Ensuring that Domestic Funding for HIV Funds the Right Things LIVING 2016 The Positive Leadership Summit July 16,2016 Durban Deogratius Peter Rutatwa Chief Executive Officer NATIONAL COUNCIL OF PLHIV (NACOPHA) TANZANIA

Outline About NACOPHA Overview of the HIV pandemic in Tanzania Overview of Global Resources to combat HIV Specific HIV Responses on Domestic Funding From Various Countries Tanzania and Struggle to Raise Domestic Funding on HIV Response Recommendations

ABOUT NACOPHA NACOPHA is the national umbrella organization established by PLHIV to serve as the Apex body and ultimate voice to advocate for issues and concerns of the PLHIV in Tanzania Founded in August 2003 and was registered in September 2005 Currently the Council works with more than 13 PLHIV networks and over 146 out of 166 PLHIV districts clusters country wide Each District council constitutes one PLHIV cluster working with support groups at grassroots level

Primary targets: PLHIV through clusters and Networks whose composition differ based on key interest such as: - Professionals teachers and Journalists ( TAPOTI, TNJ+), - young People (NYP, NNEYOP, TAYOPA), - Women( NETWO+, TNW+), - people with disabilities (NEDIPHA+), - network of organizations ( TANOPHA, TANEPHA+,SHDEPHA+ ), - Religious Leaders(TANERELA) - Key population (MSM, Sex workers, PWID) Secondary targets: Policy and decision makers (Members of parliament, Cabinet/Ministers, Councilors, Religious leaders, Development Partners, Bilateral/ Multilateral agencies) for advocacy work. NACOPHA Beneneficieries and targets

NACOPHA Strategic Priority areas

Arusha 6-41 Dsm Dodoma 8-73 Iringa4- 98 Kagera 8-38 Kigoma Kilimanjaro 7-50 Lindi5- 51 Manyara Mara 7-52 Mbeya Morogoro 5-80 Mtwara6- 47 Mwanza Pwani 6-55 Rukwa Ruvuma5- 25 Shinyanga 5-25 Singida 5-41 Tabora Tanga Number of Groups Established per District Cluster Njombe 6-17 Simiyu 4-28 Geita 4-18 Katavi Note The first number represents the number of clusters while the second represents groups NACOPHA’S DISTRICT CLUSTERS AND EMPOWERMENT GROUPS

Overview of the HIV pandemic in Tanzania

2013 Data 1.4 PLHIV New infections 72,000 AIDS Related Deaths 78,000 PLHIV Accessing Treatment Approx 720,000 (52%) (Source: NACP) PLHIV not Accessing Treatment Approx 680,000 (48%) (Source: NACP) Some Key Highlighted Statistics

Prevalence Rates Tanzania HIV and Malaria Indicator Survey 2003/2004 7% % 2011/ % There is a downward trend. The latest survey is being done this year where current statistics will be derived from Tanzania accounts for 6% of the total number of people living with HIV in SSA and 4% of all PLHIV globally

Regional Heterogeneity of the Epidemic Heterogeneity of HIV Prevalence by: Geographical region (1.5% %) Socio-economic and demographic sub-groups Socio-behavioural characteristics Implies different rates of transmission, risk factors and drivers as well as coverage of prevention services HIV prevalence even higher among key populations

Overview of Global Resources to combat HIV

Global Response to Combat HIV Ending the Global HIV epidemic as a public health threat by 2030 “three zeros campaign” ZERO New HIV infections ZERO AIDS related deaths ZERO Stigma and discrimination For this to happen an estimated $26.2 billion will be required to 2020, steadily decreasing to $22.3 by 2030 In increasing the propensity to reach the 2030 goal, a fast track short term strategy : has been adopted

UNAIDS Fast track targets by 2020 SERVICE DEMAND CREATION RETENTION ON TREATMENT AND CARE TREATMENT ADHEHERANCE AND SUSTAINED VIRAL LOAD MONITORING

Trend of HIV Financing from Donor Governments: Disbursements, Source: UNAIDS and Kaiser Foundation quoted in Katz I. et al (2014)

Overview of Funding Sources for HIV Response External and Internal funding

HIV Response Domestic and External Funding Local/ Domestic FundingExternal Funding Special HIV/AIDS Levy Additional commodity/ service tax for HIV/AIDS Concessionary loans : domestic borrowing Risk pooling schemes Special social assistance programs covering HIV services Competitive Grants Multi lateral grants Bi-lateral grants Concessionary loans : external borrowing Risk pooling schemes Special social assistance programs covering HIV services

