Transcript Document

Is AIDS Financing dying in
Asia ?
Swarup Sarkar
Senior Adviser, UNAIDS, Geneva
ICAAP, Busan, August 2010
In Collaboration with
David Wilson , World Bank
Tim Brown, East West Centre, Hawaii
Jeanette Olsson, SVETAN, Stockholm
Robert Greener, UNAIDS
Rifat Atun, Global Fund
Ryuichi Komatsu, Global Fund
Carlos Avila, UNAIDS
Pradeep Kakkattil, UNAIDS
Sukontha Kongsin, Mahidol University, Thailand
Current level of Funding
Extent of Shortfall
Trend of Investment
Effective & Efficient use
What is the Future
Funding Amount & shortfall
Estimated resources available and resource
gap in the Asia-Pacific region
3.1
1.1
Available
(billions USD)
Need
Cost of a Priority Response
Interventions
Total Cost
(millions USD)
% of
total
$1,338
43%
Treatment by ART
$761
24%
Impact mitigation
$321
10%
Programme Management
$363
12%
Creation of an Enabling Environment
$359
11%
$3,143
100%
High-impact prevention
Total
Average total cost per capita ranges from $0.50 to
$1.70, depending on the stage of the epidemic.
Comprehensive interventions
$7,000,000
6B
$6,000,000
$5,000,000
$4,000,000
3B
$3,000,000
$2,000,000
$1,000,000
$0
Total Resource Need
UNAIDS Method
Priority Resource NeedAIDS Commission
Total Program Management
Income generation for widows
Orphans and vulnerable children
Total Treatment
Community mobilization
PEP
Youth in school
Mass media
Prevention for PLHA
Blood safety
Condom social marketing
Special populations
Workplace
STI management
Youth out of school
Safe Injection
Universal precautions
Public and commercial condoms
PMTCT
VCT
MSMs
Harm reduction
CSWs and clients
Shortfall
2/3 rd core
th
5/6 of comprehensive Need
Trend of Investment
Investment is Plateauing….
1,200,000,000
Total
1,000,000,000
Domestic
External
800,000,000
600,000,000
400,000,000
200,000,000
USD2007
2008
*varies between 800 to 1000+ million
*
2009
Shifting of Hands in Donor
Resources
500,000,000
450,000,000
400,000,000
350,000,000
300,000,000
Un
250,000,000
GF
200,000,000
Bilateral
150,000,000
100,000,000
50,000,000
2007
2008
2009
Trend
•
•
•
•
Dramatic increase after UNGASS’01
Slowing after economic crisis
Less significant increase last 2 yrs
Domestic resources increasing, not
enough
Follow same global trend :
resources available for AIDS 1986–2010
16 billion
1500
10 billion
1000
c
9000
8.9 billion
Signing of Declaration of
Commitment on HIV/AIDS,
UNGASS
8000
7000
US$ million
6000
World Bank
MAP
launch
5000
4000
3000
2000
1000
8.3 billionc
Less than
US$ 1
million
59
UNAID
S
212
257
0
19861987
1990 19911992 1993
292
Gates
Foundation
PEPFAR
1623
Global
Fund
1996 1997 1998 1999 2000 20012002 2003 2004 2005 2006 2007
Follow same global trend of economic boom and recession
7.1
Source: UNAIDS & WHO unpublished estimates, 2007
Are We Using
Money Effectively &
Efficiently ?
Types of Intervention and
Financing
289
363
Other
Available ($US million)
Need ($US million)
275
ART
761
247
321
Other Prevention
Vulnerable
Prevention
86
1338
0
200
400
600
800
1000
1200
1400
1600
Resources do not follow
priorities
100
80
60
40
20
0
% New infection can be
prevented
High risk young people
% budget
Low risk young people
Where is the money gone ?
• 8 to 20% of resources only to Most at
Risk Population
• 2 to 3 % resources to the community
organisations
• Gate keepers and brokers ….
Where is all the Money Gone ?
Three reasons why community don’t
see money
In the largest bilateral funding on harm
reduction in Asia…..
- 50% to 96% resources were consumed by
UN, Government and international NGOs
- Money left for service was 4 to 50%
• Resource go to non priority and not core
interventions
• Resources go to non effective intervention
• Resource goes to non-intervention and
sometimes to unwanted interventions
In spite of the AIDS
Commission recommendation
….
