Rapidly Expanding Access to Care for hiv in Tanah Papua (reach) 2012 2016

Annex 10: Budget

The four year total budget is A$24,990,417. The budget is presented in three tables below:

• 
  Year one budget by line item (Table 21)
  
• 
  Year one budget by program component (Table 22)
  
• 
  Four year budget by line item (Table 23)
  

A10.1 Methodology

A two pronged approach was taken to development of the budget. Firstly, a review of program spending under CHAI Phase II from 2010 – 2012 was conducted. This included:

• 
  Approved program budgets for 2010-2012
  
• 
  Summary of accounts statements from 2011 detailing level of spending in major categories
  
• 
  Review of program component spending with program managers.
  

Secondly, program managers provided costing on expected expenses related to program scale up and these were analysed and further refined.

Table 21: REACH year one budget

Table 22: REACH year one budget by program component

Table 23: REACH budget July 2012 – June 2016

A10.2 Expansion of REACH in the Papuan provinces

The year one budget for REACH is A$7,335,364. This budget includes nearly A$1.3 million in expenses associated with program start up, including one-time staff training and capital purchases. Some examples of these costs are HIV, CST, IMAI, and TB-HIV trainings for new staff, vehicles for program implementation, and minor office renovations for the new sites. Budgets for subsequent years are lower. The average yearly budget for REACH is A$6,247,604.

This A$4.35 million increase in annual expenditure compared to CHAI Phase II (approximately A$1.9 million for the current year) reflects the major expansion of the program that has been requested by the GoI.

Additional funding is detailed below (these are average yearly costs):

• 
  Operational costs of nine CoE: A$0.16 million
  
• 
  Expansion of CST in Papua and West Papua Provinces through new care partnerships with the PHOs to fund 76 national staff for program implementation: A$1.06 million
  
• 
  Training for staff at all sites and expanded program activities: A$1.17 million
  
• 
  Salaries for seconded positions for the Policy Secretariat and for the PHOs: A$.85 million
  
• 
  Salaries for new CHAI positions for program expansion: A$1 million.
  

Scale up of work has associated costs that will escalate over time. For example, more sites providing CD4 testing will require more training and mentoring of healthcare workers. Transportation and logistics are significant portions of the training line item and will increase as the program in subsequent years travels to farther, more remote districts to provide technical support and mentoring. Note that without an increase in the base award, program budgets must be lowered over time. For example, if six per cent of the budget needs to be spent to meet increased cost of salaries and operational expenses then that means a six per cent reduction in available funds for program activities.

Despite the increasingly high cost of operating in the eastern most provinces of Indonesia, the budget for REACH has managed to keep overhead costs to a minimum and to maximize available resources for programming. Figure 5 below illustrates how the REACH budget breaks down by expense categories, with 59 per cent of the funds allocated for programs expenditure. If salaries and benefits for staff working on CST programming were included, the proportion of funds going to programs would even be higher.

Figure 5: REACH four year budget by expense category

Figure 6 shows the proportion of the total program budget that is allocated to the four program components. CST in the Papuan provinces constitutes 78 per cent of the program budget. SCM is nine per cent, Operational Research & Monitoring is eight per cent, and Policy five per cent. Each of these program budgets will support CST work in the Papuan provinces as well as national-level activities.

Figure 6: REACH four year budget by program component



A10.3 Salaries and benefits

Salaries and benefits represent 27 per cent of the total budget. This provides funding for a team of two in-country expatriates, 55 national staff, and portions of regional staff salaries. Salaries for CoE staff are listed under Care Partners, (see Care Partners below).

Salaries for CHAI Indonesia staff (57 positions - 57 full-time equivalent) and to cover the cost of technical support from CHAI’s regional office (4 positions - 1 full-time equivalent) average A$1.39 million per annum⁶⁶. (See Annex 12 for a full outline of CHAI staffing for REACH).

All salaries and benefits are within standard CHAI’s international and national salary ranges.

A10.4 Program

Program expenses (A$3.68 million) account for 59 per cent of the total budget. This is used to provide technical, programmatic, and operational support within:

Papua and West Papua provinces

• 
  Six CoE in Papua Province, based in provincial and district hospitals
  
• 
  Three CoE in West Papua Province, based in provincial and district hospitals
  
• 
  An additional 11 hospitals in Papua and West Papua
  
• 
  Provincial and District Health offices
  
• 
  Provincial and District AIDS Commissions
  
• 
  West Papua Provincial Warehouse
  

National

• 
  The MoH’s AIDS Sub Directorate
  
• 
  The MoH’s Pharmaceutical Directorate
  
• 
  Additional technical support to the National AIDS Commission as requested.
  

The program expenses budget will also pay for the implementation of a range of activities associated with district level scale up, quality assurance, trainings, meeting support, curriculum development and facilitation, on-site mentoring visits, and ongoing monitoring. Printing, postage, IT, program related travel and telecommunications costs are included. Significant expense line items (consultants, care partners, meetings & trainings, and operational) in this category are detailed below⁶⁷:

Consultants

Short-term consultant costs totals A$0.17 million, which includes costs for legal and accounting services, tax filing, as well as visa and work permit filing for international staff, and consulting expenses for operational research, strategic planning, technologies for rural sites, and other CST technical support not available within CHAI’s team.

Care partners

CHAI will be contracting with the PHOs as ‘Care Partners’ in Papua and West Papua to support 76 local staff positions for the nine CoE. These teams will include a range of clinical and technical expertise, including doctors, nurses, midwives, laboratory technicians, data clerks, communications officers, and administrative assistants.

