1. Financing South Africa’s HIV Response
Aaron Motsoaledi
Minister of Health, South Africa
Mcebisi Hubert Jonas
Deputy Minister of Finance, South Africa
Michel Sidibé
Executive Director, UNAIDS
Deborah Birx
Global AIDS Coordinator, United States
Mark Dybul
Executive Director, The Global Fund
Moderated by
Mia Malan
Director and Editor
Bhekisisa: M&G Centre for Health Journalism
South Africa
With technical introduction from
Robert Hecht
Results for Development Institute
Organized by
National Department of Health
South Africa
In partnership with
UNAIDS
Results for Development Institute

2. Financing South Africa’s HIV Response: Much to Celebrate, Much Left to Do
Robert Hecht
Results for Development Institute
Durban, South Africa
19 July 2016
Satellite Symposium at the 21st International AIDS Conference

3. Why South Africa matters so much…
Most number
of PLHIV
Most new infections
Most patients on treatment
Coverage (% of PLWH)
6.8M HIV-infected people live in South Africa, more than any other country
# on treatment (millions)
1/6 of all new infections occur in South Africa…
100%
Millions
50%
South Africa
Nigeria
India
…about 340,000 new infections per year
South Africa
India
Kenya
Zimbabwe
Uganda
Moz/Kenya/Uganda
Zim/Tanzania
Data notes: all data in the left and right panels are reported for 2015 at aidsinfo.unaids.org. South Africa’s new infections in the center panel is reported in the HIV and TB Investment Case for The total number of new infections globally for that year (2.1 million) comes from aidsinfo.unaids.org.

4. The decline in new infections came later in South Africa…
South Africa started late, but has since made dramatic progress in its fight against HIV/AIDS
The decline in new infections came later in South Africa…
...but coverage has
accelerated rapidly
HIV incidence among adults 15-49
% PLHIV on treatment
+48%
+91%
South Africa reduction began 5+ years after other high-burden countries
+84%
+62%
+153%
South Africa
Thailand
Zambia
Kenya
Brazil
South Africa
Zambia
Brazil
Notes on computations:
% coverage = # of people on treatment / # of PLWH
HIV incidence rate (annual) = # of new cases / population at risk – measured per 100,000 people (these rates are among adults ages 15-49)
2010
2015
Thailand
Kenya
Data notes: these data come from aidsinfo.unaids.org.

5. Increased financing has propelled and underpinned the dramatic increases in coverage
South Africa is the largest
spender among LMICs…
…and finances the majority of HIV services with domestic resources
Total HIV/AIDS Funding ($USD, In billions, 2014)
% of HIV/AIDS financing by source
Donor
Domestic
1.9
0.8
0.7
0.3
0.3
South Africa (2014)South Africa (2014)
Brazil
(2011)
Kenya (2013)Kenya (2013)
Thailand (2013)Thailand (2013)
Zambia (2012)Zambia (2012)
South Africa (2014)South Africa (2014)
Brazil (2011)
Kenya (2013)
Thailand (2013)Thailand (2013)
Zambia (2012)Zambia (2012)
Data notes: these data come from aidsinfo.unaids.org.

6. Increased HIV spending risks crowding out other health priorities
Despite these successes, there are still serious financing challenges to be addressed
Significant financial gaps remain before epidemic control can be achieved
Increased HIV spending risks crowding out other health priorities 40
Rand (billions)
-10
2015
2016
2017
2018
2019
Total resource need
Total shortfall
2009/10
2013/14
2017/18
HIV as share of health budget (%)
Data notes: the top panel is a recreation of Figure 1 in the South African HIV and TB Investment Case. Data in the bottom panel come from R4D’s analysis of South Africa’s Estimates of National and Provincial Expenditure.

7. How will South Africa keep funding its HIV scale-up
How will South Africa keep funding its HIV scale-up? Strategies to get the most out of every Rand
Lower drug and
procurement costs
Enhance workforce efficiency
Maximize program effectiveness & efficiency
Increase sustainability
Improve coordination
Procurement and market shaping, especially for diagnostics and 2nd/3rd line drugs
Downward task shifting
Better supervision of HCWs and other inputs
Adherence counseling, community and family support
Get the money to where the problem is most acute -- target high prevalence districts
Sustain the effort financially with stable long-term domestic sources – integration with PHC, incorporation in NHI
Avoid waste and unplanned gaps – better coordination and carefully designed transitions among Government and Partners

8. “ “ “ “ When people are determined they can overcome anything
It always seems impossible until it’s done
-Nelson Mandela “ “ “

9. Financing South Africa’s HIV Response
Aaron Motsoaledi
Minister of Health, South Africa
Mcebisi Hubert Jonas
Deputy Minister of Finance, South Africa
Michel Sidibé
Executive Director, UNAIDS
Deborah Birx
Global AIDS Coordinator, United States
Mark Dybul
Executive Director, The Global Fund
Moderated by
Mia Malan
Director and Editor
Bhekisisa: M&G Centre for Health Journalism
South Africa
With technical introduction from
Robert Hecht
Results for Development Institute
Organized by
National Department of Health
South Africa
In partnership with
UNAIDS
Results for Development Institute