Response of Governments/International Institutions/Civil Society on Scaling Up

HIV/AIDS Financing

Global Conference Brasilia, Brazil – November 2006

Aisha BaldehNational AIDS Secretariat

The Gambia

Part 3 – Can commitments be turned into realityPart 3 – Can commitments be turned into reality• Why are commitments lagging behind• How can we close the funding gap

Outline of Presentation

Part I - Part I - Global call for HIV/AIDS fundingGlobal call for HIV/AIDS funding HIV/AIDS HIV/AIDS FinancingFinancing• Sources of Funding• Status of Funding

Part 2 – Scaling up HIV/AIDS FinancingPart 2 – Scaling up HIV/AIDS Financing• What is Resources are needed• Scaling up Financing (resources: 2006-2008)• Meeting Abuja Targets• HIV Allocation as share of total Health Expenditure• Case study (Mozambique)

Gleneagles communiqué: aid flows to Africa by $25 billion by 2010

2001

2005

Global call for HIV/AIDS funding

UN Millennium Project (2005): $33 billion achieve the MDGs in Africa

Abuja Declaration

Global Fund to Fight AIDS, Tuberculosis and Malaria

UN Declaration of Commitment (2001) on HIV/AIDS: mobilise $7-10 million

World Bank and IMF $14 to $18 billion per year during 2006–8

Donor Government - bilateral, multilateral, intl corporations, intl NGOs)

Recipient Governments (Central government, sub-natl

govt, social security)

Civil Society(Households, out-of-pocket

expenditure (OOPE), NGOs, CBOs, FBOs, insurance)

1996

USD 300 million

2004

2005

USD 8 billion

USD 6.1 billion

Sources of Financing

Recipient Countries

Status of Funding

Sources of the estimated and projected funding Sources of the estimated and projected funding for the AIDS response from 2005 to 2007*for the AIDS response from 2005 to 2007*

* Assuming there are no new commitments 

Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.

Domestic

Bilateral

Multilateral

Private Sector

2005 2006 2007

US$ billion

0

2

4

6

8

10

12

10.10

Sources of HIV spending in three countries, 2004Sources of HIV spending in three countries, 2004

US$ 1.87

HIV and AIDS spending per capita

US$ 0.59 US$ 0.28

World Bank loan 27%

All donors 14%

Public 86%

Public 9%

Global Fund9%

Bilateral 35%

World Bankcredit 32%

Multilateral(excluding GF) 15%

Bilateral32%

Public 36%

Global Fund 2%

Multilateral(excluding GF) 3%

India Russian Federation

Burkina Faso

10.11Source: UNAIDS, based on National AIDS Spending Assessments.

Pledge to…

….commit ourselves to take all necessary measures to ensure that the needed resources are made available from all sources and that they are efficiently and effectively utilized.

.....set a target of allocating at least 15% of our annual budget to the improvement of the health sector including HIV/AIDS.

…..make available the necessary resources for the improvement of the comprehensive multi-sectoral response, and that an appropriate and adequate portion of this amount is put at the disposal of the National Commissions/Councils for the fight against HIV/AIDS, Tuberculosis and Other Related Infectious Diseases.

African Governments

Source Section 26: African Summit on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, Abuja, Nigeria 24-27 April 2001

Scaling Up HIV/AIDS Financing

What Resources are Needed?

Global HIV and AIDS resource needs 2006–2008 UNAIDS (2005)

US$ billions 2006 2007 2008 Total

Prevention 8.4 10.0 11.4 29.8

Treatment & care

3.0 4.0 5.3 12.3

OVC 1.6 2.1 2.7 6.4

Programme Costs

1.5 1.4 1.8 4.7

HR 0.4 0.6 0.8 1.9

Total 14.9 18.1 22.1 55.1

2006 2007

AvailableResources (estimate)

$8.9 billion

$10 billion

Funding gap (2005 to 2007)

At least $18 billion

Source: UNAIDS. Resource Needs for an Expanded Response to AIDS in Low and Middle Income Countries. Presented to the Programme Coordinating Board. Seventeenth Meeting, Geneva, 27-29 June 2005.

Scaling Up HIV/AIDS financing: Issues……

Adequacy: How much was pledged? And how much was committed?

Priority: How does the budget for HIV/AIDS compare to resources spent in other areas e.g. malaria etc?

Progress: Are financial commitments of different stakeholders (donor, governments & civil societyimproving?

Allocative efficiency: Are we using the funds for the right

mix of interventions or programmes?

Operational efficiency:Are funds being spent? And are they being spent on

the purposes for which they were allocated?Is there wastage or corruption?Are the funding channels used the most efficient

and effective for delivering funds to the implementing agencies?

Equity: Are resources being allocated fairly?

Scaling Up HIV/AIDS Financing: Issues…

13

Are African states meeting the Abuja target?

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

2000/1 2001/2 2002/3 2003/4 2004/5 2005/6

Mozambique

South Africa

Kenya

Namibia

Abuja Target

Sources: Mozambique National Statistics Institute Database, 2003. South African Budget Review, 2003/04 and Estimates of National Expenditure, 2003. Kenyan Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, 2003.

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

2000/1 2001/2 2002/3 2003/4 2004/5 2005/6

South Africa

Mozambique

Kenya

HIV/AIDS allocations as share of total Health Expenditure

Successes Developed strategic plan in 2004-2008 estimated at 500 million usd.

Government and the community response has grown in 2003 stimulated by NGOs, CBOs & FBOs

Mulitsectoral approach in addressing HIV/AIDS

Increased funding 2004–8 compared to 2000-2002. (29 million usd allocated)

- Common Fund (GFATM, World

Bank, Clinton Foundation, Canada &

Ireland, Pharmaceuticals).

- CDC, USAID

- Local and international NGOs

Challenges faced Consequence of the impact of HIV

Limited financial, human resources, technical and institutional capacity at all levels to implement

Limited priorities in Strategic Plan ( excludes vulnerable groups which remains unfunded) \

Brain Drain - sustaining the human resources capacity

Limited access to health care (focus is more in the urban centre)

Mozambique

Mozambique: The Challenge of HIV/AIDS Treatment and Care. Economic Commission for Africa. http://www.uneca.org

Can commitments be turned into reality?

Why are commitments lagging behind?

Less Sustainable and Predictable funding plan (apart from the GFATM Model)

Bureaucracy – Often aid comes with strings attached e.g. low Inflation target set by IMF.

‘Macroeconomic and Structural implications of increased grants aids needs to be analysed by case by case bases’ (IMF and World Bank July 26, 2004)

Absorptive Capacity – there is consensus among donors that the ability of low-income countries must improve their absorptive capacity

Resource Needs are based on assumptions on future behaviour of donors, governments and other agents (UNAIDS 2005 AIDS Resource Estimate).

Shifting Priorities/Alliances – good governance, pressure from donors to privatise, war on terror, natural disasters.

How can we close the funding gap?

I. Health Insurance, Out of pocket.

II. Strengthening governance, reducing corruption, reserve buffers

III. Debt relief, long term aid pledges and regular disbursement (support GFATM)

IV. Technical support to countries to develop long term framework

I. Share of needs that can be borne by households

II. Share of needs that can be borne by domestic revenue mobilization

III. Needs that will be externally financed

IV. Long-term (10-12 year) framework for action, including a policy and management framework for a broadly defined financing strategy

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