Changes in Donor Financing Over
Time: A Global Perspective
International AIDS Economics Network Pre-Conference Meeting
Jen Kates, PhD
Vice President; Director, Global Health & HIV Policy
Kaiser Family Foundation
jkates@kff.org
http://kff.org/global-health-policy/
July 19, 2014
Introduction
• While financial resources from all sectors have been integral to
addressing the HIV epidemic, donor government financing has
been particularly critical, accounting for much of the HIV
funding in many hard hit countries
– Donor governments provide more than 50% of all HIV funding in
79 countries; more than 75% in 51 countries (UNAIDS, 2013)
• The Kaiser Family Foundation and UNAIDS have been tracking
donor government assistance for HIV in low- and middleincome countries since 2002
• Latest report provides data for 2013, most recent period
available, and trends over time
Methodology
• All 29 members of the OECD DAC included in analysis
– Direct data collection from: Australia, Canada, Denmark, E.C., France,
Germany, Ireland, Netherlands, Norway, Sweden, U.K., U.S.
– Data for all other OECD DAC member governments from: OECD CRS
database and UNAIDS (collectively, these donors account for less than
5% donor government assistance for HIV)
• Bilateral Funding: Any earmarked (HIV-designated) amount; does not
include funding for international HIV research
• Multilateral Funding: Donor contributions to the Global Fund to Fight
AIDS, Tuberculosis and Malaria and to UNITAID; adjusted to represent
estimated “AIDS share”
Findings
A Mixed Story for 2013
• Commitments:
– Rose steeply until 2008, then flattened
– In 2013, decreased by 3% compared to 2012, to US$8.07 billion
– Decline is primarily due to decreasing bilateral funding commitments
from the U.S. government
• Disbursements:
– Also rose steeply until 2008, but have had more fluctuation
– In 2013, increased by 8% to US$8.46 billion
– Increase primarily due to the U.S. accelerating bilateral funding from
prior years (the “pipeline”)
– Without U.S. increase, donor government disbursements would have
been essentially flat
SOURCE: Kaiser Family Foundation and UNAIDS, Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from
Donor Governments in 2013.
International HIV Assistance from Donor Governments:
Commitments & Disbursements, 2002-2013
$8.7 $8.7 $8.7 $8.8
US$ Billions
$8.5
$8.3 $8.1
$7.6 $7.9
$7.7 $7.7
$6.9
$6.6
$5.6
$4.9
$4.3
$3.6
$3.5
$3.9
$2.8
$1.6
$2.0
$1.2
Commitments
(Enacted Amounts)
$1.6
Disbursements
SOURCE: Kaiser Family Foundation and UNAIDS, Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from
Donor Governments in 2013.
Donor Highlights
• U.S. largest donor, accounting for 66% of total donor assistance
(bilateral & multilateral) in 2013
• U.K. second largest (10.0%), followed by France (4.8%),
Germany (3.4%), and Denmark (2.3%)
• Five donor governments (Australia, Denmark, France, U.K., and
U.S.) increased disbursements for HIV in 2013
• Five (Germany, Ireland, Norway, Sweden, and the European
Commission) remained essentially flat
• Three donor governments (Canada, Italy, and Japan) decreased
HIV disbursements in 2013
NOTE: HIV assistance from the Netherlands also decreased in 2013, but this was due to a shift in support from bilateral HIV funding to the Global Fund
SOURCE: Kaiser Family Foundation and UNAIDS, Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from
Donor Governments in 2013.
International HIV Assistance: Donor Governments as a
Share of Total Donor Government Disbursements, 2013
Germany
United Kingdom, 10.0%
3.4%
France
4.8%
Denmark
2.3%
United States
66.4%
Netherlands
2.2%
Sweden
2.0%
Australia
1.7%
Norway
1.4%
Japan
1.2%
European Commission
1.2%
Italy
0.0%
US$8.5 billion
Total Disbursements
Canada
1.7%
Ireland
0.7%
Other Governments
1.0%
SOURCE: Kaiser Family Foundation and UNAIDS, Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from
Donor Governments in 2013.
Trends by Donor Government, 2010-2013
$1,200
$6,000
USD millions
Multilateral
$1,000
$5,000
Bilateral
$800
$4,000
$600
$3,000
$400
$2,000
$200
$1,000
$-
$-
Australia
Canada
Denmark
France
Germany
Ireland
Italy
Japan
Netherlands Norway
Sweden
U.K.
