MEETING OF MINISTERS OF HEALTH AND FINANCE ON DOMESTIC FINANCING FOR HEALTH AU Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria response in Africa ( ) Dr. MARIE-GORETTI HARAKEYE African Union Commission

2  African leaders demonstrated strong commitment to stop HIV/AIDS, TB and Malaria as exemplified by several continental, regional and international decisions and commitments  AU Commitments on AIDS, TB, Malaria (2000, 2001, 2006, 2010, 2013)  Efforts were intensified and partnerships increased as a result significant progress has been recorded, the triple challenge is abating  January 2012 : Decision on the revitalization of AIDS WATCH AFRICA: African High Level Advocacy &Accountability Platform to Combat HIV/AIDS, TB and Malaria  AWA targets expanded to include TB and Malaria, continent-wide  (AU) Assembly Decision No: Assembly/AU/Dec.413 (XVIII), requested the African Union Commission (AUC) “to work out a roadmap of shared responsibility to draw on African efforts for a viable health funding with support of traditional and emerging partners to address AIDS dependency response

AU Roadmap Principles and goal The Roadmap presents a set of practical African-sourced solutions for enhancing Shared Responsibility and Global Solidarity for AIDS, TB, and Malaria responses in Africa. The overarching goal of the AU Roadmap is to support African countries to exercise leadership to meet AIDS, TB, malaria targets by 2015 and source African solutions to ensure universal access to health-related services for all those in need on a sustainable basis. The AU Roadmap builds on a number of AU initiatives (e.g. Africa Health Strategy and Abuja Declaration) :

The Roadmap: three action pillars 1 More diversified, balanced and sustainable financing models  Develop financial sustainability plans with clear targets  Ensure development partners meet commitments and align with Africa’s priorities  Maximise opportunities to diversify funding sources and increase domestic resource allocation  Invest in leading medicines manufacturers – focusing on AIDS, TB and malaria  Lay foundations for a single African regulatory agency  Acquire essential skills through technology transfers and south-south cooperation  Incorporate TRIPS flexibilities and avoid "TRIPS-plus" measures in trade agreements  Use strategic investment approaches for scale-up of basic programmes  Support communities to claim their rights and participate in governance of the responses  Ensure investments contribute to health system strengthening  Mobilise leadership at all levels to implement the Roadmap 3 Leadership, governance and oversight for sustainability 2 Access to medicines – local production and regulatory harmonisation Priority actions 4

Key High Level Meetings related to the AU Roadmap July 2012: Ministerial dialogue on value for money on sustainability and accountability with a call to reduce aid dependency September 2012: The UNGA high level side event in September 2012 event generated broad political consensus around a novel approach to development cooperation to support implementation of the AU Roadmap and to achieve, by 2015, the MDGs targets. 29 November 2012: The United States upheld their commitment to the Shared Responsibility-Global Solidarity agenda for AIDS ‘PEPFAR Blueprint launch: Creating an AIDS- free Generation’. May and July 2013 : AWA Action Committee meeting of HSOG and the Abuja AU Special Summit.

Diversified, balanced and sustainable financing Most African countries have recognized the need to diversify and expand the sources of funding for health generally and for HIV responses specifically to reduce their dependence on a few external funders. Measures taken include quantifying the country-level funding gap (eg. financial gap analysis for malaria for 2013 – 2016 done by all malaria endemic countries), identifying policy options to increase resources, increased financial commitment by the private sector and inclusion of health, malaria and HIV services in different forms of health insurance and other health financing schemes. Member States encouraged to develop financial investment plans for health, including AIDS, TB and Malaria, showing how national programme costs will be covered with domestic and external funding and annual increases in share of domestic funding

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Key suggested actions for Pillar 1 LevelAction National LevelAnalyzing the costs of the three diseases Develop a sustainable financial plan based on evidence based strategies Building a picture of ‘returns on investment’ Identify innovative sources of domestic funding Work with development partners to ensure they meet their funding commitments Regional LevelFacilitate sharing of ideas and lessons learned on diversifying and innovating funding Continental LevelMonitor and report on progress of member states on biennial basis 8

Commitment by the HOSG for Global Fund Replenishment There was strong support from Heads of State Champions (Nigeria, Tanzania, Kenya, South Africa, Senegal, Côte d’Ivoire, Ghana, Rwanda, Malawi, Liberia, Ethiopia, Mozambique) who have called for a fully-funded Global Fund replenishment at bilateral meetings with donor Heads of State, at international events (TICAD V, May 2013 AU Summit (AWA), Abuja + 12 Special Summit), UNGA and in their communication with donors. The Heads of State and Government through the renewed commitments of Abuja Declaration 2013 urged all stakeholders to take action in support of achieving the USD fifteen (15) billion replenishment target of the Global Fund In this context, call upon Development Partners to adhere to the 0.7% target of GDP for the contribution to the Global Fund to fight AIDS, TB and Malaria

Scanning the environment: Health Financing GF: Priority has to be given to Global burden of HIV/AIDS, TB and Malaria, as well as the ability to pay. Even if countries provide the maximum ‘fair share’ domestic financing of their Health especially ATM programs, many of them, particularly low-income, high burden countries, will continue to need substantial external support for some time. More investment on health is required as Africa seeks to eliminate ATM (2030 ). This is also compounded by emerging dynamics including that AIDS is increasingly classified as a chronic disease. GF/UNAIDS/UNDP/RECS/CSOs committed to continue partner with AU to accelerate the implementation of the AU Roadmap in up to 2015

RECOMMENDATIONS AU Member States need to assess prospects for future external aid, and their own domestic fiscal space. Need for Predictable international donor funding as well as increased domestic investment and innovative financing that can tap into new resources. Need for Timely investment, Combat the emergence of MDR and XDR TB cases which can cost up 100 times more. Same issue with the ARV third line high costly and quite inaccessible in many African countries. We must put energy in getting results as the war is won not when pledges come in, but when new cases of Aids decline and all those eligible for treatment receive it; when malaria is eliminated and Tuberculosis under control. Share country experiences, best practices and challenges in implementing the 3 pillars of the Roadmap

Proposed benchmarks for diversified, sustainable and balanced financial models 1.Increase of investment plans for AIDS, TB and Malaria to close the GAP by 2015 and ensure the sustainability of the national response 2.At least one new revenue stream for domestic financ ing in operation by Increase in ‘on budget’ spending between 2013 and 2015 for the three diseases 1.Donors meet 100% of their commitments for 2015 financing. 1.Increase of investment plans for AIDS, TB and Malaria to close the GAP by 2015 and ensure the sustainability of the national response 2.At least one new revenue stream for domestic financ ing in operation by Increase in ‘on budget’ spending between 2013 and 2015 for the three diseases 1.Donors meet 100% of their commitments for 2015 financing. 13

« GETTING MORE HEALTH FOR MONEY IS CRITICAL FOR SUSTAINABILITY AND HOLDS US ACCOUNTABLE FOR RESULTS. AFRICA’S TIME IS NOW A ND OUR PEOPLE CAN NO LONGER AFFORD TO WAIT FOR HEALTH, WELL BEING AND SUSTAINABLE DEVELOPMENT H.E PRESIDENT ARMANDO GUEBUZA, MOZAMBIQUE THANK YOU