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© 2012 Bill & Melinda Gates Foundation | 1
Developing countries and response to the Global Health Initiatives
Paulin BASINGA Bill and Melinda Gates Foundation
June 17, 2013
© 2012 Bill & Melinda Gates Foundation | 2
Promising improvements with program growth
Need a new photo? I don’t know where to find them
Photo: Photo credit here if required (see speaker notes) 2 © 2012 Bill & Melinda Gates Foundation | http://hope4aidssouthafrica.wordpress.com/today-for-tomorrow/
© 2012 Bill & Melinda Gates Foundation | 3
New HIV infections
Resourcesavailable for HIV in low- and middle-income countries
1990
3.5
mill
ion
peop
le
US$
16bi
llion
2002
1994
2006
1998
2010
2011
1992
2004
1996
2008
2000
1991
2003
1995
2007
1999
1993
2005
1997
2009
2001
2011 PoliticalDeclaration
2006 PoliticalDeclaration
Millennium Declaration
Abuja Declaration
Doha Declaration
GatesFoundation
The Global Fund
PEPFAR
G8 GleneaglesPledge
G8 Okinawa Initiative
2001 Declarationof Commitment
The past decades has seen important Global Health Initiatives …”Global Health”
© 2012 Bill & Melinda Gates Foundation | 4
International AIDS Assistance from Donor Governments: Commitments & Disbursements, 2002-2010
In Billions
Commitments (Enacted Amounts)
Disbursements
Sources: UNAIDS and Kaiser Family Foundation analyses; Global Fund to Fight AIDS, Tuberculosis and Malaria online data queries; UNITAID Annual Report, 2010; OECD CRS online data queries; UNAIDS, PCB(13)/02.5, 28 November 2002; UNAIDS, PCB(14)/03 Conference Paper 2a, 25 June 2003.
$1.6$2.0
$3.6$4.3
$5.6
$6.6
$8.7$8.7$8.7
20022003
20042005
20062007
20082009
2010
$1.2$1.6
$2.8$3.5
$3.9
$4.9
$7.7$7.6$6.9
20022003
20042005
20062007
20082009
2010
© 2012 Bill & Melinda Gates Foundation | 5
Enabling a significant scale-up of ART
AIDS investment in Africa
Antiretroviral treatment in Africa
Source: UNAIDS, WHO 2012
16
14
12
10
8
6
4
2
-
7 6 5 4 3 2 1 -
AID
S R
esou
rces
(US$
bill
ion)
Mill
ions
of p
eopl
e on
AR
T
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
July 4, 2013 © 2012 Bill & Melinda Gates Foundation | 5
© 2012 Bill & Melinda Gates Foundation | 6
Source: UNAIDS, 2010. Global Report, Figure 2.2.
Incidence rates are steady or falling in much of world
July 4, 2013 © 2012 Bill & Melinda Gates Foundation | 6
Kazakstan
Kyrgyzstan Tajikistan
Georgia
Armenia
© 2012 Bill & Melinda Gates Foundation | 7
Some countries have taken opportunity to strengthen their overall health systems…
7 © 2012 Bill & Melinda Gates Foundation | http:// http://pepbonet.com/2006/10/portfolio/death-among-the-sugarcanes-hiv-aids/
© 2012 Bill & Melinda Gates Foundation | 8 © 2012 Bill & Melinda Gates Foundation |
Most African countries increased their spending on Health, but only of 2010 only three had reached the 15% target set by the Abuja Declaration (adopted in April 2001)
12.1%
9.1%
Madagascar 14.7%
Togo 15.4% Zambia 15.6%
Rwanda 20.1%
Niger
12.1%
Mali
3.3%
DRC
11.9%
Benin
8.5%
8.5%
South Africa
3.6%
5.1%
12.2%
Malawi 14.2%
Guinea
4.4%
Chad
9.6%
Eritrea
6.4%
10.6%
7.2%
11.1%
7.3% Kenya Burundi
CAR Cameroon
13.8%
Ethiopia Burkina Faso
Tanzania
Senegal
Ghana Uganda
Mozambique 13.5% 13.5%
8.1%
11.6%
1.8%
Angola Sierra Leone Cote d’Ivoire
Nigeria
2010 2001
Government spending on health (as a % of total government spending)
15% Abuja Declaration target
Source: World Bank; WHO, The Abuja Declaration: Ten Years On, 2001
8
© 2012 Bill & Melinda Gates Foundation | 9 © 2012 Bill & Melinda Gates Foundation |
Countries tracking Millennium Development Goals (MDGs) progress
Source: Centre for Global Development-MDG progress index, Dalberg Analysis.
