Domestic Financing for Health
AU/AWA Consultative Committee Meeting
27-28 May 2014, Mauritania
Shu-Shu Tekle-Haimanot
External Relations Division
Global Fund
Background – global health agenda
• Unprecedented level of international funding for health from 2002, in
particular for AIDS, TB and Malaria through the Global Fund
• Investments in health over last 10 years have resulted in significant
progress in improving peoples’ lives
• Key MDG targets are on track to be achieved in number of African
countries, but we need to protect and sustain progress
• International Development Assistance is changing
• New trends to watch for, particularly in area of support for health
Johannesburg
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Background – why invest in health?
• Economic, social and political benefits from having a healthy
nation;citizens have the potential to be more productive and it can
lead to demographic dividend
• According to the Lancet Commission: “Reductions in mortality
account for about 11% of recent economic growth in low and middleincome countries as measured in their national income account”
• Governments have an obligation to provide health care - it is a moral
imperative!
Key question is how and how much should
Governments invest.
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Key challenges & opportunities
• Value for Money: As the resource landscape is changing, focus is
now more on improving health programme efficiency and
effectiveness which calls for both “more money for health and more
health for money”
• Domestic Advocacy: a large part of any increase in public funding
for health will need to come from governments, therefore need to
develop a convincing business and advocacy case for increased
public commitment in programs of proven effectiveness
• Sustainability: Domestic public spending is set to continue as
economic growth continues, however it will not be sufficient to
address all the health needs. Therefore, still a need for external
resources in the short to medium term. Hence the need to explore
innovative domestic financing mechanisms.
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Global needs assessment for HIV, TB &
malaria for 2014-16
$100B
$90B
$80B
$70B
$60B
$50B
$40B
$30B
$20B
$10B
$0B
GF donors pledged more
than $ 12 B out of $ 15 B
target
$14B
Governments expected to
significantly increase
investments in HIV, TB and
malaria
$12B
$24B
$73B
$14B
84%
resource
needs
covered
$23B
Domestic
financing
(current
levels)
Johannesburg
$87B
March 2014
Additional
domestic
resources
Other
external
financing
Global Fund
Total need
5
Global priorities are changing & will have
implications on external health financing
Post -2015 MDG High Level Panel Report
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Africa has made commitments &
countries are demonstrating progress
•
•
•
•
Abuja Declaration on HIV/AIDS, TB and Other
Related Infectious Diseases, 2001: Heads of
State commit to spend at least 15 % of
budgets on Health
Addis Ababa, African Union roadmap on shared
responsibility and global solidarity for AIDS, TB
and malaria response, 2012. AU endorsed
Roadmap on Shared Responsibility and
Global Solidarity for HIV, TB and Malaria and
the Pharmaceutical Manufacturing Plan
Tunis Declaration on value for money,
sustainability and accountability in the health
sector, 2012. Governments commit to
enhance value for money, increase
accountability, improve sustainability of
health resources and fight corruption.
Abuja AU Special Summit Declaration on
HIV/AIDS, TB and malaria, 2013. Calls for
countries to honor the 2001 Abuja Declaration
and other health commitments.
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Health as % of total government
expenditure, 2011
Rwanda
23.7%
Malawi
18.5%
Zambia
16.0%
Togo
15.4%
Tanzania
11.1%
South Africa
10.0%
Botswana
8.7%
Nigeria
7.5%
Kenya
5.9%
Source: UNAIDS, Oxford Policy Management, Et al.
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How to determine domestic commitment
to health and AIDS,TB and malaria
• According to minimum standard? ($44)
• What is affordable?
• What is cost effective?
• Fair share between domestic and donors?
• UNAIDS developed Domestic Index of Priority
• More money for health and/or more health for money?
This is a political decision at both national
and international levels.
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How countries can sustain effective AIDS,
TB and malaria, as well as HSS programs
• Increase donor support --► getting more from existing donors or
involving new donors
• Increase domestic financing
-- ► Public or government
-- ► Private sector
-- ► Out of pocket
• Decrease the cost of the current response by improving efficiencies
in existing programs
And most importantly,
PREVENT NEW INFECTIONS
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Innovative ways of raising domestic
resources and potential gains
Source
US$ billions
75% of an alcohol levy
3.9
Contributions from high-revenue enterprises
2.4
Airline levy by all African countries
1.7
2% of public sector budgets earmarked for AIDS
2.4
Mobile phone levy
2.0
1% income tax levy earmarked for AIDS
3.1
But how to 1) sell these ideas and
2) ring-fence the funds?
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Criteria and considerations for investment
in health and AIDS, TB and malaria
• Level of national income, GDP or GNI. An approximation of
resources available within a country
• Degree to which the Government is able to raise revenue through
taxes, levies, domestic borrowing, or other means.
• Proportion of Government budget devoted to debt
• Pre-existing pattern of disbursement to different sectors. For health
if historical allocations have been low, infrastructure may be poor
reducing the short-run capacity to absorb rapid increases and
convert to service delivery.
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Plan for analyzing “Fiscal Space”
• Macroeconomic analysis
--► Evaluating potential resource needs and resource availability,
identifying future resource gaps and potential ways of eliminating such
financial gaps.
• Microeconomic analysis
--► Assessing potential opportunities to make the 3 largest interventions
more efficient, for e.g. in HIV/AIDS:
1. ART
2. PMTCT
3. OVC
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Increased domestic financing (IDF) for health – 2
complementary & mutually reinforcing strategies
Take forward the work of domestic financing internally and externally with aim to support countries and drive
ownership in domestically financing local public health agenda and to work with key partners such as AU, ADB, WB
and others in the advocacy and implementation.
Advocacy
plan with key
messages by
Donors,
private
sector and
CSOs
GF strategy
for increased
domestic
financing for
health
Domestic
Financing
Strategy and
support the
buy-in
process
Revive the
cochampionships and
identify other
champions
Option of
tools/mechanisms for
innovative
financing
Identify key
events
where to
raise
domestic
financing for
health
Documentation of Best
practices
Disseminate
best practices
Demonstrate progress towards increasing domestic financing in 2 out of 5 priority
countries (Tanzania, Ethiopia, Kenya, Senegal, and Malawi)
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The Global Fund is working with
countries and partners to:
• Improve data quality and accessibility for both domestic and
international health funding
• Nurture political leadership --► ongoing work on advocacy and
messaging to ensure health remains a top priority at national and
international levels
• Revisit and raise awareness on economic arguments for health,
including how it makes macro-economic sense
• Identify and address rigid budgeting practices that are obstacles to
the reallocation of revenues towards health
• Foster effective dialogue between local health and finance officials
--► creating space for discussion by empowering health officials and
ensuring that finance has a better understanding of health issues
• Recognize and enhance the role of civil society
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The Global Fund is working with
countries and partners to:
• Finally, by addressing the core question “it is possible to define the
“right” mix of domestic and international investment in any country” and
acknowleding that this “mix” will vary country by country --► Establish
an acceptable “benchmark” on a country by country basis for
domestic investment in health and the three diseases and develop
monitoring and evaluation framework to assess progress.
• Ensure UHC is taken into consideration when planning for domestic
health care
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Conclusions
• Health expenditures should keep pace with
economic growth
• There is no single blueprint for increasing
domestic funding for health
• Lessons learned and best practices should
THANK YOU
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