FUNDING SLOWDOWN
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FUNDING SLOWDOWN. if : 1. But we can do better. We have done a lot…. Scale up to date guided by a “commodity approach” Unsystematic prioritisation and investment with limited basis in country epidemiology and context Resources spread thinly across many parallel interventions

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FUNDING SLOWDOWN

if : 1


But we can do better

We have done a lot…

Scale up to date guided by a “commodity approach”

  • Unsystematic prioritisation and investment with limited basis in country epidemiology and context

  • Resources spread thinly across many parallel interventions

  • Focus on discrete interventions rather than overall results leading to a fragmented response

  • Unprecedented scale up of HIV prevention, treatment, care and support

  • Decline in rate of new HIV infections in many countries

  • More than 6.6 million people on ART

  • Millions of orphans receiving basic education, health, social protection

BUILDS ON PAST, BUT DOES BETTER

if : 2


IF : 3AIDS Investment Framework

CRITICAL ENABLERS

BASIC PROGRAMME ACTIVITIES

OBJECTIVES

Programmes

for keypopulations

PMTCT

  • Social enablers

  • Laws & policies

  • Community mobilization

  • Stigma reduction

Stopping new infections

Behaviour

change

Condoms

  • Programme enablers

  • Community-centered design & delivery

  • Management & incentives

  • Production & distribution

  • Research & innovation

Keeping people alive

Care & treatment

Male circumcision

SYNERGIES WITH DEVELOPMENT SECTORS

Social protection; Education; Legal Reform; Gender equality; Poverty reduction; Gender-based violence; Health systems (incl. treatment of STIs, blood safety); Community systems; Employment practices.


  • Social enablers

  • Political commitment & advocacy

  • Laws, policies & practices

  • Community mobilization

  • Stigma reduction

  • Mass media

  • Local responses, to change risk environment

  • Local responses, to change risk environment

  • Programme enablers

  • Community-centered design & delivery

  • Programme communication

  • Management & incentives

  • Production & distribution

  • Research & innovation


THE RETURN ON INVESTMENT

iF : 4


Investment framework projections for new HIV infections

Optimized investment will lead to rapid declines in new HIV infections in many countries


ALLOCATIVE EFFICIENCY

iF: 5


SHARED RESPONSIBILITY

iF : 6


100%

100%

90%

90%

80%

80%

70%

70%

60%

60%

Coverage

Coverage

50%

50%

40%

40%

30%

30%

20%

20%

10%

10%

0%

0%

>500

>500

350-499

350-499

250-349

250-349

200-249

200-249

100-199

100-199

50-99

50-99

<50

<50

CD4 Count (cells/ml)

CD4 Count (cells/ml)

ART coverage in 2015 by CD4 count

CD4 350

15 million

13.1 million (health)

T4P


Cost per patient per year (weighted average in US$)

201020152020

Lab (new patients) 180 129 79

Lab (cont patients) 180 128 76

Service delivery 176 144 112

1st Line ARVs 155147 57

2nd Line ARVs 1678984295


  • Critical enablers and development synergies:

  • are necessary but not sufficient by themselves for effective AIDS responses, by supporting basic programme activities

  • encourage sustainability of AIDS responses through integration into other non-health sectors

  • are determined and prioritized by country contexts,

  • require mechanisms for multi-sectoral financing and governance


Development synergies

Synergies and enablers – distinct, but overlapping

HIV-sensitive

(HIV outcome is one of many objectives)

HIV-specific

(sole/primary objective is an HIV outcome)

Critical enablers


Community Mobilization

  • Little information on cost

  • Country reviews (USD 1 to 14 per adult population)

  • Community Health Workers (@ USD 2 per adult population)


Community mobilization assumptions in the investment framework

Cost envelope: community mobilisation component of the critical enablers

2011 $0.3bn 2015 $0.6 bn 2020 $1.0 bn

Assumptions:

Increased community capacity

increased community service delivery

need for remuneration of community and lay workers

need for training, guidance, supervision

participation of people living with HIV


Community mobilization: makes scale up possible

Number of people tested through community mobilization

2010: 46 million (VCT) 2015: 109 million

Service delivery costs (treatment)

2010: $179 per year

2020: $125 per year ($17 in low income countries)

Driving costs down: fewer outpatient visits, community support service modalities

Better Health Outcomes


Community mobilization: increases effectiveness

  • Community mobilisation increased HIV testing rates four-fold in Tanzania, Zimbabwe, South Africa and Thailand.

  • Consistent condom use in past 12 months 4 times higher in communities with good community engagement (Kenya)

  • Hypothetical circumcision model KwaZulu-Natal :

    • core intervention: 240,000 infections averted over ten years

    • with enablers: 420,000 infections averted, with modest marginal increase in costs


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