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Sustainable Financing for the AIDS , TB and Malaria Responses Pride Chigwedere , MD, PhD Senior Advisor , UN AIDS Liaison Office to the AU. Sources of Financing International; Diversification Domestic; Innovative Investing Resources Investment thinking; Returns - PowerPoint PPT Presentation
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Sustainable Financing for the AIDS, TB and Malaria Responses
Pride Chigwedere, MD, PhDSenior Advisor , UNAIDS Liaison Office to the AU
• Sources of Financing– International; Diversification– Domestic; Innovative
• Investing Resources– Investment thinking; Returns– Effectiveness; Efficiency
2011 Political Declaration on HIV/AIDS: resources for the HIV response
Close the global resource gap by 2015 (USD 24 billion)
Support and strengthen existing financial mechanisms
Expand voluntary and additional innovative financing mechanisms
Programmes must become more cost-effective and evidence-based and deliver better value for money
Break the upward trajectory of costs through the efficient utilization of resources (simplification and integration)
THREE ACTION PILLARS
The AU Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria
I. More diversified, balanced and sustainable financing models
II. Access to meds through local production and regulatory harmonization
III. Leadership, governance and oversight for sustainability
1. Investment targets for ATM met by 2015
2. Financing sources for ATM diversified
3. Financial sustainability through predictable external and more domestic investments
1. Meds security enhanced through local centers of excellence
2. Meds regulatory harmonization mechanisms within RECs, towards African Agency
3. Trade facilitated through concerted actions at all levels
1. Investments address pressing needs and pops, evidence/rights-based and strengthen systems
2. ATM programs through inclusive processes
3. Leadership and ownership demonstrated for results with robust accountability frameworks
Resources for HIV in low- and middle-income countries grew strongly for a decade, but then slowed
1986
1987
1988
1989
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1999
2000
2001
2002
2003
2004
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2007
2008
2009
2010
2011
2012
2013
2014
2015
0
5
10
15
20
25
Global Resources Available Investments required
Under US$ 100 million
Gates Foundation
The Global Fund
UNITAIDUNAIDS
PEPFAR
2015
Source: UNAIDS, 2012
Total resources continue to grow, but fall short of total needs
Source: UNAIDS, 2012
1 2 3 4 5 6 70
2
4
6
8
10
12
14
16
18
20
International assistance Total resources available, with estimated range
US
$ bi
llion
s
Domestic resources in low-and middle-income countries
PEPFAR and Global Fund – Main External Funders of AIDS in low/middle-income countries (2011)
Map of GF and PEPFAR world coverage*PLACEHOLDER
Share of care and treatment expenditure originating from international assistance, African countries, 2009–2011
OECD countries can afford more
2010 overseas development assistance as a share of Gross National Income
0.12%0.15%
0.17%0.20%0.21%
0.26%0.29%
0.32%0.32%0.33%
0.38%0.41%
0.43%0.50%
0.53%0.55%0.56%
0.64%0.81%
0.90%0.97%
1.09%1.10%
0.0% 0.7%
KoreaItaly
GreeceJapan
United StatesNew Zealand
PortugalAustralia
AustriaCanada
Germanyswitzerland
SpainFranceIrelandFinland
United KingdomBelgium
NetherlandsDenmarkSweden
LuxembourgNorway
Options for increasing and sustaining resources for AIDS
• Use increased government revenue from economic growth to invest in health and HIV
• Increase allocation for the health sector, towards the Abuja targets
• Adopt innovative financing mechanisms that generate incremental resources for the AIDS response and health
• Raise the share of the health budget allocated to the AIDS response, in line with disease burden
• Improve the efficiency and effectiveness of programmes
DIPI chart for sub-Saharan Africa
0.00
0.05
0.10
0.15
0.20
0.25
0.30
Benin
São T
omé
and P
rínci
pe
Burkin
a Fas
o
Seneg
al
Burund
i
Seych
elle
sM
ali
Botswan
a
Eritre
a
Lesoth
o
Kenya
Gambia
South A
frica
Guinea
-Bis
sau
Guinea
Angola
Togo
Congo
Cape V
erde
Centra
l Afri
can R
epub
licChad
Zimba
bwe
Gabon
Camer
oon
Côte d
'Ivoi
re
Moz
ambi
que
Ghana
Niger
ia
Mala
wi
Abuja Target for HIV Disease Burden
Gains from economic growth…
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
2012 2013 2014 2015 2016 2017 2018 2019 2020
AID
S I
nve
stm
ents
US
$ b
illi
on Economic Growth
Plus the Abuja target for health spending…
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
2012 2013 2014 2015 2016 2017 2018 2019 2020
AID
S I
nve
stm
ents
US
$ b
illi
on Economic Growth
plus Abuja
Plus reallocation according to disease burden
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
2012 2013 2014 2015 2016 2017 2018 2019 2020
AID
S I
nve
stm
ents
US
$ b
illi
on Economic Growth
plus Abuja
plus reallocation
0
1
2
3
4
5
6
7
8
9
2012 2013 2014 2015 2016 2017 2018 2019 2020
AID
S I
nve
stm
ents
US
$ b
illi
on
Investment Need (Investment Framework)
2015$4.6 bn.
