Sustainable Financing for the AIDS, TB and Malaria Responses Pride Chigwedere, MD, PhD Senior Advisor, UNAIDS Liaison Office to the AU

Sources of Financing – International; Diversification – Domestic; Innovative Investing Resources – Investment thinking; Returns – Effectiveness; Efficiency

2011 Political Declaration on HIV/AIDS: resources for the HIV response  Close the global resource gap by 2015 (USD 24 billion)  Support and strengthen existing financial mechanisms  Expand voluntary and additional innovative financing mechanisms  Programmes must become more cost-effective and evidence-based and deliver better value for money  Break the upward trajectory of costs through the efficient utilization of resources (simplification and integration)

THREE ACTION PILLARS The AU Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria I. More diversified, balanced and sustainable financing models II. Access to meds through local production and regulatory harmonization III. Leadership, governance and oversight for sustainability 1.Investment targets for ATM met by Financing sources for ATM diversified 3.Financial sustainability through predictable external and more domestic investments 1.Meds security enhanced through local centers of excellence 2.Meds regulatory harmonization mechanisms within RECs, towards African Agency 3.Trade facilitated through concerted actions at all levels 1.Investments address pressing needs and pops, evidence/rights-based and strengthen systems 2.ATM programs through inclusive processes 3.Leadership and ownership demonstrated for results with robust accountability frameworks

Resources for HIV in low- and middle-income countries grew strongly for a decade, but then slowed 2015 Source: UNAIDS, 2012

Total resources continue to grow, but fall short of total needs Source: UNAIDS, 2012 International assistanceTotal resources available, with estimated range US$ billions Domestic resources in low- and middle-income countries

PEPFAR and Global Fund – Main External Funders of AIDS in low/middle-income countries (2011)

Map of GF and PEPFAR world coverage *PLACEHOLDER

Share of care and treatment expenditure originating from international assistance, African countries, 2009–2011

OECD countries can afford more 2010 overseas development assistance as a share of Gross National Income

Options for increasing and sustaining resources for AIDS Use increased government revenue from economic growth to invest in health and HIV Increase allocation for the health sector, towards the Abuja targets Adopt innovative financing mechanisms that generate incremental resources for the AIDS response and health Raise the share of the health budget allocated to the AIDS response, in line with disease burden Improve the efficiency and effectiveness of programmes

DIPI chart for sub-Saharan Africa

Gains from economic growth…

Plus the Abuja target for health spending…

Plus reallocation according to disease burden

Remaining gap for the investment framework

Examples of innovative country-level approaches to HIV financing  Strengthen taxation; Taxes on tobacco and alcohol  Health funds – Zimbabwe’s ‘AIDS levy’ – individual and corporate income tax for AIDS. Similar schemes being considered by Kenya and Zambia.  Tax on airline flights to finance UNITAID  Levy on mobile telephone air time Gabon, Kenya, Burkina Faso  Levy or tax remittance flows  Global tax on financial activities  Charitable and philanthropic sources, or revenue from lotteries  Private sector

Sources of Financing – International; Diversification – Domestic; Innovative Investing Resources – Investment thinking; Effectiveness – Efficiency; Returns

A checklist for applying investment thinking

AIDS: investing strategically to maximize impact SYNERGIES WITH DEVELOPMENT SECTORS CRITICAL ENABLERS Treatment & care Male circumcision Keeping people alive OBJECTIVES Stopping new infections BASIC PROGRAMME ACTIVITIES Social Programme

Source: Schwartländer et al. Lancet 2011 Better investments can achieve large gains HIV investment US$ (billions) New HIV infections (millions)

Investment Approach…. accelerates transformation Invest EffectivelyInvest EfficientlyInvest Optimally Ensure that your HIV investments are focused on the highest impact interventions to match your country’s specific needs and epidemic Reduce the cost of delivery, e.g., by capturing efficiencies of scale and scope, improve collaboration, inclusion in broader community / health system activities Funding Landscape - Reallocate resources for maximum impact; where needed, increase funding in the short term to allow scale-up and long term savings Operationalize and Implement the investment approach

International benchmark South Africa has significantly reduced the cost of ARVs June 2010 South African tender prices January 2011

Returns on investment using the new investment framework 2011–2020 Outcomes Total infections avertedMore than 12 million Infant infections averted1.9 million Deaths averted7.4 million Life years gained29.4 million

Costs and economic returns, 2011–2020 Costs and Returns Total additional investment (over 10 years) US$ 46.5 billion Future treatment need avertedUS$ 40 billion Life years gained US$ 1,060 per life year gained

Sustainable financing – North Africa Most countries are middle-income countries characterised by a low, concentrated epidemic being. Countries providing treatment from their budget; external financing, mainly the Global Fund Socio-political transformation in most countries of the region; extremely reduced fiscal space that will continue for the coming years. HIV still facing widespread stigma that also affects political commitment. Morocco is developing a progressive integration of HIV services into the social protection schemes, including social health insurance. Algeria, PLHIV health-related needs are covered through a social protection scheme similar to the one offered to disable peoples, and government committed to ensure sustainability of socio-economic support for PLHIV. Somalia, Djibouti or Sudan facing additional particular challenges related to the civil unrests

16 October 2006UNAIDS VISION ZERO NEW HIV INFECTIONS. ZERO DISCRIMINATION. ZERO AIDS-RELATED DEATHS.