Dr. Socorro
Gross-Galiano
Assistant Director
Ministerial Meeting on HIV and Development
in Latin America and the Caribbean
ECOSOC - Annual Ministerial Review
Jamaica, 4-6 June 2009
Sustained
Response to HIV:
Financial Challenges
Where does the
financing for the
response come from?
We should sustain our support
to countries with funding
gaps and avoid setbacks on
HIV financing
already
achieved
Financing Composition ofwhat
HIVwe
in have
seelcted
LAC
in selected countries
Domestic
Doméstico
Source: UNAIDS, 2008 ( last available year)
International
Internacional
ua
y
Ur
ug
Pe
ru
Me
xi c
o
Pa
na
ma
Pa
r ag
ua
y
ras
nd
u
Ha
iti
Ho
Ar
ge
nti
na
Ba
ha
ma
s
Ba
rba
do
s
Bo
liv
ia
Br
az
il
Ch
ile
Co
lom
bia
Co
sta
Ric
a
Cu
ba
Ec
ua
do
El
r
Sa
lva
do
Gu
r
ate
ma
la
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Sustained Response to HIV:
Financial Challenges
What is the roadmap ?
•Prevention
(Young People / Risk Groups, Vertical Transmission)
•Early Detection
•Interventions that address
the social and epidemiological reality
•PHC based Health Systems
with positive synergies
•Mechanisms to improve
interventions, efficiency and reduce costs
•Strengthen inter-sector collaboration
•Eliminate stigma and discrimination
Components of a
Sustained HIV
Response
 Protecting achievements
 Making progress in areas lacking ade
Health sector
Provides important role of the response – leads
inter-sectoral work, key for a sustained & comprehensive
response.
Response should
be maintained and expanded
IT IS URGENT!
Prioritize prevention
reducing rate of new
infections, targeting high-risk
populations, work on stigma
and discrimination
and
using resources rationally.
New infections will
require treatment
Sizable number of infected
people are still without
access to treatment
 Innovations in therapeutic appro
People receiving ART will
continue needing them
( more expensive plans)
For what?
Estimates
correspond to:




Necessary to introduce mechanisms that
reduce costs of providing services at all
levels of the system and barriers to
access - including out-of-pocket expenditures,
stigma and discrimination
Human Resources
Materials
Equipment
Infrastructure
Needed for the delivery
of interventions that
allow meeting of
targets …
the challenge
is not limited to
financial resources!
The
financial crisis…
Finds us with some of our
health systems fragmented
This has an impact on •The rational use of resources
•The response capacity
by the health sector …
including HIV!
Reforms in the
Re-orientation of PHC based Health Systems
HIV
Universal
Coverage
Organization
of Services
Strong
health systems
=
Robust
response
Leadership
Reform
Public
Policies
HIV is controlled,
benefits are achieved,
LIVES ARE SAVED
Progress on ARV Access
to prevent mother to child transmission in LAC
Due to insufficient coverage, an estimated 12
100%
90%
80%
70%
Impact on children:
60%
50%
40%
26%
33%
36%
36%
30%
 Lack of opportunity from birth;
 Vulnerability
Social responsibility and of
health systems
20%
10%
0%
2004
2005
2006
2007
% of HIV+ pregnant women
% mujeres embarazadas
VIH+ q'ARV
recibenfor
ARVPMTCT
para PTMI
that receive
 Deliver Social Protection
 Cover treatment costs
Costs of not preventing
Maternal-Child Transmission
Costo TARV
Niño
los 2 m eses
Costpor
of ART
perdesde
child from
15years
añosof(en
2 hasta
monthslos
to 15
age US$)
(US $)
160,000
120,000
80,000
40,000
0
Precios del Fondo Estratégico
Prices Strategic Fund
Precios negociados
sinwithout
aplicación
de precios
Prices negotiated
the
internacionales
deofreferencia
application
international reference pricing
The cost of treatment
with ARV for 15 years
Cost of child
preventing
per infected
varies
a case of mother to
child
transmission
is
$25,483
to
$140,222at(US)
estimated
US$500
canCost
be
ARVCost
range
minimized
if
total
in the Region:
prevention is provided
by anmillion
integrated
$313
&
maternal
care network
$ 1.7 billions
(US) .
Options to reduce and
contain drug and resource costs
Purchase of ARV Precios de adquisicion de ARV en dos escenarios Politicos: innovadores Vs
Two
scenarios - Innovators (Chile) versus Generics (Peru),
Genericos, bajo un mismo sistema de compras centralizadas
under the same centralized purchasing system
Dolares
americanos
(US$)
(US$)
US Dollars
3.500
3.000
2.500
PERÚ
2.000
1.500
CHILE
1.000
0.500
0.000
Lo p
in a
vi r/
R
Did
a no
s in
ito n
av i
r
a
Ab
Zi d
a ca
ov u
v ir
di n
a/l a
m iv
u di
na
Efa
vire
nz
- ca
p
60 0
mg
Difficulties in
pharmaceutical
markets
 Low access by most vulnerable populations
 Lack of regulation to improve access to drugs
 Insufficient strategies to ensure
 Limited dialogue among interested
par
Coordination
and inter-sectoral
Now more than ever!
collaboration
Critical points in the intersectoral collaboration
EDUCATION Monitoring the Inter-ministerial Declaration of Mexico at the national level
LABOUR Links with the labor sector
We need to
JUSTICE Protection of Human Rights
invest in
FINANCE & TRADE Protect public health & ensure equitable access to drugs & other products
collaboration &
SOCIAL SECURITY Include children orphaned by HIV
coordination
CIVIL SOCIETY Coordination with civil society organizations
PRIVATE SECTOR Prevention, protection and inclusion of people affected by HIV
Recommendations
To cooperation and financing partners:
 Promote utilization of strategies and coordination mechanisms
 Harmonize collaboration mechanisms and lessen demands on co
 Collaborate with countries to improve cost & efficiency
 Promote interventions and investments to strengthen
local
Recommendations
To social policy makers :
 Include people affected by HIV, in social protection programs inclu
 Allocate public spending to sustain achievements
 Prioritize vulnerable & high risk populations in
a
addressing
Recommendations
To national actors
 Revisit PHC and coordinate an integrated health system response
 Re-prioritize preventive interventions targeting
high-ri
 Mainstream sex education
 Establish an early warning system to minimize treatment interruption
Recommendations
To national health authorities:
 Revitalize leadership role in policy-making, coordination, and mana
 Revise model of care for HIV including organization & delivery;
 Conduct critical analysis and data analysis to identify deficiencies,
 Define needs for long-term reforms based on analysis results
Recommendations
To health services management
 Coordinate complementary interventions, such as the promotion of
 Incorporate actions within comprehensive and integrated care frame
 Protect and develop Human Resources for Health to maintain its qua
Recommendations
To Media
 Emphasis on prevention stigma and discrimination
 Promote voluntary testing and counseling
Recommendations
AT ALL LEVELS!
PROMOTE
solidarity
respect
and
the elimination of stigma and discrimination
Thank You!
¡Gracias!
Merci!
Muito Obrigado!