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

1. 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

2. 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

3. 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

4. 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

5. Status of Funding

6. 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

7. 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

8. 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

9. Scaling Up HIV/AIDS Financing

10. 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.

11. 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?

12. 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?

13. 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

14. 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.

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

16. Can commitments be turned into reality?

17. 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.

18. How can we close the funding gap?