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The purpose of Task Order Number 01, under Health Policy Initiative (HPI) is to exercise global leadership and provide field level programming in policy development and implementation. Futures Institute is providing assistance that is expected to improve the enabling environment for health, making it possible for men and women around the world to obtain and use the information and services they need for better health, especially in the areas of family planning/reproductive health (FP/RH), HIV/AIDS, and maternal health (MH).

Activities include:

• Expanding relevant models to include poverty and equity considerations;
• Modifying FamPlan to provide a broader contribution to repositioning FP and contraceptive security in national settings by updating the proximate determinants of fertility framework used as the basis of many the calculations;
• Further development work on the Goals model, including updating the impact matrix, validating it in two countries, and implementing it in Spectrum;
• Providing expertise on costing of male circumcision and developing and applying a model to estimate the impact and cost of implementing a male circumcision program in three countries;
• Investigating the effects of family planning on maternal mortality and incorporating the results appropriately in Spectrum; and
• Ongoing Spectrum maintenance and updates.

The aim of this effort was to produce a new round of Global Resource Needs Estimates, provide scenarios and compartmentalize the results in order to provide the UNAIDS Secretariat with a document compiling contemporary figures and scenarios helpful for advocacy, strategic planning and policy dialogue. Estimating resources needed for AIDS has been an ongoing activity aimed to improve the methods and figures by incorporating current and solid data with each cycle in the estimation process. This current endeavour entails the development of standard definitions, methods and tools as a common reference for the working groups, improving the methods used to produce a new round of global resource needs estimates. The updating process also provided an opportunity for coordination, communication and agreement that would support the technical working groups in conducting estimates of HIV and AIDS resource needs. The added value of the harmonization between resource tracking and resource needs was that the use of the same categories provided information on the financial gap between the available and the needed resources.

UNAIDS engaged the Futures Institute to provide support to the further development of the Resource Needs Model (RNM). The RNM will be used to conduct Resource Needs Assessment workshops in countries that are preparing targets and strategic plans aimed at Universal Access to prevention, treatment and impact mitigation by 2010. A series of workshops will be conducted during the period November 2006 – July 2007 to bring together country level experts to compare results from National AIDS Spending Assessments (NASA), and to carry out an assessment of Resource Needs using the RNM.

This work will contribute towards a new round of global resource needs estimates to be published during 2007, and the costing tool that is introduced will be a key component in training for the costing of national AIDS strategic plans that will be delivered by the World Bank ASAP programme.

The Uganda AIDS Commission and UNAIDS/Uganda contracted with Futures Institute to assist in the development of the new National Strategic Framework/Plan, covering the period 2007/8-2011/12. This development involved reviewing and including relevant information from previous research in Uganda, including:

• Mid-Term Reviews (MTR) of the previous NSF and for the World Bank funded MAP.
• 2004 national HIV/AIDS stakeholders and service mapping, which underscored the disproportionate distribution of services and stakeholders countrywide.
• 2004 national sero and behavioral survey, which revealed disproportionate regional HIV prevalence rates, marked social-economic and gender differentials in access to key prevention intervention and resultant impact.
• Annual Joint AIDS Review (JAR) which was took place in the last quarter of 2005

Futures Institute worked with local consultants to apply two related models as part of the strategic planning process in Uganda. The first model, the Resource Needs Model (RNM), calculated the total resources needed for prevention, care and orphan and vulnerable children (OVC) support for HIV/AIDS. The total expenditures required were then linked to the Goals model to calculate the impact of the expenditures. The results formed the basis of a prioritization process that involved all relevant stakeholders.

The World Bank contracted with Futures Institute to update their 1999 HIV/AIDS Strategy and refocus it for their new Agenda for Action, 2007-2011. This effort involved analyzing the changes in the epidemic, in the response, in the number of donors, and the competing claims on scarce human resources at the national level, as well as other factors. As part of this effort priority interventions and appropriate responses for different countries and regions for the next generation of activity were identified, based on evidence of success and lessons of experience. The analytical work resulting from this assessment contributed to the results-based framework aimed at increasing the effectiveness of actions to contain the epidemic.

Futures Institute worked with the International AIDS Vaccine Initiative to develop a computer simulation model of the impacts of a potential AIDS vaccine. The model was used to prepare estimates of the potential global impact of an HIV vaccine. The model is now incorporated into Spectrum and ready to be used at the national level by country teams. The model can be used to simulate the historical epidemic in a country and project it into the future under different assumptions. It can be used to examine the potential impact on the epidemic of an HIV vaccine given assumptions about the timing of vaccine availability, the characteristics of the vaccine (efficacy, type of action, duration of protection), demand for the vaccine, targeting strategies and costs. The model can illustrate the impacts in terms of new infections, AIDS deaths, and costs savings. It is currently being applied in Kenya, Uganda, and Brazil, with future applications planned in India and China.

The purpose of this project was to promote and facilitate evidence-based decision-making in designing neonatal and child health interventions and programs in low- and middle-income countries. Building on work by the Child Health Epidemiological Reference Group (CHERG), which estimated cause-specific morality for children under five for developing countries, the model will help countries make decisions regarding health priorities that are more evidence-based. An integrated and user-friendly tool for use by countries and their partners will be developed to help countries make better, evidence-based decisions in planning maternal, newborn and child survival programs. The output of the project will be a new module in Spectrum that can be used to estimate the impact of neonatal and child interventions on neonatal and child mortality. The model will contain a database of information on the impact of interventions on cause-specific mortality rates as well as the distribution of deaths by cause and current coverage levels by country.

Using Spectrum, a policy modeling system that has a demographic model at its core, Futures Institute will build upon the Spectrum AIDS module to add features that will enable the analysis of future long-term funding requirements for ART, and make those features part of the public domain. Futures Institute will also add the capability to do other types of economic modeling analyses, including factors such as:

• Coverage rates for ART
• Time of disease progression from HIV infection to AIDS
• Uncertainty about scale up rates
• Prices
• ART effectiveness
• Success of prevention efforts
• Time frame of achievement of universal access to ART

Futures Institute will also develop an analysis of the long-term funding requirements for the treatment of HIV, taking into account the numerous factors above.

Futures Institute is one of the partners in the AIDS Strategy & Action Plan (ASAP) program, an effort led by the World Bank on behalf of UNAIDS to support the development of well-prioritized, evidence-based, results-focused, costed AIDS strategies and action plans. AIDS specialists from UNAIDS organizations, non-UN institutions and local and international consultants undertake country and regional-level technical support activities on demand. Countries at any level of national HIV/AIDS strategy planning can request assistance, as well as peer reviews from ASAP. ASAP has also developed a scorecard-style tool (with guidelines) that countries can use themselves to assess their strategies. ASAP also implements workshops around the world to enhance the strategic planning skills in national governments.

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