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

HIV Disease Burden - PLHIV

Economic Downturn in 2009 IMF estimates

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 (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 (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

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

Domestic HIV Investment and Disease Burden UNAIDS and WHO investment data for 84 low and middle-income countries

Donor Dependency and Health

Donor Dependency of Treatment UNAIDS: NASA and UNGASS Data

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

Remaining Resource Gap

Potential Private Sources Global 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