HIV Domestic Financing Strategies

HIV domestic Financing: Selected Countries Zimbabwe AIDS Trust Fund Employers and employees to contribute 3% of their income Uganda AIDS Trust Fund Mainstreaming the HIV response in the National Social Security Kenya HIV Trust Fund Airline levy, 1% public revenue allocation, raised NSHIF premiums, RSA HIV Trust Fund Funds its own response by spending over $1 billion annually

Tanzania Funding and Gaps in HIV Response

Total Estimated cost for HIV/AIDS = $2.96 Billion Source: NMSF 2013/ Estimations ARV Treatment Other

Current Funding of HIV Response in Tanzania Source: NMSF for HIV and AIDS (2013/ /18)

Current Funding Gaps Source: HPP and Tanzania PS3 Project (2016)

Efforts to increase domestic financing in HIV response in Tanzania

AIDS Trust Fund : 2015 Contributions to HIV response by 40% ( when Fully Operational) Sources: Contributions from government revenue, grants, private gifts and other fund- raising activities To be modeled to take the form of Public- Private-Partnership (PPP) model with private contributions expected to rise while those of the public diminish over time.

AIDS Trust Fund Tanzania… Other possible contributions: 3% of value added tax (still being formulated) The government pledged Tshs. 300 billion to fund the HIV response in three years. In 2015/16 the government allocated $1.4 million Other likely measures will include the use of social security and risk pooling schemes

How to source fund: Government and Community

EXPENSING FINANCES GENERATED FROM DOMESTIC FUNDING

Expensing the ATF Human rights, stigma reduction, M&E, coordination, program mgt, advocacy and other cross cutting costs Medicines and specific equipment and investments Awareness, PMTCT, BCC, testing and condoms

Ensuring Domestic Funding Finds the Right Things

Total Portfolio of Likely Finances that Tanzania Could Leverage Special HIV/AIDS Levy Additional commodity/ service tax for HIV/AIDS Domestic borrowing Risk pooling schemes Special social assistance programs covering HIV services Local/ Domestic Funding

Recommended actions for domestic Fund for HIV Funds the Right Things

Recommendations Policy engagement and implementation : Ensure inclusiveness and active participation/Involvement of different stakeholders (PLHIV in particular) in policy and decision making. Laws and policies allowing the PLHIV to give their voice in determining resources allocations on appropriate interventions/actions to achieve the global targets. Prioritization of interventions to be funded must be guided by updated WHO guidelines, national HIV response Policy frameworks, political commitment, and mainstreaming of HIV in various public and private sectors.

Community Engagement: The community i.e CSOs, Private Sector, Households, should be engaged to become potential contributors for the interventions (e.g. social security and risk pooling schemes) which could help reduce the burden from governments and other donors. PLHIV must be provided with support to access risk pooling schemes to reduce burden incurred as a result of bearing the cost of care and treatment, while increasing capacity of government to pooling more resources for key targeted interventions ( ARVs and diagnostic)

Programmatic actions Increased evidence informed community rooted actions addressing barriers and enablers that contribute to achieving high yields to achieving targets –Community models on ART dispensing ( e.g. Uganda, Botswana, Mozambique, DRC, etc Increased investments in specific targets ( defined by types of Populations, places/locations, time (PEPFAR pivots –high yielding sites, priority populations(KPs, adolescents and young girls), high prevalence districts etc) Gender and human rights based interventions addressing stigma and discrimination, GBV, Pediatrics etc Generate and build regular and periodic evidence generation (assessments, operational research, Reviews ) to monitor and inform decisions and plans for improved performance on specific interventions or strategies Implementation of LTA tools: Stigma Index, PHDP, Human rights Count,..

Local governments Authorities Should develop own flexible and specific context strategies that address specific needs of specific targets and locations (right things) using own resources, in particular empowering the PLHIV in their localities. (eg. In TZ, 20% of revenues from own sources allocated for HIV response) Advocacy: PLHIV, (allied with CSOs) at the national and grassroots must take lead in engaging policy makers in budgetary sessions for proper allocation of resources to right interventions. We also have to be watchdogs on all expenditure and implemented interventions,

Advocacy … PLHIV and CSOs must engage development partners, Regional Economic and political affiliations for continued to support governments budgets and initiatives of CSOs when engaging strategic dialogues with government and constituent members. LTA tools should inform our advocacy agenda. The advocacy efforts must also ensure that the government is supported to fulfilling its part of co-financing (GF, PEPFAR) Sustainability – ensure that domestic financing becomes sustainable through home grown innovative strategies, effective enabling policy and legal framework, increased strong engagement of private sector, mobilized communities and local government structures. Every intervention must be backed by hard data and evidence and CSOs engagement