EC
Other
SOURCE: Kaiser Family Foundation and UNAIDS, Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from
Donor Governments in 2013.
U.S.
Bilateral & Multilateral Assistance for HIV
• Bilateral Assistance: Accounted for 76% (US$6.4 billion) of total
donor government assistance
• Multilateral Assistance: Accounted for 24% (US$2.0 billion) and
includes funding provided to the Global Fund and UNITAID
• Nine donor governments provided majority of their total HIV
assistance through bilateral channels, while five channeled
more than half through the Global Fund and UNITAID
• In recent years, many donor governments have provided an
increasing share of their total donor assistance for HIV through
the Global Fund
SOURCE: Kaiser Family Foundation and UNAIDS, Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from
Donor Governments in 2013.
International HIV Assistance: Funding Channels for Donor
Government Disbursements (USD), 2013
8%
24%
15%
18%
19%
27%
28%
35%
37%
46%
53%
69%
81%
100%
76%
92%
85%
82%
81%
73%
72%
65%
63%
54%
Global Fund/
UNITAID
70%
88%
Bilateral
47%
31%
30%
19%
12%
SOURCE: Kaiser Family Foundation and UNAIDS, Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from
Donor Governments in 2013.
Fair Share
• Rank by share of total donor government funding for HIV: U.S.
ranked first in 2013, followed by the U.K., France, Germany and
Denmark
• Share of total resources available for HIV compared to share of
the global economy (as measured by GDP): U.S., Denmark,
Sweden, and the U.K. provided greater shares of total HIV resources
than their shares of global GDP
• Rank by funding for HIV per US$1 million GDP: When donor
government disbursements are standardized by the size of their
economies (GDP per US$1 million), Denmark ranked number one
followed by the U.S., the U.K., Sweden, and Ireland
SOURCE: Kaiser Family Foundation and UNAIDS, Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from
Donor Governments in 2013.
Assessing Fair Share 1: Donor Share of World GDP*
Compared to Donor Share of All Resources Available for
HIV, 2013
22.7%
United States
Japan
1.5%
France
United Kingdom
Italy
Canada
Australia
Netherlands
Sweden
Norway
Denmark
Ireland
6.6%
0.5%
Germany
0.0%
29.4%
4.9%
3.7%
2.1%
3.4%
4.4%
2.8%
2.5%
0.7%
2.0%
0.8%
1.1%
1.0%
0.8%
0.9%
0.7%
0.6%
0.4%
1.0%
0.3%
0.3%
Share of World GDP
Share of All Resources for AIDS
US$19.14 Billion
Total Estimated Available
Resources for HIV from All Sources
NOTE: UNAIDS, preliminary estimate of resources available from all sources, 2014. This estimate includes domestic expenditures (public and private)
for all low- and middle-income countries, including five countries that transitioned into high income levels in 2013.
SOURCE: Kaiser Family Foundation and UNAIDS, Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from
Donor Governments in 2013.
Assessing Fair Share 2: Donor Rank by Disbursements for
HIV per US$1 Million GDP*, 2013
Denmark
$579.2
United States
$334.6
United Kingdom
$332.1
Sweden
$309.1
Ireland
$274.3
Netherlands
$233.0
Norway
$231.7
France
$149.7
Australia
$95.6
Germany
$78.5
Canada
$77.5
Japan
Italy
$20.7
$1.2
SOURCE: Kaiser Family Foundation and UNAIDS, Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from
Donor Governments in 2013.
Conclusion
• Donor government funding commitments to address HIV in lowand middle-income countries fell in 2013
• While disbursements increased, primarily driven by U.S.
acceleration, this may be unsustainable: U.S. annual funding
commitments are decreasing, and diminishing pipeline
• Future financing from donor governments therefore remains
uncertain
• And financing gap remains: global resources available from all
sources (estimated at $19.4 billion) still short of projected need
(US$22 to US$24 billion by 2015)
NOTE: UNAIDS, preliminary estimate of resources available from all sources, 2014. This estimate includes domestic expenditures (public and private)
for all low- and middle-income countries, including five countries that transitioned into high income levels in 2013.
SOURCE: Kaiser Family Foundation and UNAIDS, Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from
Donor Governments in 2013.
Changes in Donor Financing Over
Time: A Global Perspective
International AIDS Economics Network Pre-Conference Meeting
Jen Kates, PhD
Vice President; Director, Global Health & HIV Policy
Kaiser Family Foundation
jkates@kff.org
http://kff.org/global-health-policy/
July 19, 2014