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

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

2. Sources of Financing • International; Diversification • Domestic; Innovative • Investing Resources • Investment thinking; Returns • Effectiveness; Efficiency

3. 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 theefficient utilization of resources (simplification and integration)

4. The AU Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria • THREE ACTION PILLARS 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 Investment targets for ATM met by 2015 Financing sources for ATM diversified Financial sustainability through predictable external and more domestic investments Meds security enhanced through local centers of excellence Meds regulatory harmonization mechanisms within RECs, towards African Agency Trade facilitated through concerted actions at all levels Investments address pressing needs and pops, evidence/rights-based and strengthen systems ATM programs through inclusive processes Leadership and ownership demonstrated for results with robust accountability frameworks

5. Resources for HIV in low- and middle-income countries grew strongly for a decade, but then slowed 2015 Source: UNAIDS, 2012

6. Total resources continue to grow, but fall short of total needs US$ billions Domestic resources in low-and middle-income countries International assistance Total resources available, with estimated range Source: UNAIDS, 2012

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

8. Map of GF and PEPFAR world coverage*PLACEHOLDER

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

10. OECD countries can afford more 2010 overseas development assistance as a share of Gross National Income

11. 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 Options for increasing and sustaining resources for AIDS

12. DIPI chart for sub-Saharan Africa

13. Gains from economic growth…

14. Plus the Abuja target for health spending…

15. Plus reallocation according to disease burden

16. Remaining gap for the investment framework

17. 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

18. Sources of Financing • International; Diversification • Domestic; Innovative • Investing Resources • Investment thinking; Effectiveness • Efficiency; Returns

19. A checklist for applying investment thinking

20. AIDS: investing strategically to maximize impact OBJECTIVES BASIC PROGRAMME ACTIVITIES Child infections & maternalmortality Keypopulations Stopping new infections Behaviour change CRITICAL ENABLERS Condoms • Social • Programme Keeping people alive Male circumcision Treatment & care SYNERGIES WITH DEVELOPMENT SECTORS

21. Better investments can achieve large gains HIV investment US$ (billions) New HIV infections (millions) Source: Schwartländer et al. Lancet 2011

22. Investment Approach…. acceleratestransformation Invest Effectively Invest Efficiently Invest Optimally Reduce the cost of delivery, e.g., by capturing efficiencies of scale and scope, improve collaboration, inclusion in broader community / health system activities Ensure that your HIV investments are focused on the highest impact interventions to match your country’s specific needs and epidemic 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

23. South Africa has significantly reduced the cost of ARVs South African tender prices International benchmark June 2010 January 2011

24. Returns on investment using the new investment framework 2011–2020

25. 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 Sustainable financing – North Africa

26. VISION ZERO NEW HIV INFECTIONS. ZERO DISCRIMINATION.ZERO AIDS-RELATED DEATHS. UNAIDS