NEW INVESTMENT FRAMEWORK FOR HIV/AIDSMaking the Case in Botswana

WHY AN INVESTMENT CASE?

OVERVIEW• From 2002 to 2008 global funding for HIV/AIDS increased

exponentially

• According to estimates, the number of people newly infected with HIV has dropped by 33% and access to ARV therapy has increased more than 20-fold, reaching 9.7 million by the end of 2012.

• The global financial crisis of 2008-2009 precipitated a stagnation or plateauing of resource commitments to AIDS

• The effects of the financial crisis are still being felt

• According to UNAIDS, In 2012, donor assistance for HIV totalled US$7.86b and remained essentially flat compared to 2011 (US$7.63b)

• A slight rise in total nominal spending between 2011 and 2012 (3%) was largely due to increased bilateral disbursements from the U.S. (10%) as well as increased contributions to the Global Fund

• However, these increases are not expected to continue

NEW APPROACH TO INVESTMENT• 2011 was a turning point in HIV/AIDS financing

modalities:

Citing the impact of the global financial crisis, PEPFAR reveals its orientation to “Smart Investments” through country Partnership Frameworks

Based on a policy paper published in the Lancet, UNAIDS launches its Investment Framework

Later, the Global Fund announces that, as part of its new funding mechanism, it will be using concept notes developed using Investment Cases (among other documentary evidence)

BOTSWANA’S CONTEXT

THE DIAMOND OUTLOOK• While exact figures are

confidential, GoB receives about 80% of total diamond profits

• However, mineral revenues have been on a downward trend for at least a decade, falling from 50% to 30% of total revenues and from 25% to 10% of GDP

• Despite recent strategic movements in diamond mining, this is likely to continue

BOTSWANA’S NATIONAL RESPONSE• Botswana is known for having one of the world’s most

successful HIV/AIDS programs.

• Although important contributions have been made by donors, Botswana’s HIV/AIDS response is primarily funded by domestic revenues

Funding of HIV/AIDS Programs, 2009/10-2011/12

Source: NASA, 2009/10-2011/12 (NACA/UNAIDS)

  BWP million Percent US$ million (approx.)

Public Funds 5,013.90 66.1 730.30Private Funds 154.50 2.0 22.50External Funds 2,413.00 31.8 351.50Totals 7,581.40 100.0 1,104.30

THE FINANCIAL OUTLOOK• Domestic government funding

can meet a share of increasing total costs in the short term, but is inadequate to meet all of the rising HIV/AIDS costs

• The emergence of a financing gap is largely the result of the continued plateau or decline of donor funding

• Obviously there is a positive correlation between the loss of external funds and the increase in the funding gap

INVESTING IN BOTSWANA’S RESPONSE

PROCESS

ART SCENARIOS

FAMILY PLANNING SCENARIO

GENERAL PREVENTION SCENARIO

“OPTIMAL” SCENARIO

DOING THINGS DIFFERENTLY

• Early treatment for better impacts and sustainability

• Reinvigorate HIV prevention

• Implementing system strengthening and integration (HIV/TB; HIV/SRH and M&E systems)

• Revamping Community responses

CONCLUSIONS

• The global movement toward making more strategic funding allocations for HIV/AIDS through investment cases holds much promise in an increasingly resource-constrained environment.

• However, as national responses mature and focus more on health systems strengthening – in order to do more with less

• For example, Botswana is aware that in order to implement the “Optimal” set of interventions there is need to strengthen underlying systems that support or enhance program implementation like human resource management, monitoring and evaluation, and the integration of programs

• Therefore, a stronger evidence base for the cost and impact of such HSS investments needs to be developed promptly

THANK YOU