financing the response to hiv in low- and middle-income countries: how it is affected by the...
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Financing the response to HIV in low- and middle-income countries: how it is affected by the economic crisis?
Robert Greener
July 20, 2011
Summary of Presentation
• What was the effect of the economic downturn in low and middle-income countries?– On economic growth– On resources available for HIV
• What is the financing challenge?• What are the potential sources for
increased and sustainable investment?
Summary of Presentation
• What was the effect of the economic downturn in low and middle-income countries?– On economic growth– On resources available for HIV
• What is the financing challenge?• What are the potential sources for
increased and sustainable investment?
Typology of Countries
upper-middle incomelower prevalence
38 countries(Russia, Brazil, Mexico)
9% of PLHIV
upper-middle incomehigher prevalence
15 countries(South Africa, Botswana, Ukraine)
21% of PLHIV
30%
lower-middle incomelower prevalence
30 countries(China, Indonesia, Viet Nam)
3% of PLHIV
lower-middle incomehigher prevalence
9 countries(Thailand, Lesotho, Swaziland)
4% of PLHIV
7%
low incomelower prevalence
15 countries(India, Myanmar, Pakistan)
11% of PLHIV
low incomehigher prevalence
27 countries(Nigeria, Kenya, Mozambique)
52% of PLHIV
63%
23% 77%
HIV PrevalenceG
ove
rnm
en
t R
eve
nu
e p
er c
apit
a1%
$1150
$250
HIV Disease Burden - PLHIV
low income higher prevalence
52%
low income lower prevalence
11%
lower-middle income higher prevalence
4%
lower-middle income lower prevalence
3%
upper-middle income higher prevalence
21%
upper-middle income lower prevalence
9%
Economic Downturn in 2009
IMF estimates 2008-9
low income higher prevalence, -9.2%
low income lower prevalence, 4.5%
lower-middle income higher prevalence, -3.6%
lower-middle income lower prevalence, 8.7%
upper-middle income higher prevalence, -13.6%
upper-middle income lower prevalence, -13.1%
-15%
-10%
-5%
0%
5%
10%
GD
P g
row
th r
ate
20
08
-9
Total annual resources available for AIDS in low and middle income countries
Source: UNAIDS analysis based on (1) Kaiser Family Foundation and UNAIDS , financing the Response to AIDS in low and middle income countries from the G8, European Commission and other Donor Governments in 2009, July 2010; (2) UNAIDSOECD/DAC online database (last visited on January 05, 2011); (3) Funders Concerned About AIDS (FCAA), 2010; (4) European HIV/AIDS Funders Group (EFG, 2010; (5) UNAIDS Unified Budget of Work (UBW) for 2010 & 2011); (6) Disbursements reports and pledges and contributions reports from the GFATM (last visited on Jan 06 2011(7) budget review from Donor governments and multilateral organizations.
Total annual resources available for AIDS in low and middle income countries
Source: UNAIDS analysis based on (1) Kaiser Family Foundation and UNAIDS , financing the Response to AIDS in low and middle income countries from the G8, European Commission and other Donor Governments in 2009, July 2010; (2) UNAIDSOECD/DAC online database (last visited on January 05, 2011); (3) Funders Concerned About AIDS (FCAA), 2010; (4) European HIV/AIDS Funders Group (EFG, 2010; (5) UNAIDS Unified Budget of Work (UBW) for 2010 & 2011); (6) Disbursements reports and pledges and contributions reports from the GFATM (last visited on Jan 06 2011(7) budget review from Donor governments and multilateral organizations.
Domestic contribution
Summary of Presentation
• What was the effect of the economic downturn in low and middle-income countries?– On economic growth– On resources available for HIV
• What is the financing challenge?• What are the potential sources for
increased and sustainable investment?
