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Efficiency, Effectiveness, and Financial Sustainability: The Importance of Country Ownership. Dr Bernhard Schwartländer UNAIDS. 2011 Political Declaration on HIV/AIDS: resources for the HIV response .

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Efficiency effectiveness and financial sustainability the importance of country ownership

Efficiency, Effectiveness, and Financial Sustainability:

The Importance of Country Ownership

Dr Bernhard Schwartländer

UNAIDS


Efficiency effectiveness and financial sustainability the importance of country ownership

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

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

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

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

  • Support and strengthen existing financial mechanisms

  • Expand voluntary and additional innovative financing mechanisms


Efficiency effectiveness and financial sustainability the importance of country ownership

Total funding for AIDS in sub-Saharan Africa is slowingafter many years of growth

AIDS investment in sub-Saharan Africa

US$ billions

Source: UNAIDS


Efficiency effectiveness and financial sustainability the importance of country ownership

Treatment programmes are highly aid-dependent

International share (%)


Efficiency effectiveness and financial sustainability the importance of country ownership

Overview

  • Anew investment approach

  • We are gradually doing better – examples for incresed effectiveness and efficiency

  • Sustainable financing – a new global compact for shared responsibility


Efficiency effectiveness and financial sustainability the importance of country ownership

We have done a lot…

  • 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

But we can do better

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


Efficiency effectiveness and financial sustainability the importance of country ownership

AIDS: a new Investment Framework

CRITICAL ENABLERS

BASIC PROGRAMME ACTIVITIES

OBJECTIVES

Eliminate new

infections in

children & keep

mothers alive

Keypopulations

  • 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; Employer practices.


Efficiency effectiveness and financial sustainability the importance of country ownership

- 2.5

- 2.0

- 1.5

- 1.0

- 0.5

- 0

Three investment scenariosImpact on the epidemic

USD (Billions)

Business as usual

New HIV Infections

(millions)


Efficiency effectiveness and financial sustainability the importance of country ownership

- 2.5

- 2.0

- 1.5

- 1.0

- 0.5

- 0

New HIV Infections

(millions)

Three investment scenariosImpact on the epidemic

Investment framework

USD (Billions)

Business as usual


Efficiency effectiveness and financial sustainability the importance of country ownership

- 2.5

- 2.0

- 1.5

- 1.0

- 0.5

- 0

New HIV Infections

(millions)

Three investment scenariosImpact on the epidemic

Rapid scale up

previous projections

Investment framework

USD (Billions)

Business as usual


Efficiency effectiveness and financial sustainability the importance of country ownership

Overview

  • Anew investment approach

  • We are gradually doing better – examples for incresed effectiveness and efficiency

  • Sustainable financing – a new global compact for shared responsibility


Efficiency effectiveness and financial sustainability the importance of country ownership

Resources available for HIV

in low and middle income countries, globally, 2002-2010


Arv costs in south africa

ARV costs in South Africa


Above facility costs can be reduced

Above facility costs can be reduced

ART costs per patient at the facility and program level

Facility Level Cost

National Programme Cost


Integrated services are more efficient

Integrated services are more efficient

The example of VCT: Costs per client

Stand-alone VCT clinics

Integrated into SRH services


Efficiency effectiveness and financial sustainability the importance of country ownership

Overview

  • Times of austericy – a new investment approach

  • We are gradually doing better – examples for incresed effectiveness and efficiency

  • Sustainable financing – a new global compact for shared responsibility


Efficiency effectiveness and financial sustainability the importance of country ownership

OECD countries can afford more

2010 overseas development assistance as a share of Gross National Income


Efficiency effectiveness and financial sustainability the importance of country ownership

Economic growth in Africa, 1970–2010

Third-fastest growing region in the World


Efficiency effectiveness and financial sustainability the importance of country ownership

Domestic AIDS spending needs to match the burden of disease

Burden of disease from AIDS vs spending on AIDS

Burden of diseasecaused by AIDS

Domestic AIDS spendingas a share of health spending

Median % across countries


Efficiency effectiveness and financial sustainability the importance of country ownership

Measuring national commitment to AIDS:

the Domestic Investment Priority Index


Efficiency effectiveness and financial sustainability the importance of country ownership

Options for increasing domestic HIV investment in Africa

Domestic public AIDS investment in sub-Saharan Africa

Source: UNAIDS


Efficiency effectiveness and financial sustainability the importance of country ownership

Examples of innovative country-level approaches to HIV financing

  • Taxes on tobacco and alcohol are common to finance health initiatives

  • Zimbabwe’s ‘AIDS levy’ earmarks a part of individual and corporate income tax for the AIDS response

  • Kenya and Zambia are considering an AIDS trust fund

  • Several African countries collect a tax on airline flights to finance UNITAID’s efforts on AIDS, tuberculosis and malaria; own airline tax in Niger

  • Levy on mobile telephone air time: being explored in Gabon, Kenya, Burkina Faso

  • Leverage or tax remittance flows


Efficiency effectiveness and financial sustainability the importance of country ownership

A new global compact on shared responsibility: Domestic financing potential and international investment needs in sub-Saharan Africa


Efficiency effectiveness and financial sustainability the importance of country ownership

Conclusions

  • The leveling off in international resources is a threat – but also an opportunity

  • We need the experience and innovation of the practitioners of the global South

  • AIDS can lead the way – as it has done before

  • Country ownership is essential – but has accountability at its core

  • We can break the back of the epidemic

  • Within a new global compact on shared responsibility we can generate the resources we need


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