Funding The Fight Against AIDS

by John Kiwanuka Ssemakula

Alongside the fight to save millions of people from dying from AIDS, the struggle to ensure adequate funds for the fight against AIDS goes on. Despite recent progress on efforts to secure more money, funding still falls far short of what is required.

At the historic UNGASS summit in July 2001, UN Secretary General called for the creation of a Global Fund to fight the AIDS pandemic amidst the concern of the disease. The UN Secretary General stated $7 – 10 billion dollars annually was needed for the next 10 years if the world were to have a chance of reversing the epidemic.

In 2001 when the fund was devised, there were 40 million people living with HIV/AIDS, over two thirds of whom (25 million) were in Sub Saharan Africa. Sub Saharan Africa has only got 10% of the world population, yet it accounted for 77% of all AIDS deaths in 2001, 68% of new HIV infections and 90% of AIDS orphans.

AT UNGASS 2001 UNAIDS presented the calculations for the cost of a global campaign against HIV/AIDS on which the Global Fund was based. UNAIDS stated  “About half the resources are required in sub-Saharan Africa and about one-quarter in South and South-East Asia.

The advanced stage of the epidemic in Africa means that the bulk (about two-thirds) of the resources needed there would be devoted to care and support. In Asia, about one-third of the resources would be targeted at care and support work.

At current spending levels the funding shortfall for HIV/AIDS prevention and control programmes will grow to $7 billion dollars by 2005. According to UNAIDS, funding needs to increase by at least 50% in low to middle income countries annually on HIV/AIDS, and at least 80% of this will have to come International sources. The call for increased funding comes at the end of a decade of declining levels of aid from international sources to Africa.  Assistance to Africa, for example, fell from US$36 per person in 1990 to US$20 in 1999.

Sources of Funding

1. The Global Fund to fight HIV/AIDS, TB and Malaria

2. Multi-Country HIV/AIDS Program for Africa (MAP)

3. Debt Relief

4. The private Sector

 

 

 

The Global Fund to fight HIV/AIDS, TB and Malaria

The Global Fund was created as a global, public private partnership to act as a source of new resources for the countries in greatest need. It is intended to supplement or complement existing sources and not acts as an alternative. By the end January 2002, the first meeting of the Board of Directors of the Global Fund took place, and the call for first round of proposals was sent out. The deadline for these proposals was just 2 months. This led to criticism of the fund with some scientists accusing the fund of being slow to issue guidelines which were not clear enough, and others reporting “allegations of rushed proposals mars disease fund’s first awards”. In the first round of grants the fund approved $616 million dollars for proposal from 40 countries. HIV/AIDS projects accounted for over half the amounts (60%). About half the approvals were for proposals from countries in Africa.

Do the Global Funds first round approvals reflect the need or severity of the HIV/AIDS pandemic in the world?

Analysis of Global Fund Approvals

The table below shows a quick analysis of the funds disbursements based on the amounts approved compared to the number of people with HIV/AIDS in the population. The fund was primarily set up to assist the fight against HIV/AIDS, but funds were also to be given for TB and Malaria programmes.  It is worth remembering most of the new TB cases are found in countries with high HIV incidence which is mainly in Africa, and 90% of malaria deaths take place in Sub Saharan Africa. In this simple analysis I aggregated the total amounts disbursed over the two years and divided them by the number of peole living with AIDS (PLAs), since it is mainly an AIDS fund.

Table showing successful countries in the first round of the Global Funds disbursements

Country	Global Fund Dollars per person living with HIV	HIV Prevalence rate (%) Adults 15-49	Estimated People living with HIV/AIDS end 2001	Total
Mongolia	17,475	<0.1	99*	1,730,000
Laos	11,512	<0.1	1,400	16,116,721
Moldova	2,131	0.2	5,500	11,719,047
Chile	1,908	0.1	20,000	38,151,562
Sri Lanka	1,283	<0.1	4,800	6,160,000
Korea DPR	1,223	<0.1	4,000	4,891,000
Morocco	711	0.1	13,000	9,238,754
Senegal	698	0.5	27,000	18,857,142
Indonesia	589	0.8	120,000	70,653,837
Ukraine	369	1	250,000	92,152,744
Haiti	268	6.1	250,000	66,905,477
Argentina	221	0.7	130,000	28,756,200
Cambodia	94	2.7	170,000	15,945,803
Viet Nam	92	0.3	130,000	12,000,000
Madagascar	91	0.3	22,000	2,000,064
Zambia	77	21.5	1,200,000	92,847,000
China	64	0.1	850,000	54,476,659
Ghana	58	3	360,000	20,856,575
Rwanda	29	8.9	500,000	14,641,046
Benin	25	3.6	120,000	2,973,150
Mali	24	1.7	110,000	2,592,991
Panama	23	1.5	25,000	570,000
Burundi	22	8.3	390,000	8,657,000
Nigeria	20	5.8	3,500,000	70,891,576
Thailand	20	1.8	670,000	13,499,350
South Africa	19	20.1	5,000,000	94,029,681
Tanzania	14	7.8	1,500,000	20,980,796
Ethiopia	13	6.4	2,100,000	26,980,649
Zimbabwe	10	33.7	2,300,000	22,977,500
India	2	0.8	3,970,000	8,784,999
Source: adapted from the Global Fund first Round of Proposals, UNAIDS  HIV/AIDS Estimates and data, end 2001, Report on the Global HIV/AIDS epidemic 2002.