Resource Needs for the Global AIDS Response
0
5
10
15
20
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Glo
bal
Res
ou
rce
Nee
d $
bn upper-middle income
lower prevalence
upper-middle income higher prevalence
lower-middle income lower prevalence
lower-middle income higher prevalence
low income lower prevalence
low income higher prevalence
Summary of Presentation
• What was the effect of the economic downturn in low and middle-income countries?– On economic growth– On resources available for HIV
• What is the financing challenge?• What are the potential sources for
increased and sustainable investment?
Potential Sources of Financing
• Domestic sources in affected countries– Public budgets– Domestic private and philanthropic sources
• External donor contributions– Bilateral aid– Multilateral mechanisms– Global private and philanthropic sources
Economic Growth in Low and Middle-Income Countries
IMF Forecast growth rates 2011-2016
6.2%
7.7%
4.7%
8.8%
4.0% 4.0%
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
low income higher prevalence
low income lower prevalence
lower-middle income higher prevalence
lower-middle income lower prevalence
upper-middle income higher prevalence
upper-middle income lower prevalence
GD
P g
row
th r
ate
Domestic HIV Investment and Disease Burden
2.9%
0.4%
2.7%
0.3%
1.1% 0.9%
9.8%
1.1%
15.0%
0.5%
3.9%
1.1%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
low income higher prevalence
low income lower prevalence
lower-middle income higher prevalence
lower-middle income lower prevalence
upper-middle income higher prevalence
upper-middle income lower prevalence
Domestic HIV investment as % Domestic Health budget HIV disease burden as % of total
UNAIDS and WHO investment data for 84 low and middle-income countries
Donor Dependency and Health
52.7%
85.7%
80.6%
10.1%
16.7%
44.7%
24.6%
11.2%
17.8%
6.5%
0.2% 0.5%2.2%
0.3%0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
East & SouthernAfrica
West & CentralAfrica
South Asia Latin America Eastern Europe &Central Asia
South East Asia East Asia
% f
rom
ext
ern
al s
ou
rces
HIV Health
Donor Dependency of Treatment
UNAIDS: NASA and UNGASS Data
Percentage of care and treatment expenditure from international sources
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
AlgeriaSeychelles
EgyptCongo
BotswanaLesotho
MoroccoAngola
ChadGabonBenin
SenegalSwazilandCameroon
UgandaBurundi
GhanaTogo
KenyaBurkina FasoSierra Leone
NigeriaCote d'Ivoire
MaliGuinea
MozambiqueGuinea-Bissau
MalawiEritrea
NigerCentral African Republic
RwandaDemocratic Republic of the Congo
Domestic Financing Scenario
Suppose that by 2020:• Domestic health budgets average at least
15% of government revenue (as in the Abuja Declaration in Africa)
• Domestic allocation to AIDS is in proportion to the AIDS disease burden
Potential Domestic Public Investment
low income
lower-middle income
upper-middle income
0
5
10
15
20
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Glo
ba
l R
es
ou
rce
Ne
ed
s $
bn
Potential Domestic Public Investment
low income
lower-middle income
upper-middle income
Donors and private sources
0
5
10
15
20
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Glo
ba
l R
es
ou
rce
Ne
ed
s $
bn
Remaining Resource Gap
low income
lower-middle income
upper-middle income
0
2
4
6
8
10
12
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Re
so
urc
e G
ap
$b
n
Potential Private SourcesGlobal and Country Level
• Innovative financing mechanisms– Indirect taxation (airline tickets, mobile phone
usage, exchange rate transactions)• Front-loading mechanisms
– E.g. International Financing Facility (IFF-Im)• Advance market commitments• Voluntary solidarity levies• Philanthropic Foundations
Political Declaration on HIV/AIDS: resources for the AIDS response
• Close the global resource gap by 2015– $6 billion annually, overall target between $22 billion and $24
billion
• Support and strengthen existing financial mechanisms– including the Global Fund and relevant UN organizations
• Expand voluntary and additional innovative financing mechanisms
• Break the upward trajectory of costs through the efficient utilization of resources– Simplify treatment regimens and delivery (Treatment 2.0)– Integrate HIV programmes with other areas of the health system