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    HIV sensitive protection HIV sensitive protection Presentation Transcript

    • HIV-sensitive social protection in AsiaPolicy Dialogue on Mitigating Vulnerabilities and Promoting Sustainable Growth 1 Nov 2012, South Korea Clifton Cortez Practice Leader, HIV, Health & Development UNDP Asia Pacific Regional Centre
    • Outline1. Socioeconomic impact study2. HIV-sensitive social protection3. Sustainable health financing
    • Socio-economic impact of HIV at the individual and household levels in Asia• Surveys conducted from 2004 – 2010 in 5 countries in Asia: – Over 7000 HIV-affected households; 10,000 non-affected control households, covering 72,000 individuals across 5 countries. – Multi-county studies based on common, but nationally-adapted methodologies, enabling cross-country analysisCountry Year of Survey # HIV-HHs # NA-HHsCambodia 2009-2010 2,623 1,349China 2008 931 995India 2004-2005 2,068 6,224Indonesia 2009 996 996Viet Nam 2008 452 452TOTAL HOUSEHOLDS 7,070 10,016
    • Higher unemployment among HIV-HH 30% PLHIV NA-HH 26% 25% 25% 21% 21%Unemployment levels 20% 15% 14% 11% 10% 10% 9% 9% 5% 2% 0% Cambodia China India Indonesia Viet Nam
    • High medical expenditure / positive impact of universal access• In India, Indonesia, and Viet Nam, HIV-HHs spent over 3 times as much on health than those in NA-HHs.• In Cambodia, NA-HHs spent more on health than HIV-HHs. $180 HIV-HH NA-HH $160 P.C. Annual Health Consumption $158 $140 $120 $100 $113 $80 $60 $70 $60 $40 $44 $20 $29 $21 $8 $- Cambodia India Indonesia Viet Nam
    • Greater school drop out among girls in HIV-HHs in China, India and Indonesia 14.0 13.8 % Children Dropped Out of School 12.0 Boys Girls 10.0 8.0 7.7 6.0 6.1 4.0 4.4 4.2 4.2 3.8 2.0 2.9 2.9 3.0 2.3 2.4 0.9 1.6 1.9 1.0 0.0 HIV-HHs NA-HHs HIV-HHs NA-HHs HIV-HHs NA-HHs HIV-HHs NA-HHs Cambodia China India Indonesia
    • Higher levels of child labour among girls from HIV-HHs 7.0% 6.3% HIV-HH NA-HH 6.0% Girls 5.0% Child Labour Levels: Girls 4.0% 3.5% 3.6% 3.0% 2.4% 2.0% 1.7% 1.4% 1.0% 0.6% 0.1% 0.0% Cambodia China India Viet Nam
    • Social Protection“The objective of social protection is broadly toreduce the economic and social vulnerability ofall poor and vulnerable groups and to enhance the social status and rights of marginalised people by providing social transfers, ensuring access, and equitable regulation, which can take many forms.” - State of Evidence, UNAIDS SP Working Group
    • HIV-sensitive vs. HIV-specific• HIV-sensitive social protection: HIV considerations are integrated into the existing More : inclusive, general social protection policies andfield sustainable & equitable Emerging schemes• HIV-specific social protection: exclusive social protection schemes designed specifically for PLHIV and/or key affected populations
    • HIV-sensitive social protection: Example 1 Widow pension scheme (Rajasthan, India)• Minimum age requirements of 60• Not accessible by many widows living with HIV as they tended to be young (20s,30s…)• Rajasthan waved the min. age requirement – Today, all widows living with HIV are covered by the scheme regardless of age – Possible positive impacts on OVCs
    • HIV-sensitive social protection: Example 2 Conditional BPL status (India)• Some states give the ‘conditional’ below poverty line (BPL) status to people living with HIV• Conditional BPL allows access to certain schemes designed for BPL households – Inclusion in a health scheme – Food subsidies
    • HIV-sensitive social protection: Example 3 Legal recognition of the third gender• Ordered by the Supreme Court in Nepal and Pakistan• Now the third gender category in the national ID card – Necessary for healthcare, legal counselling and voting• Introduction of the third gender category “X” in the national passport in Australia in Sep 2012.
    • HIV-sensitive social protection: Example 4 Thai Universal Health Coverage Scheme• HIV treatment initially excluded but later included• Comprehensive HIV services through Accessing affordable medicines the compulsory license/government use• Fully funded by the government – critical from licence As per WTO sustainability viewpoints rules• Thai UHC also covers illnesses other than HIV requiring long-term and often expensive treatments such as cancer and heart diseases
    • Government use licenses (GUL) in Thailand reduced the medicine price significantly Extent of price reduction in medicines in Thailand due to government use orders to access generic versions of the same drugs 0% -10% -20% -30% -40% -50% -60% -70% HIV 1 HIV 2 -80% -66% -70% Cancer 3 -73% -90%-100% Heart Cancer 1 Cancer 2 -98% -98% -96% Source: Thai Ministry of Health (2009) Assessing the implications of Thailand’s government use licenses issued in 2006-2008
    • Price reduction led to $370 million saving and >80,000 more patients on treatment in 5 yrs Estimated additional number of patients who were given medicines due to price reduction following the government use licenses in Thailand 90,000 84,158 80,000 additional patients 70,000 60,000 Cancer 4 Cancer 3 50,000 Cancer 2 Cancer 1 Heart 40,000 HIV 2 HIV 1 30,000 20,000 10,000 0 Source: Thai Ministry of Health (2009) Assessing the implications of Thailand’s government use licenses issued in 2006-2008
    • Thailand was able to kill two birds with one stone (use of the compulsory/government use license) Financial sustainability Compulsory licenses Expansion of benefit and treatment coverage
    • Access to generic medicines – a key to sustainable health financing Price of a relatively new cancer drug in India (per person per month)$6,000 $5,500$5,000 97% price reduction after the compulsory$4,000 license for the generic version of the same$3,000 drug in March 2012$2,000$1,000 $174 $0 Bayer Netco
    • Non-communicable diseases already account for >50% of all deaths in most countries in Asia90% 83% 79% % of NCD in total deaths80% 77% 75% 72% 72% 71%70% 67% 64% 61%60% 52% 53% 53% 51% 50%50% 46% 46%40%30%20%10%0% Source: WHO (2011) “Non-communicable Disease Country Profile 2011”
    • Access to affordable medicines is one critical element for successful UHC Poverty reduction Universal health Improved productivity coverage National developmentFinancial Effective- sustai- Coverage ness nability Affordable medicines
    • Where are we headingHIV-sensitive social protection Unique Equity needs SOCIAL PROTECTION
    • HIV-sensitive social protection may open the Where are we headingdoor for other marginalised populations Slum dweller-sensitive SP Ethnic/religious minority-sensitive SP Persons with disability-sensitive SP HIV- sensitive socialprotection
    • Policy recommendations• Prioritize the most vulnerable and marginalized persons in social protection agenda• Make existing SP schemes sensitive to their unique needs, rather than creating exclusive schemes, whenever possible• Protect the right to affordable medicines for sustainable health financing, as a strategic policy option to pursue health equity, poverty reduction, social justice and financial sustainability.
    • Thank you
    • UHC in Thailand reduced impoverishment dueto catastrophic health expenditure among poor UHC Source: “Thailand’s universal coverage scheme: An independent assessment of the first 10 years “