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Response of Governments/International Institutions/Civil Society on Scaling Up HIV/AIDS Financing. Global Conference Brasilia, Brazil – November 2006 Aisha Baldeh National AIDS Secretariat The Gambia. Outline of Presentation. Part I - Global call for HIV/AIDS funding HIV/AIDS Financing

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response of governments international institutions civil society on scaling up hiv aids financing

Response of Governments/International Institutions/Civil Society on Scaling Up HIV/AIDS Financing

Global Conference

Brasilia, Brazil – November 2006

Aisha Baldeh

National AIDS Secretariat

The Gambia

slide2

Outline of Presentation

  • Part I - Global call for HIV/AIDS funding HIV/AIDS Financing
  • Sources of Funding
  • Status of Funding
  • Part 2 – Scaling up HIV/AIDS Financing
  • What is Resources are needed
  • Scaling up Financing (resources: 2006-2008)
  • Meeting Abuja Targets
  • HIV Allocation as share of total Health Expenditure
  • Case study (Mozambique)
  • Part 3 – Can commitments be turned into reality
  • Why are commitments lagging behind
  • How can we close the funding gap
slide3

Global call for HIV/AIDS funding

2005

UN Millennium Project (2005): $33 billionachieve the MDGs in Africa

Gleneagles communiqué: aid flows to Africa by $25 billion by 2010

2001

Abuja Declaration

World Bank and IMF $14 to $18 billion per year during 2006–8

Global Fund to Fight AIDS, Tuberculosis and Malaria

UN Declaration of Commitment (2001) on HIV/AIDS: mobilise $7-10 million

sources of financing

1996

USD 300 million

2004

USD 6.1 billion

2005

USD 8 billion

Sources of Financing

Donor Government -bilateral, multilateral, intl corporations, intl NGOs)

Recipient Governments

(Central government, sub-natl govt, social security)

Civil Society

(Households, out-of-pocket expenditure (OOPE), NGOs, CBOs, FBOs, insurance)

Recipient

Countries

slide6

Sources of the estimated and projected funding

for the AIDS response from 2005 to 2007*

12

US$

billion

10

Private Sector

8

Multilateral

6

Bilateral

4

Domestic

2

0

2005

2006

2007

* Assuming there are no new commitments 

Source: UNAIDS (2005). Resource needs for an expanded response to AIDS in low- and middle-income countries.

10.10

slide7

Sources of HIV spending in three countries, 2004

Russian

Federation

Burkina Faso

India

Public 9%

World Bank loan 27%

All donors

14%

World Bank

credit 32%

Public

36%

Global Fund 2%

Bilateral

35%

Global Fund

9%

Multilateral

(excluding GF)

3%

Public 86%

Multilateral

(excluding GF)

15%

Bilateral

32%

HIV and AIDS spending per capita

US$ 1.87

US$ 0.59

US$ 0.28

Source: UNAIDS, based on National AIDS Spending Assessments.

10.11

slide8

Pledge to…

African Governments

  • ….commit ourselves to take all necessary measures to ensure that the needed resources are made available from all sources and that they are efficiently and effectively utilized.
  • .....set a target of allocating at least 15% of our annual budget to the improvement of the health sector including HIV/AIDS.
  • …..make available the necessary resources for the improvement of the comprehensive multi-sectoral response, and that an appropriate and adequate portion of this amount is put at the disposal of the National Commissions/Councils for the fight against HIV/AIDS, Tuberculosis and Other Related Infectious Diseases.

Source Section 26: African Summit on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, Abuja, Nigeria 24-27 April 2001

what resources are needed
What Resources are Needed?

Source: UNAIDS. Resource Needs for an Expanded Response to AIDS in Low and Middle Income Countries.Presented to the Programme Coordinating Board. Seventeenth Meeting, Geneva, 27-29 June 2005.

slide11

Scaling Up HIV/AIDS financing: Issues……

Adequacy: How much was pledged? And how much was committed?

Priority: How does the budget for HIV/AIDS compare to resources spent in other areas e.g. malaria etc?

Progress: Are financial commitments of different stakeholders (donor, governments & civil society improving?

Allocative

efficiency: Are we using the funds for the right mix of interventions or programmes?

slide12

Scaling Up HIV/AIDS Financing: Issues…

Operational efficiency:

  • Are funds being spent? And are they being spent on the purposes for which they were allocated?
  • Is there wastage or corruption?
  • Are the funding channels used the most efficient and effective for delivering funds to the implementing agencies?

Equity:

Are resources being allocated fairly?

slide13

Abuja Target

Are African states meeting the Abuja target?

18%

Mozambique

16%

14%

12%

South Africa

10%

8%

Namibia

6%

Kenya

4%

2%

0%

2000/1

2001/2

2002/3

2003/4

2004/5

2005/6

slide14

HIV/AIDS allocations as share of total Health Expenditure

18%

South Africa

16%

Mozambique

14%

Kenya

12%

10%

8%

6%

4%

2%

0%

2000/1

2001/2

2002/3

2003/4

2004/5

2005/6

Sources: Mozambique National Statistics Institute Database, 2003. South African Budget Review, 2003/04 and Estimates of National Expenditure, 2003. Kenyan Estimates of Recurrent and Development Revenue, 2003, and National Aids Resource Envelope, 2003.

slide15

Mozambique

Mozambique: The Challenge of HIV/AIDS Treatment and Care. Economic Commission for Africa. http://www.uneca.org

why are commitments lagging behind
Why are commitments lagging behind?
  • Less Sustainable and Predictable funding plan (apart from the GFATM Model)
  • Bureaucracy – Often aid comes with strings attached e.g. low Inflation target set by IMF.
  • ‘Macroeconomic and Structural implications of increased grants aids needs to be analysed by case by case bases’ (IMF and World Bank July 26, 2004)
  • Absorptive Capacity – there is consensus among donors that the ability of low-income countries must improve their absorptive capacity
  • Resource Needs are based on assumptions on future behaviour of donors, governments and other agents (UNAIDS 2005 AIDS Resource Estimate).
  • Shifting Priorities/Alliances – good governance, pressure from donors to privatise, war on terror, natural disasters.