Session Summaries from AIDS 2018 on Funding and Financing
Posted by Share-Net Intl on July 30, 2018 at 12:05 pm
Meeting the challenge: Community financing for a sustained response, a Session Summary
As donor funding flat lines increased domestic funding is vital for the sustainable HIV response. In addition community mobilization and KP-led health services may ensure none are left behind. Data on opportunity costs of community approaches which are key are however scarce due to focus on provider/facility level perspectives.
To enable countries such as Swaziland, Thailand and Uganda meet Fast Track targets, UNAIDS estimates approximately US$26.2 billion is needed for HIV responses in 2020. However countries such as Thailand, recently classified as middle income are transitioning out of GFATM, negatively affecting sustainability of CSO-implemented HIV programs. Domestic financing so far low due to poor targeting of scarce resources can be increased and structured to not leave anyone behind. Reduction in donor government funding for HIV has also made the critical role of community-based interventions and community health entrepreneurship in the fight against HIV more imperative. Funding to local communities urgently needs prioritisation if we are to meet funding commitments and ensure health system investments are optimised. A good understanding of the empirical costs of community mobilization is therefore critical to ensure that scarce resources for community mobilization are used to largest possible health and social benefit.
Shrinking donor HIV funding has made it imperative for governments to increase health budget allocations. Successful transition in Thailand has relied on ensuring better cooperation between governments, CSO’s and local communities. Participatory budgeting and good transitioning plans as well as strengthening of civil society and community dialogues will be important. There is need to ensure funding to the local community level reaches those directly benefiting but who have no access to health facilities. Understanding the opportunity costs of community mobilization can help ensure scarce resources are used to largest possible health benefit.
Keeping it up: National ownership and financial sustainability, a Session Summary
The looming donor pullback threatens to unravel the commendable progress made so far in the fight against HIV/AIDS. To ensure financially sustainable service delivery modalities that do not leave anyone behind, a sustainability tower consisting of proven strategies, guidelines, products, tools and interventions will be critical.
Successful transition will require clearly articulated transition plans and key stakeholder participation. In addition to donors, national government and local level experiences are essential as we work on a transition framework for sustainability. Lessons can be learnt from countries such as Brazil, itself a middle income country where 500,000 people are on ART on 100% Federal Government funding. Elements of a sustainable model from Ukraine include advocacy for local funding, removal of legal impediments, introduction of new financing models and decentralisation of services to primary health care providers. In Vietnam the sustainable financing of the HIV response is premised on integration of donor funded treatment into the public health system. A period of financial and technical support will also be necessary to assure implementation, adaptation and quality. Encouragingly results of PEPFAR’s Sustainability Index and Dashboard (SID) 3.0 demonstrate that countries are making progress towards a sustainable response to the epidemic.
Shufang Zhang (Global Fund, Switzerland) summed up the session by highlighting the need to ensure sustainability of health system financing. In-order to successfully transition to new funding mechanisms accurate cost analyses will be critical to help understand costs and funding requirements and budget better for programmes both from the national and donor perspectives. It is critical to plan early and to ensure everything can be in place in the short time left. Data will be key to keep us all on track and to see how we are getting better at sustainability over time.
Money, money, money: Dynamic financing solutions, A Session Summary
In the ABBA song this session was titled after, the band reflect on “all the things I could do, if I had a little money”. This session looked at what this money can do, with presentations spanning reductions in overseas development assistance (ODA), private-sector funding, and domestic co-financing.
John Stover started us off, using the GOALS model to estimate the cost-effectiveness of a range of interventions, and showed that the most cost-effective interventions only need 15% of total resources but are currently only funded at 70% of need.
Annie Haakenstad showed that sub-Saharan Africa has very little space for additional co-financing programmes, but much more space for domestic financing exists in Eastern and Central Europe. Taavi Frank forecasted the cost of financing ART in SSA, with the most pessimistic scenario modelled estimating the number of PLHIV would triple due to reductions in funding.
Daniel Muigai Mwaura described how a catalytic funding model kicked off a workplace testing and condom promotion programme, which then became increasingly co-funded by the employer. Finally, Andrea Salas Ortiz described how Mexico, working on ways to optimise domestic funding, reviewed NGO projects for cost-effectiveness, targeting, and technical efficiency, leading to more efficient budget allocations.
This session presented some fascinating applications of the points raised at the high-profile funding panel that we reported on yesterday. This session touched on reductions in ODA spending and the implications of that, including how existing resources could be used more efficiently; the potential for private financing of the HIV response; and the extent to which there is space for domestic resources to be increased (or where there is none…) across the globe.
Where will resources come from to end AIDS, a Session Summary
Arguably the biggest question facing us at AIDS 2018, whether we work in a lab, brothel, or government office, is who pays. This was a panel of ministerial and multilateral funder big-hitters, including Alistair Burt of UK’s DfID, Zsusana Jakob of the WHO, and Peter Sands of the Global Fund.
Alistair Burt of DfID noted that the UK is transitioning from bilateral funding, but increasing support for civil society and multilateral investments, with a focus on the poorest countries. Peter Sands of the Global Fund talked on squeezing the most impact of every dollar, and tackling the intertia in ODA allocation to argue for more funding for health over other causes. Zsuzsanna Jakab of the WHO noted Europe’s MDR TB rates and called for integrated care in strong and sustainable health system moving towards UHC. Raminta Stuikyte noted how the Ukraine had reduced spending inefficiencies by 40%, focusing on reducing the prices paid for drugs and kickbacks. Finally, Ines Perea noted that Germany integrated response has included key populations from the start and has seen genuine success, and Paul Stoffels hailed advances in science, calling for investment in R&D to give people products that they can use well.
My takeaway from this session is that it’s not just about money – it’s political issues, including migration and human rights that need tackling too. All speakers mentioned domestic financing – co-financing in particular, but there was not much discussion of the pros and cons of this. There was a real sense from Global Fund and DfID in particular that co-financed programmes are important to continued support (“the power of holding the chequebook”). Finally, it was clear that we need resources to reach key populations, but also mechanisms to transfer funds to those who need to – likely NGOs.