Ani Shakarishvili, MD UNAIDS Country Coordinator in Ukraine AIDS 2012, Washington, DC – 23 July, 2012 Ensuring the financial sustainability of the national AIDS response in a low-middle income country with the growing HIV epidemic: is it feasible in the next few years in Ukraine?
16
Embed
Ani Shakarishvili, MD UNAIDS Country Coordinator in Ukraine AIDS 2012, Washington, DC – 23 July, 2012 Ensuring the financial sustainability of the national.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Ani Shakarishvili, MDUNAIDS Country Coordinator in Ukraine
AIDS 2012, Washington, DC – 23 July, 2012
Ensuring the financial sustainability of the national AIDS response in a low-middle income country with the growing HIV epidemic: is it feasible in the next few years in Ukraine?
Overview
Context Money now: from where? for what? Money in the future: predictability? how
much more needed? Possible solutions Is it feasible?
Context
Low-middle income country with growing and fragile economy: GDP per capita $2,974 (2010)
Growing HIV epidemic:
• most severe in Europe: estimated 0.8% HIV prevalence (15-49 yrs)
• highly concentrated in key populations at risk: PWID (22% HIV prevalence), FSWs (9%), MSM (6%)
National HIV response scaling up with some pockets of success (PMTCT, young/recent PWID)
Changing political environment, yet some openness around social issues at national and local levels
Health care reform slow, with only some benchmarks
Source: Ukrainian AIDS Centre
Annual AIDS expenditures (in USD) by programme areas and sources of financing – 2009-2010
US
D m
illio
ns
Total 2009: USD 65.4 M
Total 2010: USD 72.8 M
Source: Ukraine National AIDS Spending Assessments, 2009 and 2010
Number of patients on ART and contribution of the state budget and the Global Fund – 2003-2011
ART coverage of the estimated needs in selected countries, 2010
> 80%
60% - 79%
40% - 59%
Congo
Guyana
Lesotho
20% - 39%
Algeria
India
Lithuania
0% - 19%
Egypt
Tajikistan
Ukraine
Brazil
Ethiopia
Romania
Botswana
Rwanda
Slovakia
Cost (in USD) of 1st and 2nd line ARV regiments – 2008-2010
Reported number of persons receiving opioid substitution treatment and the national targets – 2008-2016
Source: Ukrainian Institute of Public Health Policy Research, 2011
National AIDS Plan – 2013 target
Current need
USD 11M from the GF R6 (2007-2012)
GF R10
Annual future financial allocations for HIV by source and the annual financial gap (in USD) – 2012-2015
Funding gap: USD 138M
Source: National Operational Plan 2011-2013; Ukraine Gap Analysis Report, 2010
Financial sustainability - possible solutions (1)
Increasing domestic investments: Programmatic priorities Equitable resource distribution
Policy and practical initiatives aimed at reduction of costs per client: Radical changes and optimization of procurement Efficient service delivery modalities (cost and
implementation efficiencies) HIV service integration and decentralization:
- Across HIV interventions- Synergies with other vertical and non-HIV programmes- Into primary care
Still required donor-funding commitments (post Y2015!) Alternative modalities of financing:
Cost-sharing arrangements ??? National health and social insurance ??? Taxation ??? Facilitating public-private partnerships ???
Financial sustainability - possible solutions (2)
Is it feasible?
Total health expenditures, percent (%) of GDP – 2007-2010
Per
cent
Health expenditure per capita (current USD) – 2007-2010
US
D
Only 0.7% of health expenditures go towards HIV in Ukraine!
Financing Service delivery Institutional Human resources Social sustainability
Sustainability
Acknowledgements
Co-authors:• Kateryna Sharapka
UNAIDS Ukraine
• Dr. George Gotsadze Curatio International Foundation
• Alexei Ilnitski UNAIDS Ukraine
• Prof. Natalia Nizova Ukrainian AIDS Centre
• Oleksandr Zhyhinas Ukrainian AIDS Centre
Other colleagues:
• Paolo Belli The World Bank
• Dr. Volodymyr Kurpita All-Ukrainian Network of People Living with HIV