HIV & AIDS FUNDING AND ECONOMIC RECESSION: A CALL

FOR VISIONARY LEADERSHIP

International AIDS Conference Vienna, 2010

Vailet Mukotsanjera-Kowayi: HEAD: AIDS BUDGET UNIT

Focus of presentation

Overview of the AIDS Budget UnitThe economic recession and HIV & AIDS fundingEffects of the global economic recessionDonor dependency and treatment implicationsAll hope is not lost: What options exist?

Funding the fight: Budgeting for HIV/AIDS in developing countries (2004)

Phase 1: 2002-2004Multi-country research:

Southern Africa (South Africa, Namibia, Kenya, Mozambique) Latin America (Argentina, Chile, Ecuador, Mexico, Nicaragua)

HIV & AIDS Financing and Spending in Eastern & Southern Africa (2008)

Phase 2: 2005-2008Multi-country research:

Ethiopia, Kenya, Tanzania (Zanzibar), Malawi, ZambiaABU extended its network to countries which were not part of phase 1First attempt to use NASAResults and experiences helped to informed phase 3

Main findingsLow absorptive capacityMismatch between international & regional commitments and resource allocationLow resource allocations for health strengthening activities Low financial commitment by the national governments More than 80% of HIV/AIDS activities donor funded

The economic recession and HIV & AIDS funding

Main sources of HIV/AIDS fundingInternational/ donorDomestic/ nationalPrivate

Economic recessionThe general slow down of economic

activity for more than two quartersNB***Recession affects the different

funding sources differently

Effects of recession on funding International financiers**

PEPFAR reduced its budget for purchase of ARVs in 2009/10 World Bank and UNITAD -- reduction in funding over the coming years in Malawi, Zimbabwe, Uganda, Mozambique & DRCUS, Netherlands and Ireland -- they will lower contributions to the Global Fund2009/10 Global Fund contributions to approved country grants reduced by 8-12%

**(Source: Medecins Sans Frontieres (2010), No Time to Quit: HIV/AIDS Treatment Widening in Africa,)

Effects of recession on fundingGovernment Government revenue base shrinking due to:

Companies closing down-- reduced corporate taxesRetrenchments---- reduced income tax Reduced household consumption--- reduced VAT

Private sectorCompanies closing down, reduced productivity, reduced profits- aim to lower costsHouseholds- unemployment, reduced disposable incomeReduction in “Diaspora income”

Reality check: Contending national priorities

National interests

Developmental aid

Social sectors Productive/ economic sectors

Defence Health

HIV & AIDS Climate change

Prevention Treatment

Over reliance on HIV & AIDS donor funding

country % domestic public expenditure

% foreign expenditure

Zambia 15% 85% Tanzania 43% 57% Malawi 32% 68% Namibia 51% 49% Ghana 21% 79% Mozambique 15% 85%

Source: http://data.unaids.org/pub/report/2008

Priority in treatment (2005-2007) country spending category Zambia Tanzania Malawi Namibia Ghana Mozambique Prevention 24.8% 44.7% 10.2% 17.2% 31.3% 33% Care & Treatment 47% 26.8% 48.7% 69.0% 68.7% 37.2% Management 14.2% 26.2% 9.8% 13.8% 0% 15.3% Enabling Environment 1.9% 0.3% 11.5% 0% 0% 0.9% OVC 4.4% 0% 1.8% 0% 0% 7.6% Incentives for HR 1.5% 0.5% 7.2% 0% 0% 5.1% Social Protection 0.3 % 0% 0.6% 0% 0% 0.7% Research 5.9% 0.7% 10.2 0% 0% 0.2%

http://www.unaids.org/en/CountryResponses/Countries

Economic recession, donor dependency and treatment

Implications for treatment programmes in Africa

Number of new patients to start ARV treatment has been cut six fold**Drug stock-outs and disruptions in drug supply** Lack of adherence- leads to mutationChallenging options on who to treat (those already on treatment, on waiting list, new infections)

**(Source: No Time to Quit: HIV/AIDS Treatment Widening in Africa, Medecins Sans Frontieres,2010)

All hope is not lost: What options exist?

Need for options to make treatment programmes more sustainableGovernments can improve revenue collection Through using effective revenue collection strategies e.g the coordinated revenue collection system of South African Revenue Service (SARS)Taxation- e. g.in 1999, Zim introduced a 3% AIDS levy on taxable income. An innovative method- as long as the funds are used efficiently and equitably

All hope is not lost: What options exist?

Public-Private Partnerships in HIV & AIDS financingThe need to employ demand driven resource allocation- based on needsPolitical commitments must be reflected through openness to participatory decision making especially in resource allocation

All hope is not lost: What options exist?

Given the economic recession:there is need for increased accountabilityAvailable resources should be allocated and in the most efficient and effective wayAvailable resources should be distributed in the most equitable manner and for intended purposes

Accountability efforts should be citizen centered, bottom-up approach to accountability

Thank you!