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Sustainable Financing for the AIDS, TB and Malaria Responses Pride Chigwedere, MD, PhD Senior Advisor , UNAIDS Liaison Office to the AU
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Sustainable Financing for the AIDS , TB and Malaria Responses Pride Chigwedere , MD, PhD

Jan 14, 2016

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Sustainable Financing for the AIDS , TB and Malaria Responses Pride Chigwedere , MD, PhD Senior Advisor , UN AIDS Liaison Office to the AU. Sources of Financing International; Diversification Domestic; Innovative Investing Resources Investment thinking; Returns - PowerPoint PPT Presentation
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Page 1: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

Sustainable Financing for the AIDS, TB and Malaria Responses

Pride Chigwedere, MD, PhDSenior Advisor , UNAIDS Liaison Office to the AU

Page 2: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

• Sources of Financing– International; Diversification– Domestic; Innovative

• Investing Resources– Investment thinking; Returns– Effectiveness; Efficiency

Page 3: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

2011 Political Declaration on HIV/AIDS: resources for the HIV response

Close the global resource gap by 2015 (USD 24 billion)

Support and strengthen existing financial mechanisms

Expand voluntary and additional innovative financing mechanisms

Programmes must become more cost-effective and evidence-based and deliver better value for money

Break the upward trajectory of costs through the efficient utilization of resources (simplification and integration)

Page 4: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

THREE ACTION PILLARS

The AU Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria

I. More diversified, balanced and sustainable financing models

II. Access to meds through local production and regulatory harmonization

III. Leadership, governance and oversight for sustainability

1. Investment targets for ATM met by 2015

2. Financing sources for ATM diversified

3. Financial sustainability through predictable external and more domestic investments

1. Meds security enhanced through local centers of excellence

2. Meds regulatory harmonization mechanisms within RECs, towards African Agency

3. Trade facilitated through concerted actions at all levels

1. Investments address pressing needs and pops, evidence/rights-based and strengthen systems

2. ATM programs through inclusive processes

3. Leadership and ownership demonstrated for results with robust accountability frameworks

Page 5: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

Resources for HIV in low- and middle-income countries grew strongly for a decade, but then slowed

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

0

5

10

15

20

25

Global Resources Available Investments required

Under US$ 100 million

Gates Foundation

The Global Fund

UNITAIDUNAIDS

PEPFAR

2015

Source: UNAIDS, 2012

Page 6: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

Total resources continue to grow, but fall short of total needs

Source: UNAIDS, 2012

1 2 3 4 5 6 70

2

4

6

8

10

12

14

16

18

20

International assistance Total resources available, with estimated range

US

$ bi

llion

s

Domestic resources in low-and middle-income countries

Page 7: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

PEPFAR and Global Fund – Main External Funders of AIDS in low/middle-income countries (2011)

Page 8: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

Map of GF and PEPFAR world coverage*PLACEHOLDER

Page 9: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

Share of care and treatment expenditure originating from international assistance, African countries, 2009–2011

Page 10: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

OECD countries can afford more

2010 overseas development assistance as a share of Gross National Income

0.12%0.15%

0.17%0.20%0.21%

0.26%0.29%

0.32%0.32%0.33%

0.38%0.41%

0.43%0.50%

0.53%0.55%0.56%

0.64%0.81%

0.90%0.97%

1.09%1.10%

0.0% 0.7%

KoreaItaly

GreeceJapan

United StatesNew Zealand

PortugalAustralia

AustriaCanada

Germanyswitzerland

SpainFranceIrelandFinland

United KingdomBelgium

NetherlandsDenmarkSweden

LuxembourgNorway

Page 11: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

Options for increasing and sustaining resources for AIDS

• Use increased government revenue from economic growth to invest in health and HIV

• Increase allocation for the health sector, towards the Abuja targets

• Adopt innovative financing mechanisms that generate incremental resources for the AIDS response and health

• Raise the share of the health budget allocated to the AIDS response, in line with disease burden

