is aids financing dying in asia ?
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Is AIDS Financing dying in Asia ?
Swarup Sarkar Senior Adviser, UNAIDS, Geneva
ICAAP, Busan, August 2010
In Collaboration with
David Wilson , World BankTim Brown, East West Centre, Hawaii
Jeanette Olsson, SVETAN, Stockholm Robert Greener, UNAIDSRifat Atun, Global Fund
Ryuichi Komatsu, Global FundCarlos Avila, UNAIDS
Pradeep Kakkattil, UNAIDS Sukontha Kongsin, Mahidol University, Thailand
Current level of Funding
Extent of Shortfall
Trend of Investment
Effective & Efficient use
What is the Future
What should be done?
Funding Amount & shortfall
Estimated resources available and resource gap in the Asia-Pacific region
1.1
3.1
Available Need
(billions USD)
Cost of a Priority Response
Interventions Total Cost (millions USD)
% of total
High-impact prevention $1,338 43%
Treatment by ART $761 24%
Impact mitigation $321 10%
Programme Management $363 12%
Creation of an Enabling Environment $359 11%
Total $3,143 100%
Average total cost per capita ranges from $0.50 to $1.70, depending on the stage of the epidemic.
Comprehensive interventions
$0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
Total Resource NeedUNAIDS Method
Priority Resource Need- AIDS Commission
Total Program ManagementIncome generation for widowsOrphans and vulnerable childrenTotal TreatmentCommunity mobilizationPEPYouth in schoolMass mediaPrevention for PLHABlood safetyCondom social marketingSpecial populationsWorkplaceSTI managementYouth out of schoolSafe InjectionUniversal precautionsPublic and commercial condomsPMTCTVCTMSMsHarm reductionCSWs and clients
6 B
3 B
Shortfall
2/3 rd core
5/6th of comprehensive Need
Trend of Investment
-
200,000,000
400,000,000
600,000,000
800,000,000
1,000,000,000
1,200,000,000
2007 2008 2009
Total
Domestic
External
Investment is Plateauing….
*
*varies between 800 to 1000+ million
USD
Shifting of Hands in Donor Resources
-
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
300,000,000
350,000,000
400,000,000
450,000,000
500,000,000
2007 2008 2009
Un
GF
Bilateral
Trend
• Dramatic increase after UNGASS’01
• Slowing after economic crisis
• Less significant increase last 2 yrs
• Domestic resources increasing, not enough
Follow same global trend : resources available for AIDS 1986–2010
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
US
$ m
illio
n
2921623
8.3 billionc
Signing of Declaration of Commitment on HIV/AIDS,
UNGASS
1996 1997 1998 19992000 20012002 2003 2004 200519861987 1990 19911992 1993
Less than US$ 1 million
59212
World BankMAP
launch
Global Fund
PEPFAR
257
UNAIDS
Gates Foundation
2006 2007
1000 c 8.9 billion
10 billion
7.1 Source: UNAIDS & WHO unpublished estimates, 2007
1500
16 billion
Follow same global trend of economic boom and recession
Are We Using Money Effectively
& Efficiently ?
Types of Intervention and Financing
1338
321
761
363
86
247
275
289
0 200 400 600 800 1000 1200 1400 1600
VulnerablePrevention
Other Prevention
ART
Other Available ($US million)
Need ($US million)
Resources do not follow priorities
0
20
40
60
80
100
% New infection can beprevented
% budget
High risk young people Low risk young people
• 8 to 20% of resources only to Most at Risk Population
• 2 to 3 % resources to the community organisations
• Gate keepers and brokers ….
Where is the money gone ?
Where is all the Money Gone ?
Three reasons why community don’t see money
In the largest bilateral funding on harm reduction in Asia…..
- 50% to 96% resources were consumed by UN, Government and international NGOs
- Money left for service was 4 to 50%
• Resource go to non priority and not core interventions
• Resources go to non effective intervention
• Resource goes to non-intervention and sometimes to unwanted interventions
In spite of the AIDS Commission recommendation ….