Current civil servant salaries are inadequate to attract and keep potential candidates for these CoE positions. CHAI will work with the provinces to hire staff at GoI contract employee (PTT) rates which are above civil service salary rates. All of these local positions are budgeted within standard GoI salary ranges as defined within the government PTT employment guidelines. The agreements with provinces will only cover salary and benefits as well as administrative and human resource costs for the PHOs to manage these contracts. CoE-related meetings and trainings costs are captured in the meetings and training line item budget.

Care Partners totals are budgeted at A$1.63 million each year for years one to three. In year four, the provinces will be assuming responsibility for these care partner costs.

Meetings & trainings

This area covers all costs associated with programmatic meetings, trainings, ongoing mentoring and technical assistance activities, including travel, accommodation, travel allowances, training materials, and other related costs (A$1.71 million).

Meetings and trainings for CST include:

• 
  Monthly clinical mentoring to health facilities - A$0.27 million
  
• 
  Monthly data analysis meetings - A$0.08 million
  
• 
  Monthly CHAI/CoE/hospital/PHO working group meetings - A$0.17 million
  
• 
  Laboratory quality control activities - A$0.09 million
  
• 
  Laboratory capacity building at health facilities - A$0.19 million
  
• 
  Quarterly and semi-annual planning meetings - A$0.21 million
  
• 
  Annual ASHM training and short-course - A$0.09 million
  

Training costs for CST service decentralization will be shared between CHAI and the CoE hospitals. While most expenses have been captured, CoE hospitals will provide hospital staff time to mentor satellite health facility staff on an ongoing basis, as well as other programmatic in-kind donations.

Supply chain management activities include:

• 
  Training and onsite support in the Papuan provinces - A$0.05 million
  
• 
  Assessment of supply chain for other HIV-related commodities in the Papuan provinces - A$0.04 million
  
• 
  Training in HIV rapid test and supply chain - A$0.05 million
  
• 
  Training and setup of inventory management systems for other provinces - A$0.03 million
  
• 
  Decentralization of ARV supply management training to provinces - A$0.01 million
  

For policy support to the MoH meetings and trainings include annual expert panel meetings for evidence-based guidelines review and meetings and trainings to disseminate policies. Operational research and monitoring activities include quarterly and semi-annual meetings with stakeholders to discuss data analysis and program progress.

Operational

Operational costs are captured under the program category as they directly support program implementation. Office equipment, office furniture, telecommunications, rent, capital charges, and staff airfares are some of the significant expense categories.

Office Equipment (including computers): This includes computers for new staff as well as netbooks for CoE staff. This also includes other equipment for the new CHAI offices and CoE offices. Most of these purchases will be in year 1 (A$0.12 million).

Office Furniture: Includes furniture for the nine CoE or CHAI offices. Most of these purchases will be in year 1 (A$114,500).

Telecommunications: Includes mobile phone costs for all CHAI staff, landlines and VSAT setup and monthly service CoE and CHAI offices. This also covers satellite phones for communications coverage in remote areas. Total telecommunications is A$0.11 million.

Rent: Total rent is A$0.08 million. Besides the Jakarta national office and the two regional offices in Jayapura and Sorong, CHAI will maintain only two other fully equipped offices (in Jayawijaya and Nabire). In the other five sites CHAI will be working out of the CoE sites or DHOs. CHAI will pay for some of the related costs (see office equipment, furniture, and supplies) but will not be paying for lease expenses.

Security: Security costs A$0.03 million.

Capital costs: A total of five utility vehicles and nine motorbikes will be purchased to support the ongoing clinical mentoring, technical assistance, and training activities by the CoE. Total capital charges are A$0.2 million.

Staff airfares: This amount of A$0.4 million includes travel for staff meetings, regional meetings, on boarding deployment and end-of-contract repatriation, annual leave and other travel not covered under meetings & trainings.

A10.9 CHAI local overhead

Key to CHAI’s philosophy is keeping in-country overhead expenses to a minimum and to maximize allocation of resources to programming. The REACH budget has managed to keep in-country overhead relatively low: at three per cent (A$0.2 million). Office, staff travel and local transportation costs account for 80 per cent of this budget category. A majority of CHAI’s offices in Tanah Papua are housed within government agencies and institutions at the provincial, district, or facility levels. This assist with maintaining low overhead costs and also reinforces CHAI’s approach of serving in alignment with efforts of GoI. Significant expense line items in this category are detailed below:

Office: In Jakarta – the office is calculated per annum at A$0.03 million.

Staff airfares: This covers staff airfares for the two annual planning meetings.

Staff lodging: This covers staff lodging for the planning meetings.

Local transport: This covers a portion of staff local travel (30 per cent) in Jakarta and the Papuan provinces. Other local transport expenses are charged to programs.

A10.10 CHAI Global

Twelve per cent of the budget (A$0.66 million) will be allocated to CHAI’s United States head office for administration, finance, accounting and human resources. This rate is standard across the countries were CHAI works and has been agreed to between AusAID and CHAI for the Phase II program. A portion of this amount helps support technical assistance by CHAI’s Global Program through the Global Paediatrics Team, the Drug Access Program which works to lower ARV prices globally, the Procurement Program which handles international commodity purchase ordering and the Laboratory Services Program which provides technical assistance, particularly in the areas of early infant diagnosis, viral load, and point of care technologies and lowers diagnostic costs globally.