TUNISIA MOROCCO
ALGERIA
MAURITANIA
MALI NIGER
LIBYA
CHAD
EGYPT
SUDAN
ETHIOPIA*
KENYA
TANZANIA
DEMOCRATIC
CENTRAL
GABON CONGO
NIGERIA BENIN
COTE DIVOIRE
SENEGAL
GHANA
CAMEROON
MALAWI
MOZAMBIQUE
ZIMBABWE
BOTSWANA
LESOTHO*
NAMIBIA
ANGOLA
UGANDA
OF THE CONGO
REPUBLIC
REP. OF
TOGO
BURKINA FASO GUINEA
SOUTH
REPUBLIC
AFRICAN
THE
AFRICA
SIERRA LEONE
LIBERIA
GAMBIA
GUINEA BISSAU
BURUNDI
DJIBOUTI
ERITREA
REP OF SOUTH SUDAN
SWAZILAND
WESTERN SAHARA
ZAMBIA
SOMALIA EQUATORIAL
GUINEA
RWANDA
EQUATORIAL GUINEA
SAO TOME AND PRINCIPE*
COMOROS MAYOTTE
SEYCHELLES
REUNION
0-0.5
MDG Progress Score
1-1.5
2
2.5
3-3.5
4-4.5
5-5.5
> 6
Data not available
9
© 2012 Bill & Melinda Gates Foundation | 10 July 4, 2013 © 2012 Bill & Melinda Gates Foundation | 10
Source : HIV Division Rwanda Biomedical Center /Ministry of Health
© 2012 Bill & Melinda Gates Foundation | 11
Rwanda case : Significant decrease in mortality between 1995 to 2008
0
50
100
150
200
250
1990 1995 2000 2008 2010 U5MR IMR (per 1,000 live births)
0 200 400 600 800
1000 1200 1400 1600
1990 1995 2000 2005 2008 MMR (per 100,000 live births)
Childhood Mortality Rate Maternal Mortality Ratio
Source: UN Inter-agency Group for Child Mortality Estimation, Report 2011
Source: UNSTATS, Millennium Indicators, July 2011
NATIONAL GOVERNMENT
LOCAL GOVERNMENT
AUTONOMOUS FACILITIES PROVIDERS
Clients / Citizens
VOICE
CLIENT POWER
Performance CONTRACTS
COMMUNITY HEALTH WORKERS PROVIDERS COMMUNITY HEALTH
INSURANCES Mutuelles
COMMUNITY GOVERNANCE
Umushyikirano, Citizen Report Cards, Ombusdman
PERFORMANCE BASED, CASH AND IN KIND INVESTMENT INPUT
SUBSIDIES TRANSFERS
Rwanda : Organization structures and health financing policy strengthening the whole system
Basinga P, Gertler PJ, Binagwaho A, Soucat ALB, Sturdy J, Vermeersch CMJ. Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation. Lancet 2011; 377: 1421–28.
Key takeaways Coordination and accountability is key Still money is needed to support countries effort but
value for money is needed even more Huge potential for high return if right investment is made Focus on value for money and accountability is key
• gap in strengthening health systems and scaling up high impact interventions
• Need to integrate private spending in policymaking Importance for external aid to be catalytic: need to
focus on results and efficiency gains
15
Most resources are to come from countries’ contributions: • Available domestic advocacy to raise attention to national
budgeting processes (direct budget support) • Need to channel private spending into risk pool In order to prevent dependence, governments
need to work with donor to set clear time frames for phase-out of increased assistance
Countries should develop their own plans for
domestic resource mobilization …but should use the current aid more effectively.
16
Merci beaucoup pour votre attention
July 4, 2013 © 2012 Bill & Melinda Gates Foundation | 17
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