Despite the enormous progress that has been made over the past decade, there are still huge gaps and deficiencies in national plans, budgets, and expenditure tracking systems, according to this paper. Few countries have developed detailed cost estimates of their national strategic plans. All too often, they do not specify how limited resources will be allocated, nor how priorities will be set if they are unable to achieve their goals. The paper argues that, even if AIDS costs are almost certain to rise between now and 2031, the cost trajectory can be significantly influenced by our actions today. Policy choices have different price tags – ranging from $397 billion to $722 billion over the 22-year period. Reducing costs will demand stronger political will and AIDS financing capacity, but the potential payoff in making the right choices is great, leading to fewer infections and more lives saved. Governments and development partners could be much more effective in the AIDS activities they back, and more financially efficient, if they focused resources on prevention programmes that are more closely aligned with specific epidemics. The paper also argues that showing that money for AIDS can be used more efficiently and to achieve greater benefits will also help to maintain political support and enthusiasm for the large-scale efforts that will need to be sustained for decades to come. These steps will require global creativity, national and international leadership, and improved policies and programmes.
Resource allocation and health financing
Community home-based care is the Botswana Government's preferred means of providing care for people living with HIV. However, according to this study, primary (family members) or volunteer (community members) caregivers experience poverty, are socially isolated, endure stigma and psychological distress, and lack basic care-giving education. Community home-based care also imposes considerable costs on patients, their caregivers and families in terms of time, effort and commitment. The study estimated the cost incurred in providing care for people living with HIV through a stratified sample of 169 primary and volunteer caregivers drawn from eight community home-based care groups in four health districts in Botswana. The results show that the mean of the total monthly cost (explicit and indirect costs) incurred by the caregivers was US$ 90.45, while the mean explicit cost of care giving was $65.22. This mean of the total monthly cost is about one and a half times the caregivers' mean monthly income of $66.00 and more than six times the Government of Botswana's financial support to the caregivers. In addition, the cost incurred per visit by the caregivers was $15.26, while the total expenditure incurred per client or family in a month was $184.17. The study concludes that, as the cost of providing care services to people living with HIV is very high, the government of Botswana should substantially increase the allowances paid to caregivers and the support it provides for the families of the clients. The overall costs for such a programme would be quite low compared with the huge sum of money budgeted each year for health care and for HIV and AIDS.
This report provides the latest data available on donor funding based on data provided by governments. The year 2009’s totals reflect a substantial increase in funding provided by the United States (rising from US$3.95 billion in 2008 to $4.4 billion in 2009), which helped to offset reductions in support from Canada, France, Germany, Ireland, Italy, and the Netherlands. According to the report, the United States remains the largest donor nation in the world, accounting for more than half (58%) of 2009 disbursements, followed by United Kingdom (10.2%), Germany (5.2%), the Netherlands (5%) and France (4.4%). UNAIDS estimates that $23.6 billion was needed to address the epidemic in low- and middle- income countries in 2009, which suggests a growing gap of $7.7 billion between available resources and need. In 2009, donor governments disbursed $5.9 billion bilaterally and earmarked funds for HIV through multilateral organisations, as well as an additional US$1.6 billion to combat HIV through the Global Fund to Fight AIDS, Tuberculosis and Malaria and US$123 million to UNITAID.
This report starts with a brief overview of the Paris/Accra approach to aid effectiveness and a definition of global funds and partnerships and their role in the overall aid architecture. It summarises strategies for allocating funds across countries, including challenge funds and results-based aid, as well as specific model examples used by selected global funds and partnerships. It found that global funds, like external funders in general, seek to maximise the impact of their assistance and use a variety of allocation mechanisms to ration their funds. Overall, country sub-sectoral support can vary in modality (including sectoral budget support) and may make use of indicative country allocations based on need and performance. The difference between the approaches of global funds and of Paris/Accra ‘horizontal’ aid is not whether they seek to achieve results. Instead, the differences lie in how the fund allocation strategies are designed and implemented to achieve these results. A key issue for all approaches to linking finance to results is the relative emphasis between short- and medium- to longer-term results and between results per se and intermediate steps that bring them about. In this context, this report also emphasises three issues related to achieving medium- to long-term results: predictability, sustainability and capacity.
