1. Financing HIV and AIDS Programs in Africa: Hopes and Challenges
Dr Debrework Zewdie
Deputy Executive Director
The Global Fund to Fight AIDS, Tuberculosis and Malaria
Talk in three parts:
Where we were: looking backwards to move forwards
Where we are now: the achievements we have made
Where we are going and how we can get there
Addis Ababa
04 December 2011

2. Outline Where we have come from
Global economic situation and implications for HIV resources
Global Fund financial situation and implications
The way forward
Addis Ababa
04 December 2011

3. AIDS at 30: Where We Have Come From
30 years since the first publications describing AIDS
Since then, very noticeable achievements made include:
1. Billions of dollars committed, and 5-6 million people receiving ART
2. Community action: Mobilization of communities and affected groups to respond to AIDS
3. International leadership and commitments secured
4. Solidarity and partnerships at all levels to execute the response
The last decade has been a historic one for global health
1996: International AIDS Conference in Vancouver: triple therapy shown to work
2000: United Nations launched the Millennium Development Goals
2000: G8 met in Okinawa and vowed to tackle communicable diseases
2000: International AIDS Conference in Durban placed access to antiretroviral treatment on global political agenda
2002: Creation of the Global Fund, and first grants started
2003: 3 by 5 launched by UNAIDS and WHO
2005: Paris Declaration on Aid Effectiveness endorsed, calling on the world to be as effective as possible in pursuing global health goals
2010: United Nations summit to assess progress toward Millennium Development Goals: more work needed
Addis Ababa
04 December 2011

4. Total Resources Available 1987–2007
1000
2000
3000
4000
5000
6000
7000
8000
9000
US$ million
US$ 1.6b
UNGASS Declaration of Commitment on HIV/AIDS
1996
1997
1998
1999
2001
2002
2003
2004
2005
1986
1987
1990
1991
1992
1993
US$ 59m
World Bank
MAP
Global Fund
PEPFAR
UNAIDS
Gates Foundation
2006
2007
10 000
US$ 10b
Source: UNAIDS & WHO unpublished estimates, 2007
1988
1989
1994
1995
WHO GPA
International mobilization resulted in significant increases in resources for the AIDS response
Global Health Initiatives (such as Global Fund) followed by unprecedented increases in commitments
While still short of the estimated annual needs, current resources have allowed programs to extend coverage of services and achieve results considered not feasible just a few years ago
Global Fund , PEPFAR and others have effective mobilized finances, political leadership and other resources
Broad approach to investment:
Quote: “on the results of the consultations, UNAIDS called on the international community to ensure that no credible, costed, evidence-informed, inclusive and sustainable national AIDS plan should go unfunded”.
Addis Ababa
04 December 2011

5. Economic Challenges: Maintaining Existing Commitments
People receiving ART through Global Fund supported programs:
Number of patients surviving if ART was discontinued:
Coverage of ART needs to increase globally to reverse the epidemic, but who is going to pick up the bill?
According to the Investment Framework, $ 22 billion will be needed in 2015 to meet demand and impact upon HIV epidemics, and this annual need will then fall to under $ 20 billion by 2020
However, these graphs show the impact of continuing existing levels of ART through the Global Fund (from a paper co-published by the Global Fund)
The panel on the left shows the rapid scale up of treatment in recent years and the future projections for this cohort of patients. This incorporates R10 grants as well.
Of the 3.5 million people receiving ART with Global Fund support in 2011, we estimate that 2.3 million will still be alive and receiving treatment in 2020
The proportion of these patients receiving second-line regimens will rise from 2.5% in 2009 to 24% by 2020
The full annual cost of supporting these patients will decline by 10% from about US$ 1.9 billion in 2011 to US$ 1.7 billion in This is just for treatment, and not including HIV prevention.
The panel on the right shows the estimated number of patients who will survive if they remain on ART (orange line), and the number of surviving patients if their ART was to be discontinued from 2011.
Note the initial rapid mortality trend in the first couple of years
This is modeled on assumptions but highlights the crucial need to ensure that ART is a priority to be continued to prevention the reverse of the gains achieved so far.
Addis Ababa
04 December 2011

6. GDP Growth Rates for 2009 The world economic recession
Brown shows countries in recession … i.e the traditional donors therefor more funding is required from newer economies
Note WHO Abuja report
Addis Ababa
04 December 2011

