Annex III - National AIDS Spending Assessments and National Health Accounts

Two tracking systems exist for tracking health spending by countries and by donors. Both are conducted on a periodic basis and in some countries provide the most comprehensive information on health and HIV spending by governments, donors, and out of pocket expenses. However, these data comes with a considerable time lag and may require annual financial audits to supplement the efforts to track, leverage, and provide transparency for annual funding.

National AIDS Spending Assessments

1. National AIDS Spending Assessments (NASA) - UNAIDS supports country NASAs every other year for its UNGASS reporting. They are HIV focused.

The National AIDS Spending Assessment Workbook provides details on its methodology; it and recent findings can be found at the website below. NASA

"is designed to describe the financial flows and expenditures using the same categories as the globally estimated resource needs. This alignment was conducted in order to provide necessary information on the financial gap between resources available and resources needed, and in order to promote the harmonization of different policy tools frequently used in the AIDS field.

NASA provides indicators of the financial country response to AIDS and supports the monitoring of resource mobilization. Thus, NASA is a tool to install a continuous financial information system within the national monitoring and evaluation framework.

NASA serves several purposes within different time-frames. In the short term, NASA might be useful to provide information on the UNGASS indicator for public expenditure; in the longer term, the full information provided by NASA may be used to:

  • Monitor the implementation of the National Strategic Plan;
  • Monitor advances towards completion of internationally or nationally adopted goals such as universal access to treatment or care;
  • Provide evidence of compliance with the principle of additionality required by some international donors or agencies; and
  • Fulfill other information needs."

NASA is not an accounting system. Rather it tracks spending as reported by countries. Donor and government spending is divided in NASA into eight spending classes or chapters of AIDS Spending Categories (ASC): prevention, care and treatment , orphans and vulnerable children, strengthening programme management and administration, incentives for human resources, social protection and social services, enablement of environment and community programmes, and research. PEPFAR guidance on USG participation in NASAs is forthcoming.

National Health Accounts

National Health Accounts are broader, more systematic surveys of all health spending within a country and are used in OECD financing estimates. They are designed to "capture the full range of information contained in these resource flows and to reflect the main functions of health care financing: resource mobilization and allocation, pooling and insurance, purchasing of care, and the distribution of benefits." Expenditures are divided by very high-level health functions such as curative care, long-term care, and prevention.

NHAs are conducted on a periodic basis, varying from country to country. For a NHA to have sufficient detail for HIV financial tracking, the HIV disease-specific module needs to be added to an NHA. This HIV disease-specific module is harmonized with the NSA so that it provides comparable information. NHA methods and recent reports can be found at The NHA is currently under revision by OECD, EUROSTAT European Commission and WHO.

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