Saphonn Vonthanak, MD. MSc. PhD Heng Sopheab, MD. MPH. PhD Chhea Chhorvann, MD. MPH. PhD Ung Luyna and Ros Seilava The Long Run Costs and Financing of HIV/AIDS in Cambodia 1

Acknowledgement 2 The Steering Committee Chaired by National AIDS Authority & Co-chaired by NCHADS Members of the steering committee are representative from; UNAIDS, WHO, CDC-GAP, FHI, USAID, KHANA, CPN+, Ministry of Health, Ministry of Economy & Finance, Ministry of Planning, Chamber of Commerce, Council for the Development of Cambodia. The Technical Team (Epidemiologists and Economists) Technical support from the Results for Development Institute (Professor Richard Skolnik, Dr. Steven Forsythe, and Dr. Robert Hecht)

Process 3 1. HIV/AIDS Projections for different intervention scenarios 2. The costing for each scenario 3. “Fiscal Space” analysis for financing the long term costs 4. Projections of resource availability and needs

Methods HIV/AIDS projections Secondary epidemiologic data Goals model HIV/AIDS Costing Spectrum AIDS impact model Resource Needs Model HIV/AIDS program financing Secondary data Medium term macroeconomic dataset of MEF ODA database from CDC National AIDS spending assessment report (NASA) Primary data (interviews) Development partners, Private sector and Government institutions 4

Scenarios for Cambodia 5 Different scenarios Prevention Program Care and Treatment Program Structural change High risk groups Low risk groups Linked response Others Current coverage Structural change Best coverage Hard choice 1 Hard choice2

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Projected Numbers of New HIV Cases (1) 7

Projected Numbers of New HIV Cases (2) 8

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Projected Cost of HIV/AIDS 10 Millions of 2009 Dollars

HIV/AIDS program financing 11

Share of HIV/AIDS to Health and Social Spending of the Government *Note that the two line has different denominator, the blue line has social spending as denominator and the red line has health spending as denominator

Total of HIV/AIDS Expense in Cambodia

Projections of Resource Availability and Needs Assumptions in the base case scenario GDP will grow at 7% per annum Public expenditure as a percentage of GDP will be 15% Social spending is 30% of public expenditures HIV/AIDS spending will be 1.5% of social spending through 2031 Donor funding would gradually decline from 90% of all HIV/AIDS funds to 50% by

Resources Needs for HIV/AIDS under Hard Choice 2 Compared to Projected Resources under the Baseline Financing Scenario (US$million)

Resource Needs for Hard Choice 2 Compared to Projected Resources Available under the Pessimistic Financing Scenario (US$ million) 16 Pessimistic Financing Scenario: Donor funding would decline from 90% of all HIV/AIDS funds to 50% by 2015

Resource needs for Hard Choice 2 Compared to Projected Resources Available under the Optimistic Financing Scenario (US$ million) 17 Optimistic Financing Scenario: Donor funding would decline slowly from 90% of all HIV/AIDS funds to 50% by 2025

Resource Needs for Hard Choice 2 Compared to Projected Resources Available under the Baseline Financing Scenario of External funding and Gradual Increase of Government Spending on HIV/AIDS as a % of Spending from 1.5% to 2.5% by

Conclusion The current HIV/AIDS programs in Cambodia in Cambodia is likely to lead to further declines in HIV prevalence and incidence over the next two decades. HIV/AIDS resource requirements will continue to increase over the next two decades. Difference in price tags is substantial and Cambodia will need to focus on getting the best value for money form its HIV/AIDS program, by focusing HIV/AIDS investments on those areas that are most cost-effective. 19

Conclusion The Cambodian HIV/AIDS program is very dependent on external financing. Over the longer term, Cambodia should be able to meet the costs of its HIV/AIDS program through increasing fiscal space for HIV/AIDS that will come with economic growth. However, if development partners withdraw financing from the HIV/AIDS program too quickly, Cambodia could face substantial difficulty in making up the deficit in the short- term. 20

Implications Cambodia will have to focus investments on HIV/AIDS in those areas that are most cost-effective Despite important successes against HIV/AIDS in Cambodia, there remains room for improving program efficiency. Cambodia will need to better manage the flow of external resources to its HIV/AIDS program; it will also need to significantly increase its own allocation to HIV/AIDS Cambodia continue to periodically assess the cost- effectiveness of different possible interventions in HIV/AIDS program, so that it can better set priorities and mobilize resources accordingly.

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