Funding AIDS Programs in the Era of Shared Responsibility: An Analysis of Domestic Spending

The Lancet has published a study on the challenges of paying for the national AIDS programs in the hardest-hit countries.

Authored by a team from the Results for Development Institute (R4D), the study titled, “Funding AIDS Programs in the Era of Shared Responsibility” breaks new ground in thinking about how much these heavily impacted countries, from Nigeria to South Africa, can pay for AIDS, and what this means for the Global Fund, PEPFAR, and other outside funding agencies. It also comes at a time when the debate on country “graduation” from donor support for AIDS and health is heating up.

The study argues that while significant progress has been made in scaling up HIV prevention, treatment and care services in recent years, many countries still lag far behind in their ability to finance their AIDS responses from domestic sources. Assessing this issue from a rigorous cross-country perspective, the study looks at the financing capacity of 12 high-prevalence African countries. It proposes and applies new metrics to estimate domestic AIDS financing capacity and generates scenarios for possible future combinations of domestic and external expenditures.

The findings are sobering. Nearly all 12 countries fall short of the proposed benchmarks. If they met these fully, domestic spending on AIDS would increase by 2.5 times, from $2.1 billion to $5.1 billion annually, covering 64% of estimated future funding requirements and leaving a more manageable gap of only $2.8 billion for donors to fill. Outside funding from the Global Fund and PEPFAR could be reduced or reallocated to other pressing AIDS and health needs. While some middle-income countries could become financially self-reliant, lower-income countries such as Mozambique and Ethiopia would remain substantially dependent on donor funds.

The authors of the report are Dr. Robert Hecht, Managing Director at R4D and Visiting Fellow at Yale University, Dr. Stephen Resch, Deputy Director of the Center for Health Decision Sciences at Harvard, and Tess Ryckman, Program Officer at R4D.

To learn more, click here and to listen to an interview with Dr. Hecht on Voice of America, click here.

The report was also covered by the New York TimesTIME Magazine and Business Day Live (South Africa).

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