• Time bound hand over to Community organisations
• Direct funding to the NGOs through Community organisations
Conditions Tied to Funding
There is no evidence that testing changes behaviour of high risk groups however, GF continues to tie funding for high risk group with number of testing -------
What the Future holds ……
Increase Health Budget, Increase Donor Budget
Increase AIDS Budget
1. Asia has the lowest health budget in the world
2. Low impact prevention ( critical enablers) to shift to health budget
3. Cost sharing with other Ministry, a must
Commission on AIDS in Asia – Projections and Implications 27
Most of Asia are least Funded countries on Health
(Health expenditure as % GDP)
Region % Country %
SE Asia 3.8 164.1 India 4.2
Africa 6.0 160.3 China 4.3
America 12.6 155.6 Indonesia 2.3
Euro 8.8 152.8 Philippines 3.7
Increase AIDS Budget, Increase Health Budget, Increase Donor
Budget
1. Asia has the lowest health budget in the world
2. Low impact prevention ( critical enablers) to shift to health budget
3. Cost sharing with other Ministry
Implications for resource need: more efficient and effective use of resources
$0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
Total Resource NeedUNAIDS Method
Priority Resource Need- AIDS Commission
Total Program ManagementIncome generation for widowsOrphans and vulnerable childrenTotal TreatmentCommunity mobilizationPEPYouth in schoolMass mediaPrevention for PLHABlood safetyCondom social marketingSpecial populationsWorkplaceSTI managementYouth out of schoolSafe InjectionUniversal precautionsPublic and commercial condomsPMTCTVCTMSMsHarm reductionCSWs and clients
6 B
Impact mitigation:Livelihood sustainability for
widows
Lifetime cost of $1000 per affected household
Positive Partnership‘: micro-financing for affected households ($600 USD loans)
Impact mitigation: care and support
for children orphaned by AIDS
• Estimated at 100 USD per child per year
• 1 million children in Asia lost at least one parent to HIV
• Total cost=100m USD
Increase AIDS Budget, Increase Health Budget, Increase Donor
Budget
1. Asia has the lowest health budget in the world
2. Low impact prevention ( critical enablers) to shift to health budget
3. Cost sharing with other Ministry4. Independence from donor funding
Overall International Fund: 53 %from > 90% in 2002*
2004 20100% 50% 100%
Cambodia
China
Indonesia
Laos
Myanmar
Philippines
Thailand
Vietnam
Bangladesh
India
Nepal
Pakistan
External
Domestic
* Not including Thailand in 2002
Who Should Fund ?
• Rhetoric's between donor and recipient countries.
• Economic progress does not lead to social equity
• Economic Crisis in north can’t be turned into humanitarian crisis in south
• Health for marginal people remains a shared responsibility
Summary: where we are
• Current HIV resources too low to create impact• Early sign: donor fatigue, funding yet to reverse• Increasing but insufficient domestic budget• Neglected MARP priority• Poor Cost sharing with health and Social sector
• "It is no longer our resources that limit our decisions; its our decisions that limit our resources." - U Thant
A resurgent epidemic?
Or a contained one?
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1985
1990
1995
2000
2005
2010
2015
2020
Ne
w in
fect
ion
s in
ye
ar
Clients Sex workers MSM IDU
Lo-risk male Lo-risk female Children
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1985
1990
1995
2000
2005
2010
2015
2020
Ne
w in
fect
ion
s in
ye
ar
Clients Sex workers MSM IDU
Lo-risk male Lo-risk female Children
For Countries of the Region…
Action now can save
- 5 million new infection- Avert 2 million deaths- Protect 80% of women and children from
AIDS impact - USD 2 billion by 2020 – cost of econmic
burden to family
No substitute for activism
No substitute for activism
The Future is Ours
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