain how it works and can be used, including that: It is an Excel-based tool that can help countries complete budgets for GFATM proposals. It is a generic tool that is available for HIV, tuberculosis, health system strengthening, and MARPs (key populations). It is available in English, French, and Spanish, and is accompanied by a user manual. It is activity-based, and costing is done at the level of activities and detailed inputs. 2. Distribute the Exercise: Global Fund Costing Tool Scenarios and Exercises, and work with participants to complete it. 14

21 Total Time: MODULE H: DECISION-MAKERS PROGRAM PLANNING TOOL (DMPPT) FOR MALE CIRCUMCISION 3 hours, 45 minutes Purpose: This Module will describe the Decision-Makers Program Planning Tool (DMPPT), which helps review the cost effectiveness and benefits of implementing male circumcision policies. Participants will be able to use the model to determine costs and averted infections based on their policy decisions. Learning Objectives: At the end of this session, participants should be better able to: Understand the purpose of costing and modeling male circumcision Explain how costing male circumcision can help support national programs Define the key male circumcision services that should be costed Understand how to use the Decision-Makers Program Planning tool PowerPoint: Costing Male Circumcision PowerPoint: Modeling the Costs of Male Circumcision Exercise: Modeling Male Circumcision Session 1: Costing Male Circumcision (1 hour) 1. Use the PowerPoint: Costing Male Circumcision to lead a discussion about the Decision- Makers Program Planning Tool (DMPPT) and its use in modeling the costs and benefits of male circumcision. 2. Lead a discussion about the current situation related to male circumcision in the various countries represented at the workshop and/or in the region. Discuss any issues and challenges that countries or the region faces. Session 2: Modeling Male Circumcision (1 hour) 1. Use the PowerPoint: Modeling Male Circumcision Costs to explain the costing methodology and impact assessment components of the DMPPT. 2. Summarize by reviewing the two components of the DMPPT: a. The unit cost component is used to develop unit costs (this is primarily a facility-based costing tool, that incorporates each component of the circumcision service). b. The impact component is used to estimate the impact of a male circumcision program in terms of new infections (used to examine the infections averted by male circumcision, depending on the target population and scale-up rate). Exercise: Estimating Male Circumcision Costs (1 hour 45 minutes) Distribute the Exercise: Modeling Male Circumcision, and work with participants to complete. 15

22 MODULE I: GOALS MODEL Total Time: 2 hour Purpose: This Module will help educate participants about the GOALS model which is used to understand what HIV/AIDS programs can be achieved with current funding, who can be reached by current resources, and understanding funding required for goals laid out in a strategic plan. Participants will learn how the GOALS model can help when making policy decisions, and how to read the data. Learning Objectives: At the end of this session, participants should be better able to: Explain the purpose and use of the GOALS Model Use the GOALS Model Understand how the information produced by the model can be used for policy decisions PowerPoint: GOALS Model Exercise: Applying the GOALS Model Projector to display software: GOALS Model Session 1: Introduction to the GOALS Model (1 hour 15 min) 1. Begin the PowerPoint: GOALS Model, and discuss the purpose and use of the GOALS Model for examining alternative national strategies and program-mix options, including that the model has been used to: Estimate global resource requirements for the United Nations General Assembly Special Session Develop the global targets and country targets for the U.S. President s Emergency Plan for AIDS Relief, Phase I Develop Global Fund applications Design strategic plans Evaluate progress toward the achievement of strategic plans 2. Explain the methodology of the Goals Model, which is typically used for policy dialogue around various resource allocation scenarios. Session 2: Exercise: Applying the GOALS Model (1 hour 45 min) 1. Distribute the Exercise: Applying the GOALS Model, and work with participants to enter data into the model and examine how different resource allocation scenarios impacted new HIV infections and prevalence, coverage of ART and OVC services, and monitoring and evaluation. 2. Discuss what might influence spending in different countries present, and in the region (including donor priorities, political considerations, and response coordination). 16

23 MODULE J: RESULTS-BASED MANAGEMENT Total Time: 1 hour, 30 minutes Purpose: This Module will help participants understand Results-Based Management (RBM), which focuses on defining the results that you want, and being sure that resources are focused on achieving specified results. Participants should be able to understand the importance of RBM in HIV/AIDS policy planning, understand how to define a result, and how to measure results. Learning Objectives: At the end of this session, participants should be better able to: Explain the purpose of Results-Based Management (RBM) Understand the importance of an RBM approach to HIV and AIDS planning Learn how to use RBM PowerPoint: Results-Based Management 1. Use the PowerPoint to discuss RBM, including its origin and rationale of use (i.e., attention to results instead of activities, improved transparency and accountability, better measurement of program results). 2. Discuss the meaning and major elements of results in the context of RBM. 3. Explain and discuss the different types of change to be measured at each level of the results. Discus the types of change (impact, outcome, output) and the results chain. 4. Discuss the importance of RBM to HIV and AIDS planning. 17

24 ANNEX A. SAMPLE WORKSHOP AGENDA Time Activity 8:30-9:00 Registration DAY ONE 9:00-10:00 Welcome, Introductions, and Expectations 10:00-10:15 Tea/Coffee 10:15-11:30 Introduction to the Principles of Costing and Economic Evaluation 11:30-12:30 Overview of Costing Models 12:30-13:30 Lunch 13:30-14:30 Estimating the Demographic Impact of HIV and AIDS: Introduction to the Spectrum Package of Models 14:30-14:45 Tea/Coffee 14:45-16:30 Spectrum Exercise 16:30-17:30 Download Models 8:30-8:45 Recap from Day 1 8:45-9:45 Strategic Planning DAY TWO 9:45-10:45 National AIDS Spending Assessments 10:45-11:00 Tea/Coffee 11:00-11:30 Determining Resource Needs: Using RNM 11:30-12:30 Overview of RNM Prevention Component 12:30-13:30 Lunch 13:30-15:00 Exercise: Developing RNM Estimates: Prevention 15:00-15:15 Tea/Coffee 15:15-16:15 Overview: Using RNM to Estimate Care and Treatment Resource Needs 16:15-17:30 Exercise: Developing RNM Estimates: Care and Treatment 18

