Transcript ICAAP presentation - Muhib - 12 Aug 2009

AIDS2031
LONG TERM COSTS AND
FINANCING FOR HIV/AIDS
ICAAP
12 AUGUST 2009
BALI INDONESIA
Farzana Muhib, Results for Development Institute
Overview




Main findings of the Cost and Financing Working
Group
Global estimates
Regional estimates for Asia
Cambodia case study
aids2031 Costs and Financing –
main objectives
Globally and through two country case studies:
1.
Estimate the long-term costs of AIDS, using a range of distinct
scenarios
2.
Make recommendations in setting priorities for resource allocation,
based on evidence of intervention and program cost-effectiveness
3.
Construct and evaluate financing scenarios that are adequate,
equitable, predictable, and sustainable
4.
Encourage global and national dialogue – promote positive policies
that will result in financing a successful long-run AIDS response at the
lowest possible cost.
Main findings – our current top 5
1.
Global AIDS funding needs will continue to grow rapidly – Asia will
account for one-third, treatment over a fifth, of future spending
2.
Cost trajectory changed with action today. Policy choices lead to
different price tags for 2031 – $19 to $38 billion annually(globally)
3.
With our current intervention tool kit, epidemic attenuated but not
extinguished – nearly one million infections in 2031. Technological
and/or behavioral game changers needed.
4.
Huge scope for spending better – technical efficiency gains potentially
large but hard to realize, allocative efficiencies increasingly clear but
politically difficult. We must fix both, starting with allocations..
5.
Sustained long-term financing for AIDS in serious jeopardy, especially
for HP/LIC, but even for some HP/MICs – domestic capacity limited
and donor prospects uncertain. Low prevalence, middle income
countries may rapidly move to self-financing
Resource needs estimates
Billions
Resource Needs in Low and Middle Income
Countries
$45
Four scenarios
$40
$35
$30
Current Trends
$25
Rapid Scale-up
Hard Choices
$20
Structural Change
$15
$10
$5
$0
2007
2012
2017
2022
2027
Policy choices
today have very
different price tags
in the future
Huge variance in
the price tags
Treatment = 25%+
Impact on incidence
New Infections Among Adults 15-49
3,000,000
2,000,000
Current Trends
1,500,000
Rapid Scale-up
Hard Choices
Structural Change
1,000,000
500,000
0
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
2015
2017
2019
2021
2023
2025
2027
2029
Number of New Adult I nfections
2,500,000
 1 million +
infections under the
best scenarios- unless
we have a vaccine, a
cure, or a social/sexual
revolution
Availability of Donor Financing
Potential funding from OECD countries
Pessimistic --No change in ODA as share of GDP
(0.25%)
Total ODA
Donor assistance for HIV/AIDS
Global Resource Needs for AIDS (rapid scale up)
GAP in Funding
2006
2015
2031
US$ billions
92
113
155
6
8
11
10
27
38
4
19
27
92
315
433
6
22
30
10
27
38
4
5
8
Optimistic -- Donors increase ODA to 0.7% of GDP
Total ODA
Donor assistance for HIV/AIDS
Global Resource Needs for AIDS (rapid scale up)
Gap in Funding
Projections of GDP growth= 2%
 A gap still exists in both
the pessimistic and
optimistic scenarios
This gap would need to
be filled, but by who?
Resource needs and impact in
Asia
New Infections Among Adults 1549 in Asia
Asia
25
700,000
600,000
20
Billions US$
500,000
15
400,000
300,000
10
200,000
5
100,000
0
0
2007 2010 2013 2016 2019 2022 2025 2028 2031
197519801985199019952000200520102015202020252030
Current Trends
Rapid Scale-up
Current Trends
Full Coverage
Hard Choices
Structural Change
Hard Choices
Structural Change
Current funding in Asia
GFATM Commitments and
Disbursements for Asia
PEPFAR Funding for Asia
Millions
$135
$130
$350
$300
$125
$250
$120
$200
$115
$150
$110
Committed
Disbursed
$100
$105
$50
$100
$0
$95
2007
2008
2009
2010?
Potential sources of funding for
Asia
Potential ODA from BRIC countries
in 2015 and 2030
2015
2030
Pessimistic --No change in ODA as share
of GDP (0.25%)
US$ billions
Total ODA*
22.4 28.9
Donor assistance for HIV/AIDS
1.56 2.02
Optimistic -- Donors increase ODA to
0.7% of GDP
Total ODA
62.8 80.9
Donor assistance for HIV/AIDS
4.39 5.66
*World Bank, Global Economic Prospects Group
•BRIC countries start to
donate, they will reduce the
gap.
•Specific regional
preferences may influence
the distribution of ODA
from these countries
•Philanthropists may play
an increasing role in
funding AIDS programs.
28 of 40 youngest
billionaires reside in Asia
Potential for Domestic
Financing of AIDS in Asia
4.0%
Zambia
3.5%
Sustained long-term
financing is in serious
jeopardy but the picture in
Asia is not so bleak
AIDS resource needs as % of GDP
3.0%
Kenya
2.5%
Mozambique
Low prevalence, middle
income countries could selffinance, without donors
Uganda
2.0%
1.5%
Cameroon
1.0%
Nigeria
South Africa
0.5%
Viet Nam
India
0.0%
0.1
China
Brazil
Russia
Thailand
1
Ukraine
Prevalence
10
100
Our case studies
Epidemic Type
Income
Generalized
Concentrated
Middle
South Africa
Botswana
Ukraine
Brazil
Low
Zambia
Malawi
Cambodia
Senegal
South Africa: 5.7 million HIV+ (18% prevalence),
350K deaths , $1-2 billion annual spending
Cambodia: ~ 1% prevalence, high treatment coverage,
$44 million annual spending (2006)
Currently Available and Needed Resources for
Cambodia
Millions US$
Cambodia case study objectives

How much will it cost to address the epidemic in the future?



How to mobilize domestic/external, public/private resources for
a sustained response?



Model 4 scenarios- modifying them to fit the epidemic pattern in
Cambodia.
Key questions to consider: What are hard choices? What is structural
change? How will the epidemic change?
Donor mapping exercise to determine current levels of funding
Fiscal space analysis – How much can we reasonably ask govts to
contribute in the future?
Stimulating dialogue and search for improved national policies
What we can do today in Asia?



Policy choices impact the ultimate price tag $4-14B Asia
New/better prevention approaches are needed
Consider a focus on the hard choices of cost effective
interventions
Focus on Most at Risk Populations
 Evaluate impact of prevention interventions




Start to develop sustainable funding mechanisms
Expand portfolio of funders
Domestic funding of HIV/AIDS programs
Thank you.
For more information please visit our website:
www.resultsfordevelopment.org
Or
www.aids2031.org