Mongolia’s Experience of Tracking National AIDS Spending

By April 10, 2024 SKPA

Evlegsuren Ser-Od
FSA, SKPA-2 – Youth for Health Center, Mongolia

Delegates from Mongolia participated in the Regional Workshop on Resource Tracking for HIV and National AIDS Spending Assessments (NASA) in Asia and the Pacific, organized by UNAIDS from 4 to 6 March 2024, in Bangkok, Thailand. 

During the event, the Mongolian team shared insights from their recent National AIDS Spending study. Dr Munkh-Erdene Luvsan, who served as the domestic Principal Investigator of the NASA, presented the study’s findings, recommendations, and reflections on the enabling factors and limitations encountered during this significant undertaking, particularly considering the comprehensive scope of the study spanning five years of expenditure (2017-2021). 

Additionally, Dr Ulzii-Orshikh Khaltar, officer in charge of monitoring and internal auditing of public health expenditure in the  Ministry of Health who had previously conducted the 2015-2016 NASA was among the Mongolia delegates. With these experienced health economists on board, the team was well-prepared to contribute meaningfully to the discussions at the workshop.

Mongolia experiences a low-level HIV epidemic, with a national HIV prevalence of less than 0.1%. However, the epidemic is primarily concentrated among men who have sex with men (MSM) and transgender individuals, with a prevalence rate exceeding 6% in these groups. A significant disparity persists in meeting diagnosis targets, with only approximately 44% of individuals living with HIV being aware of their status. This challenge is exacerbated by a 37% reduction in external donor assistance for HIV and a 14% decline in domestic public funds from 2015 to 2020, leading to an estimated annual funding gap of 70% in 2021-2023.

Given the concentrated nature of the country’s HIV epidemic and the limited resources available for the HIV response, it is crucial to concentrate efforts on prioritized interventions with enhanced programmatic and allocative efficiencies which necessitates a comprehensive understanding of current HIV expenditure, resource flow, and financing architecture. 

The first NASA report, focusing on expenditures in 2008-2009, was published in 2010. Since then, a total of five assessments have been conducted meaning Mongolia has accumulated reliable data on AIDS spending for 14 consecutive years. During the discussions, team Mongolia expressed that beside continuing tracking expenditure on HIV programs Mongolia is now exploring opportunities to more in-depth economic analysis of the available data to generate evidence on cost-benefit and cost-effectiveness of the HIV programs.  

One of the primary topics discussed during the Regional Meeting was the utilization of the NASA findings for policy advocacy. Each country outlined preliminary plans for using the NASA results and shared it with UNAIDS. Mongolia, in particular, has taken a significant step by developing a comprehensive joint policy brief that combines the findings and recommendations of two studies: NASA and Optima Modelling. 

The Optima Modelling study focuses on the allocative efficiency of available funding and was conducted with support from the SKPA-2 project of the Global Fund. This represents a pioneering effort to integrate the results of two distinct studies conducted by different institutions into a single advocacy document.

Another important topic was integrating NASA into the existing system of health accounts (SHA) and harmonized SHA/NASA resource tracking. If executed appropriately, the integration is expected to result in efficiencies in the optimal use of resource tracking funds, reduced duplication of surveys and data collection efforts, minimized burden on respondents, and improved institutionalization of resource tracking. Institutionalization of NASA is critical in Mongolia’s context; however, SHA is not well developed and this opportunity should be further discussed. 

 Published on: 08-Apr-2024

About the Contributor

Evlegsuren Ser-Od 

FSA, SKPA-2 – Youth for Health Center

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