South African Health Minister, Aaron Motsoaledi cautioned those attending the International AIDS conference, held in Vienna, Austria, from 19–27 July 2010, that backtracking on funding for HIV could threaten treatment success rates. In his speech to the Conference, he outlined success stories in the fight against HIV and AIDS in South Africa, such as integrating HIV and tuberculosis services and committing an additional US$400 million to expand anti-retroviral therapy. He noted that African civil society organisations have a key role to play in holding all stakeholders accountable. He also called for increased funding, full replenishment of the Global Fund to Fight HIV/AIDS, Malaria and Tuberculosis and long-term term partnerships between international funders and recipient countries.
According to this fact sheet, health care services overall in Tanzania benefit the rich more than the poor. In particular, the poorest 20% receive less benefit than they need. Benefits from outpatient and inpatient care in public hospitals, and private facilities are pro-rich, while benefits from faith-based facilities are generally evenly distributed with benefits being shared equally among people of all socio-economic groups, especially for inpatient care. Distance to referral facilities and cost are two factors that limit access to inpatient care for poorer groups, especially in rural areas. Poor quality of care in public facilities leads to a preference for private facilities among those who have the ability to pay. The greater availability of faith-based providers in rural areas and their flexible pricing policies leads to a more even share of benefits between rich and poor.
This fact sheet notes that donor funding and general tax revenue are the main sources of health financing in Tanzania. Funding for health care may be progressive or regressive. Tax revenue in Tanzania is relatively progressive. Income tax is the most progressive, but Value Added Tax (VAT), import and excise tax are also marginally progressive. VAT contributes the most to tax revenue. About 10% of tax revenue goes to health care. Regressive payments include out-of-pocket payments, or direct payments to health care providers, represent a significant share of total health care financing and over half of household contributions to health care. Health insurance contributions are still a relatively small share of total health financing due to the limited coverage of insurance (less than 10% of the population). Contributions to the National Health Insurance Fund are progressive as members are concentrated among higher income groups and contributions are proportional to income. The Community Health Fund is regressive as membership is concentrated among lower income groups and the contribution is a flat rate irrespective of income.
This report provides details on the performance, results and prospects in cooperation led by the European Commission (EC) with 140 countries and regions and in areas such as the Millennium Development Goals, aid effectiveness and policy coherence for development. The report also examines sectors of cooperation ranging from democracy and human rights to stability and macro-financial assistance. Specific aid instruments and delivery modalities such as the European Union (EU) Food Facility and ‘Vulnerability FLEX’ instrument, technical cooperation and budget support are also examined. Coordination with EU Member States is also assessed. Overall, EC external aid results show that project performance improved compared to the previous year. 94% of the projects are now rated positively. The report asserts that the EC has acted to ensure that the impact of its resources are maximised, that the EU has shown the capacity to innovate and adapt its aid instruments to meet new challenges and that the dynamics of this process have created new synergies and more effective results.
This paper explores the links between aid and budgets in two ways. First, it documents similarities among 14 aid-recipient country budgets, comparing them with the Creditor Reporting System of the Development Assistance Committee (DAC/CRS) and the UN Classification of the Functions of Government (COFOG) system. It assesses the fit of the latter for practical use by donor agencies. The main aim is to contribute to the development of more comprehensive sub-sector classifications, which may also be movable among top-level sectors, so as to fit around decisions made at country level on sector definitions. Second, the paper constructs a generic functional classification, designed specifically for the purpose of examining budget administrative classifications. This set of functions is grouped at sector level for ease of analysis and use, but is anchored on the lowest level of the classification. The aim was to review the commonalities between budget administrative classifications and develop a draft set of generic functional definitions that best align with the administrative structures of the countries in the sample. Those definitions may then be tested at donor headquarters level. The paper also makes recommendations on how to facilitate the transfer of aid information, particularly aid that is not spent through recipient country budget systems.
This paper challenges current practices within the research and funding community. It notes that social protection is an extremely important policy agenda for Africa, and that remarkable progress has been made in a very short time. In recent years, external funders and other external actors have invested heavily in financing social protection projects, strengthening capacity among implementing agencies, and building the evidence base to demonstrate the powerful positive impacts of social protection programmes. Nonetheless, many governments remain resistant to social protection, as advocated by external funders and international non-government organisations. Also, where governments express a preference for different funding models, these are often neglected or dismissed, while 'beneficiaries' themselves are hardly ever consulted. This paper notes that a fundamental rethinking is required that takes domestic political priorities and policy processes into account. It concludes by proposing ten principles for future engagement by development partners with social protection policy processes in Africa, including support for national policy priorities and minimise policy intrusion; limits on pilot project 'experiments'; and the involvement of programme participants at all stages, starting with vulnerability assessments and project selection.