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Developing countries and response to the Global Health Initiatives

Paulin BASINGA Bill and Melinda Gates Foundation

June 17, 2013

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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/

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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”

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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

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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

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Source: UNAIDS, 2010. Global Report, Figure 2.2.

Incidence rates are steady or falling in much of world

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Kazakstan

Kyrgyzstan Tajikistan

Georgia

Armenia

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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/

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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

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Source : HIV Division Rwanda Biomedical Center /Ministry of Health

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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

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