Expenditure tracking of public fund utilization is widely accepted and recognized concept and practice in global perspective for identifying inefficiencies, leakages, transparency in procedures, better planning that is linked with needs and performance and to develop citizen’s right to know. So many challenges are deeply incorporated with expenditure tracking, but opportunities are always endless. Challenges are naturally deepest where this is yet to be conducted earlier. This can be the most important job in a country with weak institutional framework of less transparency and accountability exists in public money spending. The practice of expenditure tracking may be considered as new in particular to our country. Indeed this is the first time in our country that we conduct a survey for tracking expenditure in any of the areas of development. Expenditure Tracking can be done through using both Public Expenditure Tracking Survey (PETS) and Quantitative Service Delivery Survey (QSDS), these two tools can bring together data on inputs, outputs, user charges, quality, and other characteristics directly from the service-providing unit, more can be learned about the linkages, leakage, and the way spending is transformed into services.
The Government of Bangladesh, the Principal Recipient (PR) of the GFATM for HIV grants, has signed an agreement with Save the Children- USA (SC-USA) as the Management Agency (MA) to manage the Projects at national scale in both rural and urban settings. SC-USA has been managing the grants through facilitating the implementation by sub-recipients at the NGO, institutional, private sector and community level. The Round-2 HIV grant is from 2004-2009 and has a total budget of 19.7 million US$, while the Round-6 HIV grant is from 2007-2012 and has a total budget of 40 million US$. Both projects are intended to complement and harmonize the National Strategic Responses through Public-Private-Partnership efforts. Majority of the Round-6 of HIV grants are mainly involved with implementation of intervention programs for high-risk groups. As we know the country is considered as concentrated AIDS epidemic as one of the high-risk populations in a particular geographic area contains HIV prevalence is almost 10% despite huge effort from government, non-government and private sector with huge amount of money has been spent to keep this prevalence lower. Keeping this scenario in mind, CEDAR submitted a proposal to TAP of R4D to track the expenditure and to survey the quality and quantity of facilities being tailored for high-risk intervention through using the grants of Round- 6, and was awarded as grantee of TAP. In the planning stage, this study aimed at conducting both expenditure tracking and facility survey. But it is ended up with only facility survey through using QSDS as huge constraints, limitations and non-cooperation were faced during survey. The study team of CEDAR comprises of five-members headed by a Lead Coordinator where one member is consultant, one is statistician and remaining twos are collaborators. Besides, two survey teams were also assigned to survey the frontline service providing outlets for collecting information through using four types of structured questionnaire. In addition one-to-one consultation meeting with key state and non-state actors in HIV sector were held to congregate their expert opinion and recommendation on the country’s HIV/AIDS prevention with special emphasis on the high-risk intervention under GFATM Round-6 HIV grants. The study surveyed of 17 DICs for SWs and IDUs operated by 3 different consortiums under GFATM and 2 IHCs operated by 3 different NGOs under FHI funding. Under this survey, 129 SWs, 51 IDUs, 34 members of DMC and 68 government stakeholders were interviewed. Besides, information was collected on 165 staff working at surveyed DICs/IHCs, and the quality and quantity of facilities being tailored to the clients and their satisfaction level on provided services, governance structure, and extent of transparency and accountability of the surveyed DICs/IHCs were gathered through this survey. Data gathered and information collected was taken into a robust database for analysis and thereby exploring the study findings in the light of the study objectives.
Brief Results:
Rudimentary government authority responsible to work in HIV/AIDS sector with a very weak institutional framework exists.
Family Health International (FHI) funded NGOs were found more cooperative, willing and responsive to provide information about their frontline service providing outlets than that of the GFATM Round-6 funded Consortiums/NGOs.
Majority of the clients show their dissatisfaction or limited satisfaction about staff’s attitude and behavior of the Drop-In-Center (DICs) towards them, and on the facilities and quality of services provided by the DICs.
The clients who were interviewed inside the DIC/IHCs were found bias to provide information about DIC/IHC staff or services delivered to them, whereas the clients interviewed outside were found free and frank to provide information during interview.
At the very starting of our survey we found the salary-curtail scenario in one DIC with a rate vary from 16% to 20% in respect to the monthly salary of all staff of that DIC, but after that we could not found such scenario in any of the remaining 16 DICs surveyed that is also interesting.
37.8% of the interviewed clients i.e.- Sex Workers (SWs) and Injecting Drug Users (IDUs) have been infected with STI;
DICs don’t continue enough advocacy programs among other stakeholders to create enabling environment for the clients in accordance with the opinion of 76% SWs and 63% of IDUs.
52% of the clients reported that DICs sell condoms among the clients with profit or cost-price or subsidized price;
93% of both Sex Workers and IDUs opined that they are to spend money for receiving STI services being delivered from DICs.
Brief Recommendations:
The National Strategic Plan for HIV/AIDS 2004-2010 has to be reformed for allowing free distribution of condom and STI medicine among the target community.
Current criminal laws and practices of policing must be reviewed to ensure an enabling environment for the high-risk groups and vulnerable population to HIV/AIDS.
Capacity building of NASP is crucially needed for strengthening public-private partnership of HIV/AIDS prevention programs under GFATM.
The Government of Bangladesh should take necessary step for developing a process of dissemination to the people on financial and technical input and ultimate output of HIV/AIDS program.
More potential small & medium NGOs and CBOs with committed track-record to working in HIV sector should be incorporated under GFATM grants for HIV instead of existing monopoly of big national level NGOs.
DIC must be opened 24 hours a day and 7 days a week with enough space and facilities for resting, bathing, and hygienic sanitation and safe drinking water.
DIC must have a provision to set up a separate counseling room, and STI treatment facilities have to be tailored by appropriate professional with adequate experience and expertise.
The DIC management committees need to be formed as quickly as possible to incept the DICs.
