1. The Rising Prevalence of NCDs: Implications for Health Financing and Policy Charles Holmes, MD, MPH Office of the U.S. Global AIDS Coordinator Department of State HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome

2. Objectives 1.Examine the economic impacts of NCDs in LMIC, and what we know and don’t know about the costs of developing a robust NCD response. 2.Explore what we have learned from the HIV financing response and to consider how the NCD response can be earlier adopters of these methods moving forward. 3.To highlight policy and other financing issues that are essential to continuing to build strong HIV and NCD responses HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome

3. HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome Health and Economic Impacts of NCDs NCD rates are nearly two-times higher in low- and middle-income countries then in high-income countries 250 million deaths and $84 billion of lost national output from 2006-2015 in 23 low- and middle-income countries Household effects: –Out of pocket expenses for treatment range from 4 to 34% of household income/expenditures –Decreased earnings –Increased healthcare expenditures including Catastrophic expenditures for NCDs in up to 20% of affected households

4. Estimated Cost Categories for CVD Prevention Package HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome Lim et al, Lancet 2007

5. Average Annual Cost for an NCD Response HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome Lim et al, Lancet 2007

6. Theoretical CVD Response as a Proportion of Health Expenditure HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome Lim et al, Lancet 2007

7. Lower Costs of “Upstream” Interventions in LMIC HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome

8. HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome Donor Funding for Health

9. HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome

10. Leveraging Available Resources “Every dollar spent by PEPFAR on [our] Medical Record System to control HIV was also spent on NCD control. In a similar vein, PEPFAR dollars that were spent to strengthen communications, monitoring and evaluation, transportation system, data management, pharmacy, and supply chain, in order to control HIV, are also relevant to the control of other chronic diseases like cardiovascular disease, hypertension, and diabetes.” -PEPFAR Implementing Partner HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome

11. LESSONS LEARNED FROM THE HIV FINANCING RESPONSE HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome

12. Development and Use of Empiric Cost Data HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome 2010 PEPFAR Congressional Report

13. Note: Per-patient PEPFAR budget allocation is estimated as lagged treatment allocation divided by end-of-reporting of patients directly supported on ART by PEPFAR. Budget per result estimates may vary from site-level costing estimates. Declining HIV Treatment Costs under PEPFAR, 2004-2009 HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome

14. Use of Expenditure Analysis HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome

15. Creative Financing Private sector programs will fill an important niche Opportunity for risk sharing through insurance and other mechanisms Leveraging existing health platforms HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome

16. Expanded NSP Treatment Costs, South Africa HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome aids2031

17. OTHER POLICY ISSUES HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome

18. Country Ownership and Stakeholder Collaboration National strategies are helpful Opportunity to define roles for country governments, and other partners HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome

19. Country Ownership and Stakeholder Collaboration 21 PEPFAR Partnership Frameworks signed –5-year joint strategic frameworks for collaboration on HIV/AIDS –Service delivery –Policy reform –Financing HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome

20. Building on Existing Platforms: A Need for Both Marginal Effectiveness and Costs HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome Detection of HIV among TB Suspects in Rwanda (2009 – 2010)

21. Applying Lessons Going Forward Be Efficient from the Start: Identify and target key drivers of the NCD response cost early and conduct special studies be efficient from the start. Use Cost Data: Develop methods for generating and using cost data as standard monitoring and evaluation data points, and expand beyond unit costs of treatment. Country Owned and Multiple Funding Sources: Ensuring that the response is country owned and defined through national health strategies, assisting in the coordination of multiple sources of funding, including governments, donors, and private sector and risk pooling. Marginal Costs and Effectiveness of Integration HIV and Non-communicable Diseases Pre-Conference, July 15-16, 2011, Rome