HIV & AIDS FUNDING AND ECONOMIC RECESSION: A CALL FOR VISIONARY LEADERSHIP International AIDS Conference Vienna, 2010 Vailet Mukotsanjera-Kowayi: HEAD: AIDS BUDGET UNIT

Focus of presentation Overview of the AIDS Budget Unit The economic recession and HIV & AIDS funding Effects of the global economic recession Donor dependency and treatment implications All hope is not lost: What options exist?

Funding the fight: Budgeting for HIV/AIDS in developing countries (2004) Phase 1: Multi-country research: Southern Africa (South Africa, Namibia, Kenya, Mozambique) Latin America (Argentina, Chile, Ecuador, Mexico, Nicaragua)

HIV & AIDS Financing and Spending in Eastern & Southern Africa (2008)  Phase 2: Multi-country research: Ethiopia, Kenya, Tanzania (Zanzibar), Malawi, Zambia ABU extended its network to countries which were not part of phase 1 First attempt to use NASA Results and experiences helped to informed phase 3

Main findings Low absorptive capacity Mismatch between international & regional commitments and resource allocation Low resource allocations for health strengthening activities Low financial commitment by the national governments More than 80% of HIV/AIDS activities donor funded

The economic recession and HIV & AIDS funding  Main sources of HIV/AIDS funding International/ donor Domestic/ national Private  Economic recession The general slow down of economic activity for more than two quarters NB***Recession affects the different funding sources differently

Effects of recession on funding  International financiers** PEPFAR reduced its budget for purchase of ARVs in 2009/10 World Bank and UNITAD -- reduction in funding over the coming years in Malawi, Zimbabwe, Uganda, Mozambique & DRC US, Netherlands and Ireland -- they will lower contributions to the Global Fund 2009/10 Global Fund contributions to approved country grants reduced by 8-12% **(Source: Medecins Sans Frontieres (2010), No Time to Quit: HIV/AIDS Treatment Widening in Africa,)

Effects of recession on funding Government  Government revenue base shrinking due to: Companies closing down-- reduced corporate taxes Retrenchments---- reduced income tax Reduced household consumption--- reduced VAT Private sector Companies closing down, reduced productivity, reduced profits- aim to lower costs Households- unemployment, reduced disposable income Reduction in “Diaspora income”

Reality check: Contending national priorities National interestsDevelopmental aid Social sectorsProductive/ economic sectors Defence Health HIV & AIDSClimate change PreventionTreatment

Over reliance on HIV & AIDS donor funding Source:

Priority in treatment ( )

Economic recession, donor dependency and treatment Implications for treatment programmes in Africa Number of new patients to start ARV treatment has been cut six fold** Drug stock-outs and disruptions in drug supply** Lack of adherence- leads to mutation Challenging options on who to treat (those already on treatment, on waiting list, new infections) **(Source: No Time to Quit: HIV/AIDS Treatment Widening in Africa, Medecins Sans Frontieres,2010)

All hope is not lost: What options exist? Need for options to make treatment programmes more sustainable Governments can improve revenue collection Through using effective revenue collection strategies e.g the coordinated revenue collection system of South African Revenue Service (SARS) Taxation- e. g.in 1999, Zim introduced a 3% AIDS levy on taxable income. An innovative method- as long as the funds are used efficiently and equitably

All hope is not lost: What options exist? Public-Private Partnerships in HIV & AIDS financing The need to employ demand driven resource allocation- based on needs Political commitments must be reflected through openness to participatory decision making especially in resource allocation

All hope is not lost: What options exist?  Given the economic recession: there is need for increased accountability Available resources should be allocated and in the most efficient and effective way Available resources should be distributed in the most equitable manner and for intended purposes  Accountability efforts should be citizen centered, bottom-up approach to accountability

Thank you!