Response of Governments/International Institutions/Civil Society on Scaling Up HIV/AIDS Financing Global Conference Brasilia, Brazil – November 2006 Aisha Baldeh National AIDS Secretariat The Gambia

Part 3 – Can commitments be turned into reality Why are commitments lagging behind How can we close the funding gap Outline of Presentation Part I - Global call for HIV/AIDS funding HIV/AIDS Financing Sources of Funding Status of Funding Part 2 – Scaling up HIV/AIDS Financing What is Resources are needed Scaling up Financing (resources: ) Meeting Abuja Targets HIV Allocation as share of total Health Expenditure Case study (Mozambique)

Gleneagles communiqué: aid flows to Africa by $25 billion by Global call for HIV/AIDS funding UN Millennium Project (2005): $33 billion achieve the MDGs in Africa Abuja Declaration Global Fund to Fight AIDS, Tuberculosis and Malaria UN Declaration of Commitment (2001) on HIV/AIDS: mobilise $7-10 million World Bank and IMF $14 to $18 billion per year during 2006–8

Donor Government - bilateral, multilateral, intl corporations, intl NGOs) Recipient Governments (Central government, sub-natl govt, social security) Civil Society (Households, out-of-pocket expenditure (OOPE), NGOs, CBOs, FBOs, insurance) 1996 USD 300 million USD 8 billion USD 6.1 billion Sources of Financing Recipient Countries

Status of Funding

Sources of the estimated and projected funding for the AIDS response from 2005 to 2007* * Assuming there are no new commitments Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries. Domestic Bilateral Multilateral Private Sector US$ billion

Sources of HIV spending in three countries, 2004 US$ 1.87 HIV and AIDS spending per capita US$ 0.59US$ 0.28 World Bank loan 27% All donors 14% Public 86% Public 9% Global Fund 9% Bilateral 35% World Bank credit 32% Multilateral (excluding GF) 15% Bilateral 32% Public 36% Global Fund 2% Multilateral (excluding GF) 3% India Russian Federation Burkina Faso Source: UNAIDS, based on National AIDS Spending Assessments.

Pledge to… ….commit ourselves to take all necessary measures to ensure that the needed resources are made available from all sources and that they are efficiently and effectively utilized......set a target of allocating at least 15% of our annual budget to the improvement of the health sector including HIV/AIDS. …..make available the necessary resources for the improvement of the comprehensive multi-sectoral response, and that an appropriate and adequate portion of this amount is put at the disposal of the National Commissions/Councils for the fight against HIV/AIDS, Tuberculosis and Other Related Infectious Diseases. African Governments Source Section 26: African Summit on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, Abuja, Nigeria April 2001

Scaling Up HIV/AIDS Financing

What Resources are Needed? Global HIV and AIDS resource needs 2006 – 2008 UNAIDS (2005) US$ billions Total Prevention Treatment & care OVC Programme Costs HR Total Available Resources (estimate) $8.9 billion $10 billion Funding gap ( 2005 to 2007) At least $18 billion Source: UNAIDS. Resource Needs for an Expanded Response to AIDS in Low and Middle Income Countries. Presented to the Programme Coordinating Board. Seventeenth Meeting, Geneva, June 2005.

Scaling Up HIV/AIDS financing: Issues…… Adequacy: How much was pledged? And how much was committed? Priority: How does the budget for HIV/AIDS compare to resources spent in other areas e.g. malaria etc? Progress: Are financial commitments of different stakeholders (donor, governments & civil society improving? Allocative efficiency: Are we using the funds for the right mix of interventions or programmes?

Operational efficiency: Are funds being spent? And are they being spent on the purposes for which they were allocated? Is there wastage or corruption? Are the funding channels used the most efficient and effective for delivering funds to the implementing agencies? Equity: Are resources being allocated fairly? Scaling Up HIV/AIDS Financing: Issues…

13 Are African states meeting the Abuja target? 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 2000/12001/22002/32003/42004/52005/6 Mozambique South Africa Kenya Namibia Abuja Target

Sources: Mozambique National Statistics Institute Database, South African Budget Review, 2003/04 and Estimates of National Expenditure, Kenyan Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, % 2% 4% 6% 8% 10% 12% 14% 16% 18% 2000/12001/22002/32003/42004/52005/6 South Africa Mozambique Kenya HIV/AIDS allocations as share of total Health Expenditure

Successes Developed strategic plan in estimated at 500 million usd. Government and the community response has grown in 2003 stimulated by NGOs, CBOs & FBOs Mulitsectoral approach in addressing HIV/AIDS Increased funding 2004–8 compared to (29 million usd allocated) - Common Fund (GFATM, World Bank, Clinton Foundation, Canada & Ireland, Pharmaceuticals). - CDC, USAID - Local and international NGOs Challenges faced Consequence of the impact of HIV Limited financial, human resources, technical and institutional capacity at all levels to implement Limited priorities in Strategic Plan ( excludes vulnerable groups which remains unfunded) \ Brain Drain - sustaining the human resources capacity Limited access to health care (focus is more in the urban centre) Mozambique Mozambique: The Challenge of HIV/AIDS Treatment and Care. Economic Commission for Africa.

Can commitments be turned into reality?

Why are commitments lagging behind? Less Sustainable and Predictable funding plan (apart from the GFATM Model) Bureaucracy – Often aid comes with strings attached e.g. low Inflation target set by IMF. ‘Macroeconomic and Structural implications of increased grants aids needs to be analysed by case by case bases’ (IMF and World Bank July 26, 2004) Absorptive Capacity – there is consensus among donors that the ability of low-income countries must improve their absorptive capacity Resource Needs are based on assumptions on future behaviour of donors, governments and other agents (UNAIDS 2005 AIDS Resource Estimate). Shifting Priorities/Alliances – good governance, pressure from donors to privatise, war on terror, natural disasters.

How can we close the funding gap? I. Health Insurance, Out of pocket. II. Strengthening governance, reducing corruption, reserve buffers III. Debt relief, long term aid pledges and regular disbursement (support GFATM) IV. Technical support to countries to develop long term framework I. Share of needs that can be borne by households II. Share of needs that can be borne by domestic revenue mobilization III. Needs that will be externally financed IV. Long-term (10-12 year) framework for action, including a policy and management framework for a broadly defined financing strategy From Commitments To Actions