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 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
 A Comprehensive Approach to Sustainable Financing of National HIV Responses
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A Comprehensive Approach to Sustainable Financing of National HIV Responses

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  • 1. Christoph Hamelmann UNDP RBEC Regional Team Leader HIV, Health and Development A Comprehensive Approach to Sustainable Financing of National HIV Responsesc c UNDP Global Fund Partnership Meeting Istanbul, 16-17 June 2014
  • 2. From ‘Getting to Zero’ to ‘End AIDS’ UNAIDS: Getting to Zero Strategy Get to Zero • new infections • AIDS related death • Discrimination
  • 3. Investment Framework UNAIDS/UNDP: Critical Enablers and Development Synergies for Strategic Investment
  • 4. Investing for results. Results for people UNAIDS: Investing for results
  • 5. Country Specific Investment Case UNAIDS: Investing for results
  • 6. Example output: Improved HIV response Net savings (through treatment and hospitalization costs averted) $600 million Current programme 85,000 Resource needs for business as usual over the next decade (based on current plan) Total number of new infections averted $600 million 98,000 Total number of DALYs averted Optimal programme Costs required over the next decade for optimal investment of resources (accounting for enhanced investments and efficiency gains) $900 million 135,000 Total number of new infections averted 176,000 Total number of DALYs averted 1,165 Cost / infection averted
  • 7. Global Fund NFM Investment Strategy
  • 8. Question Approach Objective 1.What is the socio-economic and development context? • Key macroeconomic indicators, not only GDP, but also distribution of incomes, unemployment, poverty, government revenue, debt and budget deficit • Human development index • Gender equality index • Key demographic indicators including age dependency ratios Understand and quantify country’s capacities, challenges, priorities and potential opportunity costs during transition processes, in absolute and relative ((sub-)regional) terms 2.What are the priority health challenges? • Key health indicators • MDG 4, 5, 6 status and progress Understand and quantify country’s health priorities, progress in addressing them and potential opportunity costs in the health sector during transition processes, in absolute and relative ((sub- )regional) terms 3.How is the health system organized? Descriptive overview of key stakeholders at national, regional and municipal levels, their responsibilities; governance and key regulatory frameworks Understand system structure and functions relevant for transition process
  • 9. Question Approach Objective 4.What are the health financing mechanisms and how big is the health budget? • Key health financing indicators • Descriptive overview of health financing mechanisms, stakeholders and relevant processes Understand country’s health financing mechanisms and processes relevant for transition; Evaluate health budget in absolute and relative terms considering public/private mix, social protection 5.What are status, trends and key features of the HIV epidemic? • Key HIV epidemic indicators • Key HIV service coverage indicators • Focus on key populations (concentrated epidemic) ‘Know your epidemic’ 6.What is the national HIV response? • Descriptive analysis of a) the legal framework and regulations b) the organizational structure and stakeholder • Quantitative analysis of external funding • Qualitative and quantitative analysis of a) GF grant objectives, SDA, activities b) related GF budgets and implementers ‘Know your response’; Quantify the dependencies on external resources; If the GF is by far the single largest funder, understand the grant’s detailed programme components, budget components and implementers as the
  • 10. Question Approach Objective 7.Does the legal and regulatory framework (and capacities) allow for outsourcing to NGOs of critical preventive and treatment interventions to key populations? • Detailed analysis of the type, role and budget of NGOs under the GF grant • Analysis of contracting mechanisms of NGOs by government and contracting capacities • Evidence of effective service linkages between public sector and NGO services • Evidence of effectiveness and efficiency of NGO services particularly for key populations Governments appreciate the critical role of NGO services for key population in concentrated epidemics; NGO contracting mechanisms and capacities are (put) in place during the transition process to domestic financing 8.Does the legal and regulatory framework (and capacities) allow for accountable and transparent ARV procurement at competitive prices? • Comparative analysis of national ART guideline and WHO 2013 guideline • Qualitative and quantitative analysis of treatment regimens (by INNs and products) and their prices under the GF grant • Analysis of ARV IP and registration status recommended under national and Who 2013 guidelines • Analysis of national procurement mechanisms for essential medicines Optimize ART guidelines, ARV procurement mechanisms and prices during the transition process
