Determining costs and financing
Financing
Funding requirements vary widely with countries and contexts. There is a wide range of options for funding. Many HIV testing and counselling sites receive funding from a combination of sources.
Funding sources
Local and central government
Many national programmes are largely funded by government and form part of an integrated comprehensive HIV programme. In other settings the government may provide some funding or may supply and fund or second staff or pay for or supply commodities, e.g. test kits.
Bilateral and multilateral donors
Bilateral and multilateral donors remain a major source of funding for HIV interventions in most developing countries. Access to funds depends on local criteria.
International agencies
GFATM and private foundations have become major sources of new funding for HIV interventions. Governments or NGOs can access funding for HIV testing and counselling services from these organizations.
Private ector
Increasingly, the offer of testing and counselling is considered a part of workplace medical schemes or voucher schemes are used to fund HIV testing and counselling for employees at independent sites. Private medical services frequently offer HIV testing with or without counselling to clients. In these circumstance the clients have to pay the full cost of testing. This is beyond the reach of many people.
User fees / cost recovery
Some NGOs charge clients a small fee for HIV testing and counselling services. This is usually a fraction of the actual costs and in practice does not contribute significantly to the costs of the services. It is recognized that if more people are given the opportunity to know their HIV status the testing and counselling services will not be sustainable and will rely on external funding, at least in the short term.
Local fundraising
Some testing and counselling services may be able to engage in local fundraising or to raise funds by providing training or other services for other organizations or by renting out temporarily available facilities and services to other bodies.
Fundraising techniques
Because of the complexities of funding sources and mechanisms in many countries, it is often cost-effective to employ a person to source and secure funding. Some testing and counselling programmes employ resource mobilizers who are knowledgeable about funding sources and have expertise in the preparation of funding applications.
Resource mobilizer's tasks may include:
- identifying local and international funding sources;
- ascertaining, for each funding source, areas of focus and interest of the donor, funding cycles and deadlines;
- preparing proposals with a clear strategic plan and budget tailored to the donor?s interests;
- exploring ways of being represented on the CCM in order to facilitate access to funding;
- coordinating with other team members (programme manager, accountant, etc.) to ensure that reports are on time and in line with donor requirements with a view to securing continuing and future funding;
- documenting past successes and disseminating the results widely, as funders often want to support programmes that have already proved themselves effective, acceptable and successful;
- arranging dissemination workshops and presentations at meetings and conferences.
Tools
Managing your finances
This chapter provides key information on financial principles that include: preparing a budget for your workplan; projecting revenues and monitoring cash; controlling and managing funds (establishing basic standards and controls); financial monitoring (comparing program results with budget projections); determining and comparing the cost of services; meeting both donor and institutional reporting requirements; understanding and using financial reports for decision making. There are 'how to' strategies that are easy to understand and tailor.
Analysing costs for management decisions
This online manual consists of worksheets for calculating the costs for personnel and contraceptive products. The costing procedures included are: determining the total cost of family planning personnel; allocating personnel costs to different types of family planning visits; determining the cost of contraceptive products; calculating the total personnel and contraceptive supplies cost per unit of service, or type of visit; estimating cost per year of use and overcoming resistance to measuring costs.
Using cost and tevenue analysis tools
This issue provides insight into the importance of a cost revenue analysis as well as options for increasing cost efficiency and revenue generation. There are 3 electronic software tools, some of which need to be ordered by the organizations that produce them: Cost Analysis Methodology for Clinic Based Family Planning methods; Cost and Revenue Analysis Tool (CORE); A Supply-demand Model of Health Care Financing with an Application to Zaire: a Training Tool.
Costing and financing capacity
When testing and counselling services are being planned the emphasis is often on service provision, i.e. the provision of services of high quality, whereas the need for expertise in costing and financing is frequently overlooked. For smaller services it may not be practical or cost-effective to employ full-time staff. The use of part-time employees or the hiring of consultants may be more efficient.
Once funds have been received , their efficient management is crucial and the best accounting practices, whether accrual-based or cost-based, should be implemented in order to ensure this.
Skills needed in costing and financing for HIV testing and counselling services
- Management. Management training is needed to support the accounting and finance staff and to coordinate financial systems and processes.
- Proposal-writing. A key part of any project proposal is to ensure that the budget is as accurate and realistic as possible and that it is presented in a consistent way.
- Accounting. Training in accounting is needed but varies with the site. The method and complexity of accounting depends on the size and scope of HIV testing and counselling services and the reporting required by donors and government.
- Inventory control. Basic inventory control skills are needed at all sites in order to ensure a consistent supply of consumables such as test kits and condoms and to provide a check against possible loss or theft.
- Record-keeping and monitoring and evaluation. Many testing and counselling services find it useful to be able to report on the costs of the services for the purposes of future planning, comparison with other sites or service providers and costing over time. Staff require training in accurate record-keeping as part of a monitoring and evaluation programme.
Staff retention/burnout
Many HIV testing and counselling services have a high turnover of staff, sometimes because of burnout. This can lead to high recruiting and training costs and may result in a services of reduced effectiveness if experienced staff are lost. Planning for staff support services and ongoing supervision and education of staff can prevent this and is eventually beneficial in respect of service provision and cost-cutting. It is also necessary to pay staff realistic market salaries in order to dissuade them from moving as soon as they gain experience (see Capacity-building and training).
Costs for clients
The indirect costs for clients accessing HIV testing and counselling services are often overlooked. They can be minimized if careful thought is given to the siting of the services and to the adoption of flexible opening times. If sites are open during lunch times, after work and on Saturdays, clients may be able to attend without missing work or needing child care.
Client costs:
- transport;
- child care;
- loss of income because of time off work.
Tool
Project Expansion Proposal submitted by the Government of the Republic of Uganda to NORAD
This proposal for 'Decentralized HIV Counselling and Testing Services' consists of a justification for the expansion of VCT in Uganda. It contains information on Uganda's policies and protocols. It also includes: implementation (outputs, strategies, C&T procedure etc.); work plans; quality assurance; monitoring and evaluation indicators and project budget sheet. The Annex consists of information on: items for procurement; financial flowchart and VCT flowchart.
Counselling and Voluntary HIV Testing for Pregnant Women in High HIV Prevalence Countries (UNAIDS 2001)
Refer to section 6, Cost Considerations. This document is specific to the VCT needs and requirements of pregnant women. It includes operational considerations such as staffing, cost and types of counselling and testing that needs to be considered.