Though by no means absolutely scientific, this simple analysis reveals some quite startling facts. On the basis of just calculating spending per person living with HIV/AIDS (PLA), Mongolia tops the list at almost $17,500 per PLA while India barely receives $2 dollars per PLA. For the African countries the amounts range from $10 dollars per PLA in Zimbabwe to $698 per PLA in Senegal.

For example in absolute terms, Chile and Argentina ranked as ‘”Non-G7 high Human Development Index” countries at the same level as Australia received more money than either Tanzania and Ethiopia, each of which has 15 times more people living with HIV/AIDS than both Chile and Argentina combined.

Multi-Country HIV/AIDS Program for Africa (MAP)

The World Bank announced a new $500 million Multi Country HIV/AIDS Program (MAP) for Africa, in 2000. The program takes the form of zero-interest loans to support government efforts to significantly increase access to HIV/AIDS prevention care and treatment programs. The program is set to run for 10-15 years. The first stage was approved in September 2001, with funds being channeled as grants to projects in 13 Sub Saharan countries. In February 2002, The World Bank committed another $500 million dollars to MAP in the fight against HIV/AIDS that will support programs in another 12-15 countries, including sub-regional and cross border initiatives.

World Bank Map of lending

Debt Relief

“The principal objective of the Debt Initiative for the heavily indebted poor countries (HIPCs) is to bring the country's debt burden to sustainable levels, subject to satisfactory policy performance, so as to ensure that adjustment and reform efforts are not put at risk by continued high debt and debt service burdens. “ ( World Bank)

Spending on HIV/AIDS in Africa in 2000

 HIV/AIDS spending could significantly be increased in countries with a high debt burden if it was reduced. On average in 38 of the most HIPCs, the debt burden is four times export earnings.  In 2001 16 African countries were still spending more on debt servicing than on health.

The HIPC debt initiative devised by the World Bank and The International Monetary Fund is an attempt to relax the constraints on domestic spending for governments and allocate more resources for social programmes.

There are 34 HIPC classified countries in Africa. Under the programme eligible countries qualify for debt relief  if they meet certain conditions, that include poverty reduction strategies (PRSPs) that have social spending programmes as a priority that include HIV/AIDS programmes, and economic adjustment programmes.

Source:  Figures are adapted or derived from a variety of sources, including the WHO, UNAIDS, World Bank, WHOSIS taken from medilinkz.org

Is there enough funding?

Greater levels of funding are required. Without adequate international funding and assistance African countries will be unable to mount effective campaigns to reverse the HIV/AIDS campaign.  A group of eminent UNDP panelists described the AIDS response as being “desperately under-funded” in press release from UNDP on 10 July 2002.

According to Dr Jeffrey Sachs, a renowned economist and Special Adviser to the UN Secretary General, “The Global Fund is the most promising single instrument to fight AIDS”. The Global Fund itself is not without its critics. “Cooperation between many governments and NGOs in country coordinating mechanisms (CCMs) for the Global Fund was absent during the first round of funding proposals”, the Global Network of People living with HIV/ AIDS (GNP+) said. There was general agreement that funding for HIV/AIDS, and the Global Fund in particular was still woefully inadequate.

Yet as the most high profile HIV/AIDS programme the Global Fund from the point of view of matching the need and severity of the HIV/AIDS epidemic seems to have fallen short of its mandate of funding the countries most in need. Clearly there is great pressure for the fund to be seen to perform, but by appearing not to be targeting fund to those that most need it will leave the Global Fund open to continued criticism.  The Global Fund will have to do much better in its next round of approvals if it is going to answer its critics.

In the meantime there was a call for the immediate and complete cancellation of debt for those countries most seriously impacted by AIDS. Few countries had as yet managed to meet the conditions under the HIPC programme to qualify for debt relief which meant scarce and precious resources were still going to service crippling debt burdens. Over a third of the people living with HIV/AIDS were found in the 38 HIPCs.

As Zephrin Diabre of UNDP put it “For Countries struck by floods and civil strife, we take it for granted that humanitarian assistance, increased aid and accelerated debt relief is needed. We need to do the same for countries ravaged by AIDS, a disaster infinitely more devastating”.

 

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