25 DAY THREE 8:30-8:45 Recap from Day 2 8:45-9:30 Exercise: Modeling ART Costs Using Spectrum 9:30-11:00 Costing OVC Programs 11:00-11:15 Tea/Coffee 11:15-12:45 Using RNM to Estimate Mitigation (OVC) Resource Needs 12:45-13:45 Lunch 13:45-14:30 Exercise: Policy and Program Support Costs 14:30-15:30 Exercise: Using RNM to Estimate Total Resource Needs and Resource Gap 15:30-16:30 Individual Practice and Consultation 8:30-8:45 Recap from Day 3 8:45-11:00 WHO Costing Tool 11:00-11:15 Tea/Coffee 11:15-12:30 WHO Costing Tool 12:30-13:30 Lunch 13:30-14:30 Costing Male Circumcision DAY FOUR 14:30-15:30 Modeling Male Circumcision 15:30-15:45 Tea/Coffee 15:45-17:30 Exercise: Estimating the Costs of Male Circumcision 8:30-8:45 Recap from Day 4 DAY FIVE 8:45-10:00 Introduction to Goals Model 10:00-10:30 Tea/Coffee 10:30-12:00 Exercise: Applying the Goals Model 12:00-13:00 Lunch 13:00-14:30 Results-Based Management 14:30-15:00 Tea/Coffee 15:00-16:00 Next steps/planning 16:00-16:30 Evaluation Note: The Handouts folder includes evaluations for each day, as well as a workshop evaluation at the end of the five days. 19

26 ANNEX B. ADDITIONAL/OPTIONAL SESSIONS Additional Asia-specific Sessions (see folder PPT and Exercises for Asia folder): PowerPoint: Economics of AIDS in Asia: AIDS Spending This presentation can serve as an introduction to AIDS spending in Asia. It shows trends in domestic and international expenditure in Asian countries. It also provides information about sources of AIDS funding in the region, breaks down AIDS spending by categories/components, and presents the contribution of international resources in AIDS spending. PowerPoint: Resource Allocation and HIV/AIDS in Asia This presentation can be inserted prior to the session on Principles of Costing and Economic Evaluation. It takes the participants through a series of questions to help them think about resource allocation specifically for Asia: 1. What is an optimal allocation of resources? 2. Why is it important to know your epidemic when allocating resources? 3. Where are current resources being spent and who is providing those resources? 4. Where will future resources come from? 5. How effective are the interventions that are being funded? PowerPoint: Introduction to the Asian HIV/AIDS Resource Needs Estimation and Costing Model (Asian Model) The Asian HIV/AIDS Resource Needs Estimation and Costing Model (The Asian Model) is an Excelbased tool designed to help the government and other stakeholders with short-, medium- and long-term resource needs estimation exercises on the comprehensive HIV/AIDS response. This presentation discusses key features and functions of the Asian Model, which is built on the strengths of the RNM. The Asian Model allows users to project the epidemiological trajectory, assess the impact of a response on the future course of the epidemic and examine the cost-effectiveness of responses in alignment with the Commission on AIDS in Asia (CAA) Report. Exercise: RNM for MARPs (Key Populations) The RNM Exercise for MARPs can be used to help participants think through how to go about estimating the required resources for MARP interventions. Other Optional Sessions: Next Steps and Planning This is a useful session to have at the end of a multiple day workshop. The session can be used to discuss any next steps that participants might have, including how they plan to use their newly acquired skills. Some questions to consider asking participants include: How might participants use their skills in-country or in the region? What upcoming opportunities exist in-country or in the region with which participants can further apply their skills and consolidate their learning? What additional needs exist to build capacity in costing and budgeting in-country or in the region? In what ways can participants continue to build their capacity in costing and modeling after the workshop, and what resources are available to them? 20

27 This is also the time to discuss any needs for additional technical assistance, and what this might entail. Facilitators can ask participants whether they feel that their countries might be interested in further training to develop better unit costs for specific interventions (e.g., male circumcision, OVC, treatment, etc.). This is also a good time for participants to complete an evaluation of the workshop (see Handouts folder for a sample Workshop Evaluation), and participants can share any recommendations that they might have for future workshops. Using Excel Based on participant experience with Excel spreadsheets, facilitators might want to organize an open session during which participants can make recommendations on useful equations and calculations. This session can also be used to help participants become more familiar with Excel-based formulas and calculations. 21

28 ANNEX C. ADDITIONAL MATERIAL AND RESOURCES The following material and additional resources can be found in the folder: Material and Resources Strategic Investment Framework: In 2011, the Investment Framework Study Group recently proposed a strategic investment framework to guide international and domestic AIDS investments. The framework proposes three categories of investment: six basic programmatic activities, interventions that create an enabling environment to achieve maximum effectiveness, and programmatic efforts in other health and development sectors related to HIV and AIDS. It incorporates major efficiency gains to be achieved through community mobilization, synergies between program elements, and benefits of the extension of ART for prevention of HIV transmission. Supplemental Schwartländer B, et al "Towards an improved investment approach for an effective response to HIV/AIDS." The Lancet DOI: /S (11) PowerPoint: Towards an improved investment approach for an effective response to HIV, UNAIDS Seminar, 15 June PowerPoint: Community Mobilization in the Investment Framework. K Thompson, UNAIDS Seminar, 15 June

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