  • 11. Scenarios for the transition process towards sustainable financing of national HIV responses Scenario 1: ‘Maintaining status quo’ • maintaining current investment mix under current budget ceiling Scenario 2: ‘optimizing efficiencies, maintaining current budget’ • Assuming improved allocative and technical efficiencies during the transition to domestic financing mechanisms: optimized investment mix under current budget ceiling Scenario 3: ‘Achieving universal coverage’ • Building on scenario 2, but scaling-up to universal coverage for prevention and treatment intervention for key populations: the rights-based investment case
  • 12. Scenario 1 outputs: ‘Maintaining status quo’ • Identification of detailed budget slots of domestic financing mechanisms who would need to absorb current external funding; determination of absolute and relative amounts • Feasibility assessment for transition to domestic financing • Information for strategic decisions on phased-in approach of domestic financing, for example under co-financing requirements • Model estimates for epidemic impact in mid-(2020) and long- (2030) perspective • Model estimates for impact on service coverage for essential interventions with focus on key populations
  • 13. Objective 1: To reduce high-risk sexual and injecting behaviors among populations most vulnerable to HIV infection including injecting drug users; sex workers; and men who have sex with men. Sub-total: US $ 2,310,337 Objective 2: To reduce high-risk behaviors among other populations at-risk of HIV infection including migrants and their wives; and young people by scaling up their coverage by comprehensive quality prevention. Sub-total: US $ 1,174,124 Objective X... CENTRAL LEVEL Sub-total: US $ 26.1 million & US $2,192,073 would need to be allocated additionally for transition from GF: 8.4% MUNICIPALITY LEVEL Sub-total: US $ 58.7million & US $ 2,446,512 would need to be allocated additionally for transition from: 4.2% Objectives of GF HIV grant State budget for health Grand total: US $ 143.5 million & US $ 7,084,098 would need to be allocated additionally for transition from GF: 4.9% Grant total: US $ 7,084,098 US $ 462,067 (20%) US $ 924,125 (40%) US $ 234,824(20%) US $ 469,650 (40%) REGIONAL LEVEL Sub-total: US $ 58.7 million & US $2,1446,512 would need to be allocated additionally for transition from GF: 4.2%US $ 469,650 (40%) US $ 924,125 (40%) Scenario 1 Example: Mapping of transition towards domestic financing mechanisms
  • 14. Scenario 2 outputs: ‘Optimizing efficiencies, maintaining current budget’ • Model outputs for optimzed allocative investment mix under the ‘Getting to zero’ objectives (new infections, DALY) and current budget ceiling • Targets for reasonable technical efficiency gains • Model estimates for epidemic impact in mid-(2020) and long- (2030) perspective • Model estimates for impact on service coverage for essential interventions with focus on key populations
  • 15. Scenario 3 outputs: ‘Achieving universal coverage – the rights-based investment case’ • Model outputs for service increase of key prevention and treatment interventions to universal coverage by 2020 including cost estimates • Comparative analysis under current national ART guideline and adaptation to WHO 2013 guideline • Model estimates for epidemic impact in mid-(2020) and long- (2030) perspective
  • 16. Lessons learnt so far • Country driven processes is critical, including a joint UNCT approach • UNDP can make major contributions, particularly in countries with UNDP GF PR-ship • Data required are available, but spread over many sources • A well-trained technical team and standardized tools are essential • A substantial reduction of dependencies on external funding appears feasible for a number of countries • Transitioning to domestic financing of national HIV responses offers strategic investment opportunities under national and (sub-)regional perspectives • A rights-based investment case is attainable under shared responsibilities
  • 17. Thank You! christoph.hamelmann@undp.org Twitter: @cahamelmann

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