Response of GovernmentsInternational InstitutionsCivil Society on Scaling Up

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

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: 2006 -2008) • Meeting Abuja Targets • HIV Allocation as share of total Health Expenditure • Case study (Mozambique) Part 3 – Can commitments be turned into reality • Why are commitments lagging behind • How can we close the funding gap

Global call for HIV/AIDS funding 2005 2001 Abuja Declaration Global Fund to Fight AIDS, Tuberculosis and Malaria UN Declaration of Commitment (2001) on HIV/AIDS: mobilise $7 -10 million UN Millennium Project (2005): $33 billion achieve the MDGs in Africa Gleneagles communiqué: aid flows to Africa by $25 billion by 2010 World Bank and IMF $14 to $18 billion per year during 2006– 8

Sources of Financing 1996 Donor Government - bilateral, multilateral, intl corporations, intl NGOs) Recipient Governments (Central government, sub-natl govt, social security) Civil Society USD 300 million 2004 USD 6. 1 billion (Households, out-of-pocket expenditure (OOPE), NGOs, CBOs, FBOs, insurance) 2005 USD 8 billion Recipient Countries

Status of Funding

Sources of the estimated and projected funding for the AIDS response from 2005 to 2007* 12 US$ billion 10 Private Sector 8 Multilateral 6 Bilateral 4 Domestic 2 0 2005 2006 2007 * Assuming there are no new commitments Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries. 10

Sources of HIV spending in three countries, 2004 Burkina Faso World Bank loan 27% Public 9% World Bank credit 32% Bilateral 35% Global Fund 9% Multilateral (excluding GF) 15% Russian Federation India All donors 14% Public 36% Global Fund 2% Multilateral (excluding GF) 3% Bilateral 32% Public 86% HIV and AIDS spending per capita US$ 1. 87 US$ 0. 59 US$ 0. 28 Source: UNAIDS, based on National AIDS Spending Assessments. 10. 11

African Governments P e g led 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. Source Section 26: African Summit on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, Abuja, Nigeria 24 -27 April 2001

Scaling Up HIV/AIDS Financing

What Resources are Needed? Global HIV and AIDS resource needs 2006– 2008 UNAIDS (2005) US$ billions 2007 $8. 9 billion $10 billion 2006 2007 2008 Total 29. 8 Available Resources 12. 3 Prevention 8. 4 10. 0 11. 4 Treatment & care 3. 0 4. 0 5. 3 OVC 1. 6 2. 1 2. 7 Programme Costs 1. 5 1. 4 1. 8 6. 4 Funding gap 4. 7 (2005 to 2007) HR 0. 4 0. 6 0. 8 1. 9 14. 9 18. 1 22. 1 55. 1 Total 2006 (estimate) 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, 27 -29 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?

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

Are African states meeting the Abuja target? Abuja Target 18% Mozambique 16% 14% 12% South Africa 10% 8% Namibia 6% Kenya 4% 2% 0% 2000/1 2001/2 2002/3 2003/4 2004/5 2005/6 13

HIV/AIDS allocations as share of total Health Expenditure 18% South Africa 16% Mozambique 14% Kenya 12% 10% 8% 6% 4% 2% 0% 2000/1 2001/2 2002/3 2003/4 2004/5 2005/6 Sources: Mozambique National Statistics Institute Database, 2003. South African Budget Review, 2003/04 and Estimates of National Expenditure, 2003. Kenyan Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, 2003.

Mozambique Successes Challenges faced Developed strategic plan in 2004 -2008 estimated at 500 million usd. l l Government and the community response has grown in 2003 stimulated by NGOs, CBOs & FBOs l Mulitsectoral approach in addressing HIV/AIDS l Increased funding 2004– 8 compared to 2000 -2002. (29 million usd allocated) - Common Fund (GFATM, World Bank, Clinton Foundation, Canada & Ireland, Pharmaceuticals). - CDC, USAID - Local and international NGOs Consequence of the impact of HIV Limited financial, human resources, technical and institutional capacity at all levels to implement l Limited priorities in Strategic Plan ( excludes vulnerable groups which remains unfunded) l l Brain Drain - sustaining the human resources capacity l l. Limited access to health care (focus is more in the urban centre) Mozambique: The Challenge of HIV/AIDS Treatment and Care. Economic Commission for Africa. http: //www. uneca. org

Can commitments be turned into reality?

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

How can we close the funding gap? I. Share of needs that can be borne by households II. Share of needs that can be borne by domestic revenue mobilization III. IV. Needs that will be externally financed Long-term (10 -12 year) framework for action, including a policy and management framework for a broadly defined financing strategy 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 From Commitments To Actions