Transcript UNIS Template - University of Melbourne

External Funding for HIV and NCD
Activities in the Pacific: implications on
priority setting and aid effectiveness
SYDNEY
MEDICAL SCHOOL
AAAPS
Conference
| 10 April 2010
Joel Negin
Background
› Project was conducted for the Nossal Institute for Global
Health’s Health Policy and Health Finance Knowledge Hub
› Analysis conducted with Helen Robinson of the Nossal
Institute
› Part of the data collection and analysis conducted for the
Commission on AIDS in the Pacific in collaboration with
UNSW and the George Institute for International Health
› Working paper available from the Nossal Institute
2
Methodology
› Focused on external funding for HIV and NCD activities in the
Pacific
› Literature review of academic, aid agency, multilateral agency
reports
› Key informant interviews with representatives of AusAID,
Global Fund, NZAID, SPC, etc.
3
Context: Dramatic growth in Development Assistance for Health
DAH from 1990 to 2007 by source of funding
Source: IHME DAH Database
Context: Australia ODA as % of GNI
Context: Pacific Island countries are some of the largest recipients of health aid
Top 10 countries in terms of per capita development assistance for health received
from 2002 to 2007
Source: IHME Project Database and UN World Population Database
6
Pacific Disease Burden
› Non-communicable diseases contribute to more than 75% of deaths in the
Pacific
Deaths due to NCDs and AIDS per 100,000 population, by country, 2002 and 2005
1200
1000
800
600
Dea ths due to NCDs , 2002
Dea ths due to AIDS, 2005
400
200
Source: WHOSIS
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Funding for HIV activities increasing
External funding for HIV activities by source, 2001-2009, in US$ million
20
18
$18.2
Other
United States
16
UN Agencies
14
Asian Development Bank
$12.3
AusAID
12
NZAID
10
Global Fund
$8.0
8
$5.5
6
$6.3
$3.0
4
2
$13.2
$1.3
$1.9
0
2001
2002
2003
2004
Source: Commission on AIDS in the Pacific
2005
2006
2007
2008
2009
Distribution of HIV Funding by Country
Annual HIV funding per capita from PRHP, US and the Global Fund, 2004-07, in US$
20
16.42
15
10
6.63
4.22
5
4.10
3.97
3.69
3.65
3.36
3.35
3.00
1.14
0.99
0.53
0.36
0.33
0.29
0.23
Source: Commission on AIDS in the Pacific
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Funding for NCD activities
External funding for NCD programs in the Pacific, by source, 2002-09, in US$ million
14
WHO
12
$11.6
Japan
NZ
$10.3
Australia
10
US
8
6
4
$2.4
$2.6
$2.4
$1.8
2
$0.7
$1.1
0
2002
2003
2004
2005
2006
2007
2008
2009
Funding for HIV and NCD activities
External Funding for HIV and NCD Responses in the Pacific, 2002-09 (US$)
$20,000,000
$18,000,000
NCDs
$16,000,000
HIV
$14,000,000
$12,000,000
$10,000,000
$8,000,000
$6,000,000
$4,000,000
$2,000,000
$0
2002
2003
2004
2005
2006
2007
2008
2009
Key Findings
› From 2002 to 2009, funding totalled US$68,481,730 for HIV and
US$32,910,778 for NCDs
› Funding data were difficult to gather. There is a need for more thorough
record keeping and greater transparency in access to funding information.
› Donor funding does not align with burden of disease and mortality figures.
Despite the low burden of disease for HIV, external actors provide
significantly more funding for HIV response than for NCD activities.
- While there may be good reasons why funding does not align with the burden of
disease, the disparities seen in the Pacific are significant.
› There does not appear to be a clear rationale supporting the patterns of
donor funding.
- Some highly affected countries receive little compared to those with lower
disease burdens. To some extent, funding appears to follow historic and
geopolitical interests.
Why might this be the case?
› Actor Power:
- Strong global HIV policy community and institutions including UNAIDS,
Global Fund.
- Civil society mobilisation in the Pacific with Pacific Islands AIDS
Foundation
- There are many NCDs, each having its own stakeholders, thus limiting
cohesion
- Limited voice of Pacific governments
› Ideas:
- Singularity of purpose around one disease makes for simplicity of
message
- Myths of NCDs being diseases of ‘rich, white males’ are difficult to
counter
Source: Shiffman and Smith 2007
Why might this be the case?
› Political Contexts:
- Inclusion in the MDGs and Global Fund put HIV on the agenda
- NCD challenges overshadowed by MDGs
› Issue Characteristics:
- Being a ‘single’ disease makes it easier to track and identify efforts and
inputs
- Infectious disease threatens donor neighbours
- Clearly developed HIV response with global evidence
- More complex interplay of multiple NCD risk factors and interventions makes
it more difficult to isolate inputs and efforts
- Poor NCD data limit clear indications of severity of problem
Source: Shiffman and Smith 2007
Implications
› What does this say about priority setting mechanisms in the region?
› What drives donor funding allocations and how much does a Pacific
voice contribute?
› We do not argue that funding for HIV should be cut or even that
funding for NCDs should be increased – but we do believe that
transparency of funding and more discussion of allocations is
imperative
› And fits in with the Paris Declaration and the Pacific Principles on Aid
Effectiveness
› Recommendation: suggests need for more flexible and responsive aid
mechanisms rather than disease specific models