Is AIDS Financing dying in Asia ?

1. Is AIDS Financing dying in Asia ? Swarup Sarkar Senior Adviser, UNAIDS, Geneva ICAAP, Busan, August 2010

2. In Collaboration with David Wilson , World Bank Tim Brown, East West Centre, Hawaii Jeanette Olsson, SVETAN, Stockholm Robert Greener, UNAIDS Rifat Atun, Global Fund Ryuichi Komatsu, Global Fund Carlos Avila, UNAIDS Pradeep Kakkattil, UNAIDS Sukontha Kongsin, Mahidol University, Thailand

3. Current level of Funding Extent of Shortfall Trend of Investment Effective & Efficient use What is the Future What should be done?

4. Funding Amount & shortfall

5. Estimated resources available and resource gap in the Asia-Pacific region 3.1 1.1 Available Need (billions USD)

6. Cost of a Priority Response Average total cost per capita ranges from $0.50 to $1.70, depending on the stage of the epidemic.

7. Comprehensive interventions Total Program Management $7,000,000 6 B Income generation for widows Orphans and vulnerable children $6,000,000 Total Treatment Community mobilization PEP $5,000,000 Youth in school Mass media Prevention for PLHA $4,000,000 Blood safety 3 B Condom social marketing Special populations $3,000,000 Workplace STI management Youth out of school $2,000,000 Safe Injection Universal precautions Public and commercial condoms $1,000,000 PMTCT VCT $0 MSMs Harm reduction Total Resource Need UNAIDS Method Priority Resource Need- AIDS Commission CSWs and clients

8. Shortfall 2/3 rd core 5/6th of comprehensive Need

9. Trend of Investment

10. Investment is Plateauing…. USD * *varies between 800 to 1000+ million

11. Shifting of Hands in Donor Resources

12. Trend • Dramatic increase after UNGASS’01 • Slowing after economic crisis • Less significant increase last 2 yrs • Domestic resources increasing, not enough

13. Follow same global trend : resources available for AIDS 1986–2010 16 billion 1500 10 billion 1000 c 8.9 billion 9000 Signing of Declaration of Commitment on HIV/AIDS,UNGASS 8000 8.3 billionc 7000 6000 World Bank MAP launch 5000 US$ million 4000 Gates Foundation PEPFAR 3000 UNAIDS Less than US$ 1 million 2000 1623 1000 Global Fund 292 257 212 59 0 2006 2007 1986 1987 1990 1991 1992 1993 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Follow same global trend of economic boom and recession Source: UNAIDS & WHO unpublished estimates, 2007 7.1

14. Are We Using Money Effectively & Efficiently ?

15. Types of Intervention and Financing

16. Resources do not follow priorities

17. Where is the money gone ? • 8 to 20% of resources only to Most at Risk Population • 2 to 3 % resources to the community organisations • Gate keepers and brokers ….

18. Where is all the Money Gone ?Three reasons why community don’t see money

19. In the largest bilateral funding on harm reduction in Asia….. • 50% to 96% resources were consumed by UN, Government and international NGOs • Money left for service was 4 to 50%

20. Resource go to non priority and not core interventions • Resources go to non effective intervention • Resource goes to non-intervention and sometimes to unwanted interventions

21. In spite of the AIDS Commission recommendation …. • Time bound hand over to Community organisations • Direct funding to the NGOs through Community organisations

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23. Conditions Tied to Funding There is no evidence that testing changes behaviour of high risk groups however, GF continues to tie funding for high risk group with number of testing -------

24. What the Future holds ……

25. Increase Health Budget, Increase Donor Budget Increase AIDS Budget

26. 1. Asia has the lowest health budget in the world 2. Low impact prevention ( critical enablers) to shift to health budget 3. Cost sharing with other Ministry, a must

27. Most of Asia are least Funded countries on Health(Health expenditure as % GDP) Commission on AIDS in Asia – Projections and Implications 27

28. Increase AIDS Budget, Increase Health Budget, Increase Donor Budget 1. Asia has the lowest health budget in the world 2. Low impact prevention ( critical enablers) to shift to health budget 3. Cost sharing with other Ministry

29. Implications for resource need: more efficient and effective use of resources Total Program Management $7,000,000 6 B Income generation for widows Orphans and vulnerable children $6,000,000 Total Treatment Community mobilization PEP $5,000,000 Youth in school Mass media Prevention for PLHA $4,000,000 Blood safety Condom social marketing Special populations $3,000,000 Workplace STI management Youth out of school $2,000,000 Safe Injection Universal precautions Public and commercial condoms $1,000,000 PMTCT VCT $0 MSMs Harm reduction Total Resource Need UNAIDS Method Priority Resource Need- AIDS Commission CSWs and clients

30. Impact mitigation:Livelihood sustainability for widows Lifetime cost of $1000 per affected household Positive Partnership‘: micro-financing for affected households ($600 USD loans)

31. Impact mitigation: care and support for children orphaned by AIDS • Estimated at 100 USD per child per year • 1 million children in Asia lost at least one parent to HIV • Total cost=100m USD

32. Increase AIDS Budget, Increase Health Budget, Increase Donor Budget 1. Asia has the lowest health budget in the world 2. Low impact prevention ( critical enablers) to shift to health budget 3. Cost sharing with other Ministry 4. Independence from donor funding

33. Overall International Fund: 53 %from > 90% in 2002* 2004 2010 * Not including Thailand in 2002

34. Who Should Fund ? • Rhetoric's between donor and recipient countries. • Economic progress does not lead to social equity • Economic Crisis in north can’t be turned into humanitarian crisis in south • Health for marginal people remains a shared responsibility

35. Summary: where we are • Current HIV resources too low to create impact • Early sign: donor fatigue, funding yet to reverse • Increasing but insufficient domestic budget • Neglected MARP priority • Poor Cost sharing with health and Social sector

36. "It is no longer our resources that limit our decisions; its our decisions that limit our resources." - U Thant

37. A resurgent epidemic? Or a contained one?

38. For Countries of the Region… Action now can save • 5 million new infection • Avert 2 million deaths • Protect 80% of women and children from AIDS impact • USD 2 billion by 2020 – cost of econmic burden to family

39. No substitute for activism

40. No substitute for activism The Future is Ours