Track E report by Anna Miller
TUSY01 - Strategic Use of Resources: Doing The Right Things With The Right Money Mix
This panel gave presentations and engaged in discussion of the strategic use of resources during an “era of austerity”, looking at ways of maximising effectiveness and efficiency and developing creative approaches to address the funding gaps.
UNAIDS presented the Investment Framework model as an instrument to assist countries design strategic investments to stop new infections and keep people alive, including the need for countries to identify and address critical enablers and development synergies and a four-step checklist for investment planning (Understand; Design: Deliver: Sustain). Many countries are now applying an investment approach using a variety of entry points, including reprogramming of Global Fund grants; joint AIDS programme reviews ; development of new national strategies and review of existing ones.
Tanzania presented their country experience with an annual estimated total budget need for HIV of 1 billion USD, and actual spending about 50% of this. The Tanzanian HIV/AIDS programme is 95% dependent on donor support, with the global financial crisis recently resulting in reduced donor and domestic allocations to HIV/AIDS. The Investment Framework has helped inform a new HIV/AIDS strategy for 2013-2017 based on Tanzanian drivers of the epidemic and focusing on implementation of interventions with high return in combatting HIV. Tanzania will soon establish an AIDS Trust fund from taxation of certain products which is expected to reduce the funding gap by 40%.
A presentation from the Office of US Global AIDS coordinator highlighted the importance of optimising programmatic input through smart investments, coordination and country ownerships. PEPFAR has been engaged in developing systems for expenditure analysis and these will be integrated into routine annual reporting later in 2012, initially in selected high investment countries. Work is also ongoing with other donors on harmonisation of expenditure categories across donors. Partnership framework agreements represent a new model to promote country ownership and have been signed with 21 countries.
Zimbabwe presented their significant success in scaling up ART, from 8,000 patients in 2004 to 480,000 by May 2012. Zimbabwe has a national AIDS levy (3% on taxable income) which is supporting increasing proportions of ART patients over time. However, the response is still largely dependent on external resources although donors are committed and work in close alignment with the national plans. The new strategic plan for HIV/AIDS 2011-2015 is highly prioritised around three zeros (new infections, deaths, discrimination) and 10 targets of the UNAIDS framework and linked to broader health strategies, and a variety of approaches will be employed to try and ensure sustainable resourcing of the response.
The Dutch Postcode Lottery sells lottery tickets with 50% of every ticket sold going to good causes including civil society organisations working in global health. Every month 2.5 million households buy 4 million tickets, with 3.5 billion Euros raised since it began 22 years ago, and 284 million Euros in 2012. A Dream Fund has been established and organisations can apply for large, high risk, projects with potentially high impact. It was observed that “the right money mix” also needs some venture capital like this to support projects that can be “game changers”.
In conclusion, there are important lessons on planning and budgeting using the Investment Framework from African countries that could be applied to other countries. A variety of approaches to sustainable resource mobilisation will need to be taken on a country-by-county basis, depending on nature of epidemic and sources of funds available. It will also be important to find ways to ensure budget allocations to HIV are protected in country contexts with multiple competing priorities.