• Time bound hand over to Community
organisations
• Direct funding to the NGOs through
Community organisations
Conditions Tied to Funding
There is no evidence that testing changes
behaviour of high risk groups however,
GF continues to tie funding for high risk
group with number of testing -------
What the Future holds ……
Increase Health Budget,
Increase Donor Budget
Increase AIDS Budget
1. Asia has the lowest health budget in
the world
2. Low impact prevention ( critical enablers)
to shift to health budget
3. Cost sharing with other Ministry, a must
Most of Asia are least Funded
countries on Health
(Health expenditure as % GDP)
Region
%
Country
%
SE Asia
3.8
164.1
India
4.2
Africa
6.0
160.3
China
4.3
America
12.6
155.6
Indonesia
2.3
Euro
8.8
152.8
Philippines
3.7
Commission on AIDS in Asia – Projections and Implications 27
Increase AIDS Budget, Increase
Health Budget, Increase Donor
Budget
1. Asia has the lowest health budget in the
world
2. Low impact prevention ( critical
enablers) to shift to health budget
3. Cost sharing with other Ministry
Implications for resource need:
more efficient and effective use of resources
$7,000,000
6B
$6,000,000
$5,000,000
$4,000,000
$3,000,000
$2,000,000
$1,000,000
$0
Total Resource Need
UNAIDS Method
Priority Resource NeedAIDS Commission
Total Program Management
Income generation for widows
Orphans and vulnerable children
Total Treatment
Community mobilization
PEP
Youth in school
Mass media
Prevention for PLHA
Blood safety
Condom social marketing
Special populations
Workplace
STI management
Youth out of school
Safe Injection
Universal precautions
Public and commercial condoms
PMTCT
VCT
MSMs
Harm reduction
CSWs and clients
Impact mitigation:
Livelihood sustainability for
widows
Lifetime cost of $1000
per affected
household
Positive Partnership‘:
micro-financing for
affected households
($600 USD loans)
Impact mitigation: care and
support
for children orphaned by AIDS
• Estimated at 100 USD
per child per year
• 1 million children in
Asia lost at least one
parent to HIV
Increase AIDS Budget, Increase
Health Budget, Increase Donor
Budget
1. Asia has the lowest health budget in the
world
2. Low impact prevention ( critical enablers)
to shift to health budget
3. Cost sharing with other Ministry
4. Independence from donor funding
Overall International Fund: 53 %
from > 90% in 2002*
2004
0%
50%
2010
100%
Cambodia
China
Indonesia
Laos
Myanmar
Philippines
Thailand
Vietnam
Bangladesh
India
Nepal
Pakistan
* Not including Thailand in 2002
External
Domestic
Who Should Fund ?
• Rhetoric's between donor and recipient
countries.
• Economic progress does not lead to social
equity
• Economic Crisis in north can’t be turned into
humanitarian crisis in south
• Health for marginal people remains a shared
responsibility
Summary: where we are
•
•
•
•
•
Current HIV resources too low to create impact
Early sign: donor fatigue, funding yet to reverse
Increasing but insufficient domestic budget
Neglected MARP priority
Poor Cost sharing with health and Social sector
• "It is no longer our resources that limit our
decisions; its our decisions that limit our
resources." - U Thant
A resurgent epidemic?
1,200,000
800,000
600,000
400,000
200,000
1,200,000
800,000
600,000
400,000
200,000
Clients
Lo-risk male
Sex workers
Lo-risk female
MSM
Children
IDU
Or a contained one?
20
20
20
15
20
10
20
05
20
00
19
95
0
19
90
IDU
19
85
MSM
Children
20
20
20
15
20
10
20
05
20
00
Sex workers
Lo-risk female
1,000,000
New infections in year
Clients
Lo-risk male
19
95
19
90
0
19
85
New infections in year
1,000,000
For Countries of the Region…
Action now can save
- 5 million new infection
- Avert 2 million deaths
- Protect 80% of women and children from
AIDS impact
- USD 2 billion by 2020 – cost of econmic
burden to family
No substitute for activism
No substitute for activism
The Future is Ours