SYDNEY MEDICAL SCHOOL AAAPS Conference | 10 April 2010 Joel Negin External Funding for HIV and NCD Activities in the Pacific: implications on priority setting and aid effectiveness

Background ›Project was conducted for the Nossal Institute for Global Health’s Health Policy and Health Finance Knowledge Hub ›Analysis conducted with Helen Robinson of the Nossal Institute ›Part of the data collection and analysis conducted for the Commission on AIDS in the Pacific in collaboration with UNSW and the George Institute for International Health ›Working paper available from the Nossal Institute 2

Methodology ›Focused on external funding for HIV and NCD activities in the Pacific ›Literature review of academic, aid agency, multilateral agency reports ›Key informant interviews with representatives of AusAID, Global Fund, NZAID, SPC, etc. 3

Context: Dramatic growth in Development Assistance for Health Source: IHME DAH Database DAH from 1990 to 2007 by source of funding

Context: Australia ODA as % of GNI

6 Context: Pacific Island countries are some of the largest recipients of health aid Source: IHME Project Database and UN World Population Database Top 10 countries in terms of per capita development assistance for health received from 2002 to 2007

Pacific Disease Burden ›Non-communicable diseases contribute to more than 75% of deaths in the Pacific Deaths due to NCDs and AIDS per 100,000 population, by country, 2002 and 2005 Source: WHOSIS

$1.3 $1.9 $3.0 $5.5 $6.3 $8.0 $12.3 $13.2 $18.2 External funding for HIV activities by source, , in US$ million Funding for HIV activities increasing Source: Commission on AIDS in the Pacific

Annual HIV funding per capita from PRHP, US and the Global Fund, , in US$ Source: Commission on AIDS in the Pacific Distribution of HIV Funding by Country

$0.7 $1.1 $1.8 $2.4 $2.6 $2.4 $10.3 $11.6 External funding for NCD programs in the Pacific, by source, , in US$ million Funding for NCD activities

External Funding for HIV and NCD Responses in the Pacific, (US$) Funding for HIV and NCD activities

Key Findings ›From 2002 to 2009, funding totalled US$68,481,730 for HIV and US$32,910,778 for NCDs ›Funding data were difficult to gather. There is a need for more thorough record keeping and greater transparency in access to funding information. ›Donor funding does not align with burden of disease and mortality figures. Despite the low burden of disease for HIV, external actors provide significantly more funding for HIV response than for NCD activities. -While there may be good reasons why funding does not align with the burden of disease, the disparities seen in the Pacific are significant. ›There does not appear to be a clear rationale supporting the patterns of donor funding. -Some highly affected countries receive little compared to those with lower disease burdens. To some extent, funding appears to follow historic and geopolitical interests.

Why might this be the case? Source: Shiffman and Smith 2007 ›Actor Power: -Strong global HIV policy community and institutions including UNAIDS, Global Fund. -Civil society mobilisation in the Pacific with Pacific Islands AIDS Foundation -There are many NCDs, each having its own stakeholders, thus limiting cohesion -Limited voice of Pacific governments ›Ideas: -Singularity of purpose around one disease makes for simplicity of message -Myths of NCDs being diseases of ‘rich, white males’ are difficult to counter

Why might this be the case? Source: Shiffman and Smith 2007 ›Political Contexts: -Inclusion in the MDGs and Global Fund put HIV on the agenda -NCD challenges overshadowed by MDGs ›Issue Characteristics: -Being a ‘single’ disease makes it easier to track and identify efforts and inputs -Infectious disease threatens donor neighbours -Clearly developed HIV response with global evidence -More complex interplay of multiple NCD risk factors and interventions makes it more difficult to isolate inputs and efforts -Poor NCD data limit clear indications of severity of problem

Implications ›What does this say about priority setting mechanisms in the region? ›What drives donor funding allocations and how much does a Pacific voice contribute? ›We do not argue that funding for HIV should be cut or even that funding for NCDs should be increased – but we do believe that transparency of funding and more discussion of allocations is imperative ›And fits in with the Paris Declaration and the Pacific Principles on Aid Effectiveness ›Recommendation: suggests need for more flexible and responsive aid mechanisms rather than disease specific models