Reports

HIV allocative efficiency studies are generally posing the question “How can HIV funding be optimally allocated to the combination of HIV response interventions that will yield the highest impact?”. In this context the government of Zambia approached the World Bank with a request to conduct an allocative efficiency analysis to inform the revised national AIDS strategic framework (R-NASF), prioritisation of the HIV response, and value for money considerations in the context of resource mobilisation. Four main policy questions were posed: (1) What are the estimated and projected HIV epidemic trends until 2030 and the transmission dynamics between sub-populations? (2) What is the optimised HIV resource allocation to minimise HIV incidence and AIDS mortality between 2014 and 2030? (3) What is the minimum spend required to meet moderate or ambitious national strategic impact targets? (4) What are the long-term financial commitments of HIV treatment and healthcare costs? Zambia, recently reclassified as a low- and middle-income country (LMIC), had an estimated total population of 14.08 million in 2012. The country enjoys positive annual GDP growth—at 6.4% in 2013—and a fairly stable macroeconomic situation. Nevertheless, income levels are highly skewed and in 2010, 60.5% of the population were living below the national poverty line, which impacts negatively on health.

The Joint Mid-Term Review (JMTR) of the NASF was undertaken through August to the end of September 2013 and was mainly aimed at assessing the implementation of the NASF using a forward looking approach that would document achievements, lessons learnt, gaps, obstacles, challenges and opportunities at community, district, provincial and national level with regard to the four pillars including monitoring and evaluation and financing aspects of the NASF, and to make recommendations for strengthening and improving Zambia’s national HIV response.

Zambia has made important progress in its AIDS response, achieving more than 41% decrease in new infections between 2005 and 2015. Overall, Zambia experienced a decline of about 20% of HIV incidence between 2005 and 2014. The trend is projected to be declining in the near future5.

CSE has demonstrated impact in termsof improving knowledge and self-esteem changing attitudes, gender and social norms, and building self-efficacy. This is particularlycritical during adolescence, as young people make the transition into adulthood.Integrating content on gender and rights, and delivering CSE together with effortsto expand access to a full range of highquality,youth-friendly sexual and reproductivehealth services and commodities, makes sexuality education even more effective.

The National AIDS Spending Assessment (NASA) (2010-2012) is the third effort to track all the HIV/AIDS spending in Zambia from all sources (excluding out-of-pocket) and across all sectors. The first NASA was undertaken for the years 2005 and 2006. For the years 2007 to 2009, the Public Expenditure Tracking (PETS) approach was applied1. The NASA provides an in depth examination of the HIV/AIDS by detailed categories of activities, providers of services and the beneficiaries. NASA applies a standardised and comprehensive methodology for collecting, coding and analysing of HIV expenditure. It allows countries to understand if they are allocating funds according to their priorities and for the greatest investment in terms of impact.

The Corridors of Hope III/FHI360 with funding from USAID/PEPFAR implemented (September 2009-October 2015) a comprehensive HIV prevention strategy in 10 border and transit selected districts in Zambia to reduce sexual transmission of HIV among most at risk populations including FSWs and their clients residing in or passing through border towns. The strategies included HIV testing and counselling, behaviour change through outreach and peer education, improved management of STIs, social marketing of condoms and family planning. The 2015 integrated Bio-Behavioural Surveillance Survey (IBBSS) among FSWs and Behavioural Surveillance Survey (BSS) among LDTDs were carried out to measure the outcomes of these prevention interventions efforts among FSWs and LDTDs

2013-14 Zambia Demographic and Health Survey (ZDHS) is a national sample survey designed to provide up-to-date information on background characteristics of the respondents, fertility levels, nuptiality, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of mothers and young children, early childhood mortality and maternal mortality, maternal and child health, awareness and behaviours regarding HIV/AIDS and other sexually transmitted infections (STIs), and prevalence and incidence of HIV/AIDS and other STIs. The target groups were men age 15-59and women age 15-49 in randomly selected households across Zambia. Information about children age 0-5 was also collected, including data on weight and height. The survey collected blood samples for HIV testing in order to determine national and provincial prevalence and incidence rates.

This report therefore, provides highlights on activities undertaken by NAC from January to June 2013 and is in line with the National Strategic Framework (NASF) results areas and their expected outputs