• Improve the efficiency and effectiveness of programmes

Page 12: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

DIPI chart for sub-Saharan Africa

0.00

0.05

0.10

0.15

0.20

0.25

0.30

Benin

São T

omé

and P

rínci

pe

Burkin

a Fas

o

Seneg

al

Burund

i

Seych

elle

sM

ali

Botswan

a

Eritre

a

Lesoth

o

Kenya

Gambia

South A

frica

Guinea

-Bis

sau

Guinea

Angola

Togo

Congo

Cape V

erde

Centra

l Afri

can R

epub

licChad

Zimba

bwe

Gabon

Camer

oon

Côte d

'Ivoi

re

Moz

ambi

que

Ghana

Niger

ia

Mala

wi

Abuja Target for HIV Disease Burden

Page 13: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

Gains from economic growth…

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

2012 2013 2014 2015 2016 2017 2018 2019 2020

AID

S I

nve

stm

ents

US

$ b

illi

on Economic Growth

Page 14: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

Plus the Abuja target for health spending…

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

2012 2013 2014 2015 2016 2017 2018 2019 2020

AID

S I

nve

stm

ents

US

$ b

illi

on Economic Growth

plus Abuja

Page 15: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

Plus reallocation according to disease burden

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

2012 2013 2014 2015 2016 2017 2018 2019 2020

AID

S I

nve

stm

ents

US

$ b

illi

on Economic Growth

plus Abuja

plus reallocation

Page 16: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

0

1

2

3

4

5

6

7

8

9

2012 2013 2014 2015 2016 2017 2018 2019 2020

AID

S I

nve

stm

ents

US

$ b

illi

on

Investment Need (Investment Framework)

2015$4.6 bn.

2020$2.9 bn.

2012$3.9 bn.

Economic Growth

plus Abuja

plus reallocation

Remaining gap for the investment framework

Page 17: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

Examples of innovative country-level approaches to HIV financing

Strengthen taxation; Taxes on tobacco and alcohol

Health funds – Zimbabwe’s ‘AIDS levy’ – individual and corporate income tax for AIDS. Similar schemes being considered by Kenya and Zambia.

Tax on airline flights to finance UNITAID

Levy on mobile telephone air timeGabon, Kenya, Burkina Faso

Levy or tax remittance flows

Global tax on financial activities

Charitable and philanthropic sources, or revenue from lotteries

Private sector

Page 18: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

• Sources of Financing– International; Diversification– Domestic; Innovative

• Investing Resources– Investment thinking; Effectiveness– Efficiency; Returns

Page 19: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

A checklist for applying investment thinking

Page 20: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

AIDS: investing strategically to maximize impact

SYNERGIES WITH DEVELOPMENT SECTORS

CRITICAL ENABLERS

Treatment & care

Male circumcision

Keeping people alive

Keypopulations

OBJECTIVES

Stopping new infections

Behaviourchange

BASIC PROGRAMME ACTIVITIES

• Social

• Programme

Child infections & maternalmortality

Condoms

Page 21: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

2011 2012 2013 2014 2015 2016 2017 2018 2019 20200

5

10

15

20

25

0

1,000,000

2,000,000

3,000,000

4,000,000

Source: Schwartländer et al. Lancet 2011

Better investments can achieve large gainsH

IV in

vest

men

t US

$ (b

illio

ns)

New

HIV

infe

ctio

ns (

mill

ions

)

Page 22: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

Investment Approach…. accelerates transformation

Invest Effectively

Invest Efficiently Invest Optimally

Ensure that your HIV investments are focused on the highest impact interventions to match your country’s specific needs and epidemic

Reduce the cost of delivery, e.g., by capturing efficiencies of scale and scope, improve collaboration, inclusion in broader community / health system activities

Funding Landscape - Reallocate resources for maximum impact; where needed, increase funding in the short term to allow scale-up and long term savings

Operationalize and Implement the investment approach

Page 23: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

International benchmark

South Africa has significantly reduced the cost of ARVs

June 2010

South African tender prices

0

50

100

150

200

250

300

350

ABACAVIR300mg

EFAVIRENZ200mg

EFAVIRENZ600mg

LAMIVUDINE150mg

NEVIRAPINE50mg/5ml

TENOFOVIR300mg

Pri

ce p

er

pack

(R

and

)

January 2011

Page 24: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

Returns on investment using the new investment framework 2011–2020

Outcomes

Total infections averted More than 12 million

Infant infections averted 1.9 million

Deaths averted 7.4 million

Life years gained 29.4 million

Page 25: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

Sustainable financing – North Africa

• Most countries are middle-income countries characterised by a low, concentrated epidemic being.

• Countries providing treatment from their budget; external financing, mainly the Global Fund

• Socio-political transformation in most countries of the region; extremely reduced fiscal space that will continue for the coming years.

• HIV still facing widespread stigma that also affects political commitment.• Morocco is developing a progressive integration of HIV services into the

social protection schemes, including social health insurance. • Algeria, PLHIV health-related needs are covered through a social

protection scheme similar to the one offered to disable peoples, and government committed to ensure sustainability of socio-economic support for PLHIV.

• Somalia, Djibouti or Sudan facing additional particular challenges related to the civil unrests

Page 26: Sustainable Financing for the  AIDS , TB and Malaria Responses Pride  Chigwedere , MD,  PhD

16 October 2006 UNAIDS

VISIONZERO NEW HIV INFECTIONS.

ZERO DISCRIMINATION.

ZERO AIDS-RELATED DEATHS.