Transcript Making the case in Botswana

NEW INVESTMENT
FRAMEWORK FOR HIV/AIDS
Making the Case in Botswana
WHY AN INVESTMENT CASE?
OVERVIEW
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From 2002 to 2008 global funding for HIV/AIDS increased
exponentially
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According to estimates, the number of people newly infected
with HIV has dropped by 33% and access to ARV therapy has
increased more than 20-fold, reaching 9.7 million by the end of
2012.
•
The global financial crisis of 2008-2009 precipitated a
stagnation or plateauing of resource commitments to AIDS
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The effects of the financial crisis are still being felt
•
According to UNAIDS, In 2012,
donor assistance for HIV totalled
US$7.86b and remained
essentially flat compared to
2011 (US$7.63b)
•
A slight rise in total nominal
spending between 2011 and
2012 (3%) was largely due to
increased bilateral
disbursements from the U.S.
(10%) as well as increased
contributions to the Global Fund
•
However, these increases are
not expected to continue
NEW APPROACH TO INVESTMENT
•
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2011 was a turning point in HIV/AIDS financing modalities:
Citing the impact of the global financial crisis, PEPFAR reveals its
orientation to “Smart Investments” through country Partnership
Frameworks
Based on a policy paper published in the Lancet, UNAIDS
launches its Investment Framework
Later, the Global Fund announces that, as part of its new
funding mechanism, it will be using concept notes developed
using Investment Cases (among other documentary evidence)
BOTSWANA’S CONTEXT
THE DIAMOND OUTLOOK
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While exact figures are
confidential, GoB receives
about 80% of total diamond
profits
•
However, mineral revenues
have been on a downward
trend for at least a decade,
falling from 50% to 30% of total
revenues and from 25% to 10%
of GDP
•
Despite recent strategic
movements in diamond mining,
this is likely to continue
BOTSWANA’S NATIONAL RESPONSE
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Botswana is known for having one of the world’s most
successful HIV/AIDS programs.
•
Although important contributions have been made by donors,
Botswana’s HIV/AIDS response is primarily funded by domestic
revenues
Funding of HIV/AIDS Programs, 2009/10-2011/12
BWP million
Public Funds
Private Funds
External Funds
Totals
5,013.90
154.50
2,413.00
7,581.40
Source: NASA, 2009/10-2011/12 (NACA/UNAIDS)
Percent
66.1
2.0
31.8
100.0
US$ million
(approx.)
730.30
22.50
351.50
1,104.30
THE FINANCIAL OUTLOOK
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Domestic government funding
can meet a share of increasing
total costs in the short term, but
is inadequate to meet all of the
rising HIV/AIDS costs
•
The emergence of a financing
gap is largely the result of the
continued plateau or decline of
donor funding
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Obviously there is a positive
correlation between the loss of
external funds and the increase
in the funding gap
INVESTING IN BOTSWANA’S
RESPONSE
PROCESS
ART SCENARIOS
FAMILY PLANNING SCENARIO
GENERAL PREVENTION SCENARIO
“OPTIMAL” SCENARIO
DOING THINGS DIFFERENTLY
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Early treatment for better impacts and sustainability
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Reinvigorate HIV prevention
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Implementing system strengthening and integration (HIV/TB;
HIV/SRH and M&E systems)
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Revamping Community responses
CONCLUSIONS
•
The global movement toward making more strategic funding
allocations for HIV/AIDS through investment cases holds much
promise in an increasingly resource-constrained environment.
•
However, as national responses mature and focus more on
health systems strengthening – in order to do more with less
•
For example, Botswana is aware that in order to implement the
“Optimal” set of interventions there is need to strengthen
underlying systems that support or enhance program
implementation like human resource management, monitoring
and evaluation, and the integration of programs
•
Therefore, a stronger evidence base for the cost and impact
of such HSS investments needs to be developed promptly
THANK YOU