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Ani Shakarishvili, MD UNAIDS Country Coordinator in Ukraine

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? . Ani Shakarishvili, MD UNAIDS Country Coordinator in Ukraine

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Ani Shakarishvili, MD UNAIDS Country Coordinator in Ukraine

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  1. 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? Ani Shakarishvili, MD UNAIDS Country Coordinator in Ukraine AIDS 2012, Washington, DC – 23 July, 2012

  2. Overview • Context • Money now: from where? for what? • Money in the future: predictability? how much more needed? • Possible solutions • Is it feasible?

  3. 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

  4. Annual AIDS expenditures (in USD) by programme areas and sources of financing – 2009-2010 Total 2009: USD 65.4 M Total 2010: USD 72.8 M USD millions Source: Ukraine National AIDS Spending Assessments, 2009 and 2010

  5. Number of patients on ART and contribution of the state budget and the Global Fund – 2003-2011

  6. ART coverage of the estimated needs in selected countries, 2010

  7. Cost (in USD) of 1st and 2nd line ARV regiments – 2008-2010

  8. Reported number of persons receiving opioid substitution treatment and the national targets – 2008-2016 Current need National AIDS Plan – 2013 target USD 11M from the GF R6 (2007-2012) GF R10 Source:Ukrainian Institute of Public Health Policy Research, 2011

  9. 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

  10. 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

  11. Financial sustainability - possible solutions (2) • Still required donor-funding commitments (post Y2015!) • Alternative modalities of financing: • Cost-sharing arrangements ??? • National health and social insurance ??? • Taxation??? • Facilitating public-private partnerships ???

  12. Is it feasible?

  13. Total health expenditures, percent (%) of GDP – 2007-2010 Health expenditure per capita (current USD) – 2007-2010 USD Percent Only 0.7% of health expenditures go towards HIV in Ukraine!

  14. Sustainability • Financing • Service delivery • Institutional • Human resources • Social sustainability

  15. Other colleagues: • Paolo Belli The World Bank • Dr. Volodymyr Kurpita All-Ukrainian Network of People Living with HIV • Robert Greener UNAIDS Geneva Co-authors: • Kateryna Sharapka UNAIDS Ukraine • Dr. George Gotsadze CuratioInternational Foundation • Alexei Ilnitski UNAIDS Ukraine • Prof. Natalia NizovaUkrainian AIDS Centre • Oleksandr ZhyhinasUkrainian AIDS Centre Acknowledgements

  16. Thank you!Дякую!

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