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AIDS2031LONG TERM COSTS AND FINANCING FOR HIV/AIDS
ICAAP12 AUGUST 2009BALI INDONESIA
Farzana Muhib, Results for Development Institute
Overview
Main findings of the Cost and Financing Working Group
Global estimates Regional estimates for Asia Cambodia case study
aids2031 Costs and Financing –main objectives
Globally and through two country case studies:
1. Estimate the long-term costs of AIDS, using a range of distinct scenarios
2. Make recommendations in setting priorities for resource allocation, based on evidence of intervention and program cost-effectiveness
3. Construct and evaluate financing scenarios that are adequate, equitable, predictable, and sustainable
4. Encourage global and national dialogue – promote positive policies that will result in financing a successful long-run AIDS response at the lowest possible cost.
Main findings – our current top 5
1. Global AIDS funding needs will continue to grow rapidly – Asia will account for one-third, treatment over a fifth, of future spending
2. Cost trajectory changed with action today. Policy choices lead to different price tags for 2031 – $19 to $38 billion annually(globally)
3. With our current intervention tool kit, epidemic attenuated but not extinguished – nearly one million infections in 2031. Technological and/or behavioral game changers needed.
4. Huge scope for spending better – technical efficiency gains potentially large but hard to realize, allocative efficiencies increasingly clear but politically difficult. We must fix both, starting with allocations..
5. Sustained long-term financing for AIDS in serious jeopardy, especially for HP/LIC, but even for some HP/MICs – domestic capacity limited and donor prospects uncertain. Low prevalence, middle income countries may rapidly move to self-financing
Four scenariosPolicy choices today have very different price tags in the futureHuge variance in the price tagsTreatment = 25%+
Resource needs estimates
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
2015
2017
2019
2021
2023
2025
2027
2029
Num
ber
of N
ew A
dult
I nfe
ction
s
New Infections Among Adults 15-49
Current Trends
Rapid Scale-up
Hard Choices
Structural Change
1 million + infections under the best scenarios- unless we have a vaccine, a cure, or a social/sexual revolution
Impact on incidence
Availability of Donor Financing
A gap still exists in both the pessimistic and optimistic scenariosThis gap would need to be filled, but by who?
Projections of GDP growth= 2%
Potential funding from OECD countries 2006 2015 2031
Pessimistic --No change in ODA as share of GDP (0.25%) US$ billions
Total ODA 92 113 155
Donor assistance for HIV/AIDS 6 8 11
Global Resource Needs for AIDS (rapid scale up) 10 27 38
GAP in Funding 4 19 27
Optimistic -- Donors increase ODA to 0.7% of GDP
Total ODA 92 315 433
Donor assistance for HIV/AIDS 6 22 30
Global Resource Needs for AIDS (rapid scale up) 10 27 38
Gap in Funding 4 5 8
Resource needs and impact in Asia
Current funding in Asia
Potential sources of funding for Asia
Potential ODA from BRIC countries in 2015 and 2030
2015 2030Pessimistic --No change in ODA as share of GDP (0.25%) US$ billionsTotal ODA* 22.4 28.9Donor assistance for HIV/AIDS 1.56 2.02
Optimistic -- Donors increase ODA to 0.7% of GDP Total ODA 62.8 80.9Donor assistance for HIV/AIDS 4.39 5.66
*World Bank, Global Economic Prospects Group
•BRIC countries start to donate, they will reduce the gap. •Specific regional preferences may influence the distribution of ODA from these countries•Philanthropists may play an increasing role in funding AIDS programs. 28 of 40 youngest billionaires reside in Asia
Sustained long-term financing is in serious jeopardy but the picture in Asia is not so bleak
Low prevalence, middle income countries could self-finance, without donors
Potential for Domestic Financing of AIDS in Asia
Our case studies
South Africa: 5.7 million HIV+ (18% prevalence), 350K deaths , $1-2 billion annual spending
Cambodia: ~ 1% prevalence, high treatment coverage, $44 million annual spending (2006)
Generalized Concentrated
MiddleSouth AfricaBotswana
UkraineBrazil
LowZambiaMalawi
CambodiaSenegal
Epidemic Type
Income
Currently Available and Needed Resources for Cambodia
Millions US$
Cambodia case study objectives
How much will it cost to address the epidemic in the future? Model 4 scenarios- modifying them to fit the epidemic pattern in
Cambodia. Key questions to consider: What are hard choices? What is structural
change? How will the epidemic change?
How to mobilize domestic/external, public/private resources for a sustained response? Donor mapping exercise to determine current levels of funding Fiscal space analysis – How much can we reasonably ask govts to
contribute in the future?
Stimulating dialogue and search for improved national policies
What we can do today in Asia?
Policy choices impact the ultimate price tag $4-14B Asia New/better prevention approaches are needed Consider a focus on the hard choices of cost effective
interventions Focus on Most at Risk Populations Evaluate impact of prevention interventions
Start to develop sustainable funding mechanisms Expand portfolio of funders Domestic funding of HIV/AIDS programs
Thank you.
For more information please visit our website:
www.resultsfordevelopment.org
Or
www.aids2031.org