7. Financing trend in Recent Years
Slide shows international commitments for HIV on the left, and international disbursements on the right
Shows the leveling off of funds that has occurred in recent years
to $7.6 billion in 2009 (on the right)
The decrease primarily reflects reductions in direct bilateral funding by several governments as well as currency fluctuations
The drop in funding for the AIDS response between 2009 and 2010 comes after years of significant increases: disbursements rose by more than six-fold between 2002 and 2008
In 2010, the Global Fund’s disbursements reached US$ 3 billion for the first time, compared to US$ 1 billion in 2005
Source: UNAIDS, Kaiser Foundation, 2011
Addis Ababa
04 December 2011

8. What does this mean? 2011 – 2013: 10 Billion USD to be disbursed
2008 – 2010: 8 Billion USD disbursed
Donors will honour their pledge
For all signed grants, including Round 10, the resources are available for the life of the project
Everyone who is on treatment funded by the Global Fund will stay on treatment
We are introducing a transitional funding mechanism to bridge any treatment gaps
Addis Ababa
04 December 2011

9. Progress Being Made: Changes in HIV Incidence 2001-2009
What have been the results of these investments:
According to UNAIDS in 2009 there were 22.5 million people living with HIV in Sub-Saharan Africa
There were 1.8 million new HIV infections in the region in 2009, compared to 2.2 million in 2001
33 countries were highlighted by UNAIDS as reducing incidence by more than 25% between 2001 and 2009 (see slide)
There were 1.3 million HIV-related deaths in the region in 2009, compared to 1.4 million in 2001
There have been notable successes in starting and maintaining people on ART
3.9 million people receiving ART in the region at the end of 2009 – 37% of the estimated need
NEW UNAIDS DATA TO BE ADDED
Source: UNAIDS 2010

10. Annual HIV Domestic and International Spending
Annual HIV domestic public and international spending in current US dollars, total and per person living with HIV, among the 15 low- and
middle-income countries with the highest spending, 2009 or last available year, international dollars (purchasing power parity).
We don’t have the slide but when we present this slide can mention that although many countries do provide substantial amounts of funding internally and externally very often the MoF have ‘ not a clue’ how much money is going to AIDS – hence the need for better communication
Source: Country Progress Reports 2010
Addis Ababa
04 December 2011

11. Moving from Emergency to Sustainability
Group I: Longer-term reliance on external funding
Group II: Can move toward self-sufficiency
Later to make the point that in spite of context, some countries will contiue to need intrernational support
Build upon the gains but the current AIDS financing is not sustainable
Weak health systems, fiduciary control and absorptive capacities
Aid effectiveness and co-ordination
Optimizing programmatic and donor synergies
Global economic downturn affecting donors
Ensuring sustainable domestic contributions to HIV responses and health budgets
This slide is from the results from the R4D group
It shows the calculated spending requirements up to 2015 for selected countries, as a % of their Gross Domestic Product
Countries in Africa are already making some contributions to their AIDS budgets from domestic sources
However, external support will need to continue for the longer term in order to maintain HIV responses
The group I countries all in Africa will continue to require external investments in order to maintain their HIV response , however there is a second group of countries who , based on their emerging economies could move toward more sustainable self financing
Some African countries – such as South Africa – could move toward greater sustainability in the foreseeable future
Source: Spending Requirements in 2015, R4D
Addis Ababa
04 December 2011

12. Private Sector and Innovative Financing
Could be an easy slide with some photos from product red and private sector partnerships in Africa
Addis Ababa
04 December 2011

13. Effective Interventions/Value for Money
Could be an easy slide with some photos from product red and private sector partnerships in Africa
Addis Ababa
04 December 2011

14. Accountability
This slide could show photo’s of the HLP report; the white report from last year (results with accountability) and the lessons learned report of the OIG – although these are all GF things. There could also be photo’s of Transparency International or Mo Ibrahim Foundation logos/events
Addis Ababa
04 December 2011

15. Note: There are animations in this slide – click to reveal further text.
‘The choices we make today will define who we are as people and as a global community’ 1
Acknowledgements: Tarek Elshimi, Ade Fakoye, James Bridge, Natalie Cartwright