ELIZABETH MZIRAYHealth, Nutrition and Population Department

World Bank

Acknowledgements

Lead Consultant and Author Dr. Markus Haacker

Planning Institute of Jamaica Ms. Barbara Scott, Mr. Easton Williams, Mr. Walter James, and other PIOJ staff

Ministry of Health Dr. Nicola Skyers and the NHP

Development Partners PAHO, CHAI

UNAIDS Dr. Ernest Massiah, Dr. Pierre Somse, Ms. Roxanne Morris

Outline

1• Context

2• Purpose of the Study

3• Approach and Methodology

4• Results of Analysis

5• Recommendations

Status of the Epidemic in Jamaica

• Prevalence rate: 1.1%– MSM (31.8%)– CSW (4.9%)– Crack cocaine users

(4.5%)– Prisoners (3.35%)

Status of the Epidemic in Jamaica

• Main achievements: – Reduction in AIDS mortality– Reduction in MTCT– Improved prevention

programs with increased focus on MARPs

• Challenges: – Current prevention efforts

have failed to impact the epidemic among MSM

– Only 50% of PLHIV know their status

Context - Jamaica

• Jamaica maintains a robust treatment program– More than 90% of

ANC clients access VCT

– Treatment coverage is 58%

Slowdown in donor financing globally

Source: UNAIDS

IHP+

Gates Foundation

Financing of the National HIV/AIDS Response

• Financing for the current national AIDS strategy (2007-2012) includes:– $10mil from the World Bank– $45mil from the Global Fund– $10mil from the US Government

• Future donor financing is likely to decline substantially in the next 2 years– Challenge is how to sustain the national AIDS program, and finance the

next NSP• The availability of domestic resources is and will be very tight, and

– Fiscal space constrained by high public debt (139% of GDP)• Financing of the national response is under pressure both from the

domestic fiscal adjustment and the shrinking external resources

Purpose of the Study

1. Review and assess the current spending for HIV/AIDS and the sources of financing (both domestic and external)

2. Assess the future availability of financing for HIV/AIDS and the anticipated fiscal burden of an efficient and effective response

3. Project the course of the epidemic and the costs associated with different policy scenarios

4. Provide recommendations to inform policy decisions on sustaining the national HIV response

Methodology – 3 Building Blocks

Epidemiological Model

Economic Framework

Costing Framework

Current Spending and Sources of Financing

Projected Costs of National Response (2010-2030)

Scenario 1: Declining HIV incidenceScenario 2: Constant HIV incidenceScenario 3: Increasing HIV incidence

Projected Costs of National Response (2010-2030)

• Little variance in projected costs of the national response across the three scenarios

• Most significant cost of the national response is in treatment and care

Costs Incurred by new HIV infections

• Direct costs incurred by an HIV infection estimated at US$5,800

• Analysis shows disproportionate role in the spread of HIV by some population groups (taking into account downstream infections)– MSM: Almost 10X the

direct costs– FSW: More than 4X the

direct costs

Costs Incurred by HIV infections, by Population Group

Direct Costs Incurred by HIV infection

US$ 5,800

Additional Costs from Downstream Infections•Low-risk individual US$ 4,200

•Female Sex Worker US$24,700

•Men who have sex with men US$56,400

Fiscal Evaluation of the Costs of the HIV Program

Spending needs rise from :0.14% of GDP (2010) to 0.2% of GDP (2030)

Implications of Reduced External Financing

• Decline in external financing will result in even steeper increase in domestic financing needs

• Declines from 67 to 45% will require a doubling of domestic financing by 2015, and more than triple by 2030– Changes in financing needs

across scenarios are subtle in the short run but more significant by 2030

Perspectives on Sustainability

• Analysis finds large differences in the cost caused by additional infections across population groups– Costs significantly higher for most at risk populations (MSM

and Sex Workers) due to large share of current infections and disproportionate risk of onward infections

• HIV spending is projected to remain at about 2-3% of public health spending which is in line with the burden of disease

• Annual treatment costs (10-20% of GDP/capita) within range that could be reasonably supported through public health spending

• Commitments on provision of treatment cannot be rescinded

Perspectives on Sustainability

• Total projected costs for the national response will remain below 0.2% of GDP – HIV/AIDS does not pose immediate challenges to

fiscal sustainability. But will need to compete for scarce fiscal resources

• The national response faces considerable financing challenges due to: – Rising costs of the program (mainly from the

increasing need for treatment)– Uncertain outlook for the availability of financing

with the end of the current sources of external financing

Key Messages

• A significant increase in domestic financing for HIV/AIDS is FISCALLY SUSTAINABLE

• The bulk of the projected costs for the national AIDS response represent TREATMENT costs (both first and second line treatment)

• For an efficient and effective national AIDS response there’s need to ACCELERATE PREVENTION EFFORTS particularly targeted prevention interventions for MARPs

Thank You!www.worldbank.org/lacaids

www.worldbank.org/aids