Understanding the Investment Approach Faith Mamba Regional Support Team Eastern and Southern Africa

The investment approach answers 8 critical questions UNDERSTANDDESIGNDELIVERSUSTAIN ▪ What is the current state of the epidemic? And how is that expected to change? 1 ▪ Where are we focusing our efforts and resources today? What is the current impact? And where does the money come from? 2 ▪ What programme elements are required and at what scale for an optimal response? 3 ▪ What would the impact of this optimal programme be? 4 ▪ How much money will be needed for HIV in the future and what are the net savings over time? 6 ▪ What bottlenecks and inefficiencies can be addressed and how? 5 ▪ What financing options are available to close the financing gap once efficiency gains are achieved? 7 ▪ How will you guarantee stakeholder buy-in and operational excellence required? 8

AIDS: investing strategically to maximize impact SYNERGIES WITH DEVELOPMENT SECTORS Critical Enablers Social: Political commitment and advocacy Laws, legal policies, and practices Community mobilisation Stigma reduction Mass media Local responses to change risk environment Programme Community centred design and delivery Programme communication Management and incentives Procurement and distribution Research and innovation Treatment & care Male circumcision Keeping people alive OBJECTIVES Stopping new infections BASIC PROGRAMME ACTIVITIES

Countries Implementing the Investment Approach in ESA Investment Cases: BotswanaSouth Africa EthiopiaSwaziland LesothoTanzania KenyaUganda MadagascarZambia MauritiusZimbabwe Namibia NSP Development/MTR: Lesotho Kenya Namibia Rwanda Swaziland Zambia

Core components of an HIV Investment Case Ideally, an investment case should: ▪ Summarize the state of the epidemic and the response ▪ Highlight what needs to be done to respond to HIV more effectively and at scale ▪ Identify ways to improve value for money in HIV interventions ▪ Outline current and future resource needs ▪ Quantify additional lives saved and infections averted ▪ Display the returns of investing more smartly in HIV ▪ Suggest options for ensuring the sustainability of the HIV response ▪ Articulate key decisions to be taken to maximize the impact ▪ In addition, investment cases need to be led by senior government officials and key stakeholders in each country.

Observed shifts in the AIDS response as countries implement the Investment Approach Better focus on the prioritization of high impact interventions and ensuring that interventions are delivered at scale; The evidence generated has allowed countries to improve targeting and geographic focus of interventions; Countries are exploring effective delivery models, integration and strengthening community systems; There is better focus on the returns on the investments made in AIDS and a long term view planning (beyond 2015) adopted by countries;

Observed Shifts in the AIDS response as countries implement the Investment Approach: Countries are recognizing that efficiency improvements can reduce the resource gap; placed Sustainable financing high on the agenda of most governments. Through this work countries are exploring: – The fiscal implications of HIV – Alternative sources of financing (AIDS Levy – Tanzania, Uganda; AIDS Trust – Kenya) – Shared responsibility (leveraging the dialogue to advocate for improved domestic allocations and predictable external financing that is aligned to national priorities

Lessons Learnt from Implementing the IA: Investment decisions are political. Country buy-in and ownership central to the IC development ….essential for hard choices about where to invest/disinvest National processes have been helpful in securing buy-in and ownership of the IA and IC development process The engagement of Ministries of Finance/Treasury, Development Planning remains a priority Poor articulation of Critical Enablers and Synergies in Investment Cases/NSPs - Investment requirements for critical enablers are poorly understood and therefore often not prioritized Strengthening the economic backbone of the current ICs and making linkages with broader health and development agenda Data issues….unit costs. Leveraged partnerships with World Bank, PEPFAR, CDC, CHAI to overcome data challenges

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