2020$2.9 bn.
2012$3.9 bn.
Economic Growth
plus Abuja
plus reallocation
Remaining gap for the investment framework
Examples of innovative country-level approaches to HIV financing
Strengthen taxation; Taxes on tobacco and alcohol
Health funds – Zimbabwe’s ‘AIDS levy’ – individual and corporate income tax for AIDS. Similar schemes being considered by Kenya and Zambia.
Tax on airline flights to finance UNITAID
Levy on mobile telephone air timeGabon, Kenya, Burkina Faso
Levy or tax remittance flows
Global tax on financial activities
Charitable and philanthropic sources, or revenue from lotteries
Private sector
• Sources of Financing– International; Diversification– Domestic; Innovative
• Investing Resources– Investment thinking; Effectiveness– Efficiency; Returns
A checklist for applying investment thinking
AIDS: investing strategically to maximize impact
SYNERGIES WITH DEVELOPMENT SECTORS
CRITICAL ENABLERS
Treatment & care
Male circumcision
Keeping people alive
Keypopulations
OBJECTIVES
Stopping new infections
Behaviourchange
BASIC PROGRAMME ACTIVITIES
• Social
• Programme
Child infections & maternalmortality
Condoms
2011 2012 2013 2014 2015 2016 2017 2018 2019 20200
5
10
15
20
25
0
1,000,000
2,000,000
3,000,000
4,000,000
Source: Schwartländer et al. Lancet 2011
Better investments can achieve large gainsH
IV in
vest
men
t US
$ (b
illio
ns)
New
HIV
infe
ctio
ns (
mill
ions
)
Investment Approach…. accelerates transformation
Invest Effectively
Invest Efficiently Invest Optimally
Ensure that your HIV investments are focused on the highest impact interventions to match your country’s specific needs and epidemic
Reduce the cost of delivery, e.g., by capturing efficiencies of scale and scope, improve collaboration, inclusion in broader community / health system activities
Funding Landscape - Reallocate resources for maximum impact; where needed, increase funding in the short term to allow scale-up and long term savings
Operationalize and Implement the investment approach
International benchmark
South Africa has significantly reduced the cost of ARVs
June 2010
South African tender prices
0
50
100
150
200
250
300
350
ABACAVIR300mg
EFAVIRENZ200mg
EFAVIRENZ600mg
LAMIVUDINE150mg
NEVIRAPINE50mg/5ml
TENOFOVIR300mg
Pri
ce p
er
pack
(R
and
)
January 2011
Returns on investment using the new investment framework 2011–2020
Outcomes
Total infections averted More than 12 million
Infant infections averted 1.9 million
Deaths averted 7.4 million
Life years gained 29.4 million
Sustainable financing – North Africa
• Most countries are middle-income countries characterised by a low, concentrated epidemic being.
• Countries providing treatment from their budget; external financing, mainly the Global Fund
• Socio-political transformation in most countries of the region; extremely reduced fiscal space that will continue for the coming years.
• HIV still facing widespread stigma that also affects political commitment.• Morocco is developing a progressive integration of HIV services into the
social protection schemes, including social health insurance. • Algeria, PLHIV health-related needs are covered through a social
protection scheme similar to the one offered to disable peoples, and government committed to ensure sustainability of socio-economic support for PLHIV.
• Somalia, Djibouti or Sudan facing additional particular challenges related to the civil unrests
16 October 2006 UNAIDS
VISIONZERO NEW HIV INFECTIONS.
ZERO DISCRIMINATION.
ZERO AIDS-RELATED DEATHS.