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Where will the money come from? Alternative mechanisms to HIV donor funding

BACKGROUND: Donor funding for HIV programs has flattened out in recent years, which limits the ability of HIV programs worldwide to achieve universal access and sustain current progress. This study examines alternative mechanisms for resource mobilization. METHODS: Potential non-donor funding source...

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Autores principales: Katz, Itamar, Routh, Subrata, Bitran, Ricardo, Hulme, Alexandra, Avila, Carlos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171544/
https://www.ncbi.nlm.nih.gov/pubmed/25224636
http://dx.doi.org/10.1186/1471-2458-14-956
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author Katz, Itamar
Routh, Subrata
Bitran, Ricardo
Hulme, Alexandra
Avila, Carlos
author_facet Katz, Itamar
Routh, Subrata
Bitran, Ricardo
Hulme, Alexandra
Avila, Carlos
author_sort Katz, Itamar
collection PubMed
description BACKGROUND: Donor funding for HIV programs has flattened out in recent years, which limits the ability of HIV programs worldwide to achieve universal access and sustain current progress. This study examines alternative mechanisms for resource mobilization. METHODS: Potential non-donor funding sources for national HIV responses in low- and middle-income countries were explored through literature review and Global Fund documentation, including data from 17 countries. We identified the source, financing agent, magnitude of resources, frequency of availability, as well as enabling and risk factors. RESULTS: Four non-donor funding sources for HIV programs were identified: earmarked levy for HIV from country budgets; risk-pooling schemes such as health insurance; debt conversion, in which the creditor country reduces the debt of the debtor country and allocates at least a part of that reduction to health; and concessionary loans from international development banks, which unlike grants, must be repaid. The first two are recurring sources of funding, while the latter two are usually one-time sources, and, if very large, might negatively affect the debtor country’s economy. Insurance schemes in five African countries covered less than 6.1% of the HIV expenditure, while social health insurance in four Latin American countries covered 8–11% of the HIV expenditure; in Colombia and Chile, it covered 69% and 60%, respectively. Most low-income countries will find concessionary loans hard to repay, as their HIV programs cost 0.5–4% of GDP. Even in a middle-income country like India, a US$255 million concessionary loan to be repaid over 25 years provided only 7.8% of a 5-year HIV budget. Earmarked levies provided only 15% of the annual HIV funding needs in Zimbabwe and Kenya. Debt conversion provided the same share in Indonesia, but in Pakistan it was much higher - the equivalent of 45% of the annual cost of the national HIV program. CONCLUSIONS: Domestic sources of funding are important alternatives to consider and might be able to replace donor HIV funding in specific country contexts, coupled with effective prioritization and efficiency measures. Successful resource mobilization design and implementation require close collaboration with other sectors, particularly with the Ministry of Finance, to make sure that the new financing mechanism is fully synchronized with economic growth and that HIV investments yield returns in the form of higher social benefits.
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spelling pubmed-41715442014-09-24 Where will the money come from? Alternative mechanisms to HIV donor funding Katz, Itamar Routh, Subrata Bitran, Ricardo Hulme, Alexandra Avila, Carlos BMC Public Health Research Article BACKGROUND: Donor funding for HIV programs has flattened out in recent years, which limits the ability of HIV programs worldwide to achieve universal access and sustain current progress. This study examines alternative mechanisms for resource mobilization. METHODS: Potential non-donor funding sources for national HIV responses in low- and middle-income countries were explored through literature review and Global Fund documentation, including data from 17 countries. We identified the source, financing agent, magnitude of resources, frequency of availability, as well as enabling and risk factors. RESULTS: Four non-donor funding sources for HIV programs were identified: earmarked levy for HIV from country budgets; risk-pooling schemes such as health insurance; debt conversion, in which the creditor country reduces the debt of the debtor country and allocates at least a part of that reduction to health; and concessionary loans from international development banks, which unlike grants, must be repaid. The first two are recurring sources of funding, while the latter two are usually one-time sources, and, if very large, might negatively affect the debtor country’s economy. Insurance schemes in five African countries covered less than 6.1% of the HIV expenditure, while social health insurance in four Latin American countries covered 8–11% of the HIV expenditure; in Colombia and Chile, it covered 69% and 60%, respectively. Most low-income countries will find concessionary loans hard to repay, as their HIV programs cost 0.5–4% of GDP. Even in a middle-income country like India, a US$255 million concessionary loan to be repaid over 25 years provided only 7.8% of a 5-year HIV budget. Earmarked levies provided only 15% of the annual HIV funding needs in Zimbabwe and Kenya. Debt conversion provided the same share in Indonesia, but in Pakistan it was much higher - the equivalent of 45% of the annual cost of the national HIV program. CONCLUSIONS: Domestic sources of funding are important alternatives to consider and might be able to replace donor HIV funding in specific country contexts, coupled with effective prioritization and efficiency measures. Successful resource mobilization design and implementation require close collaboration with other sectors, particularly with the Ministry of Finance, to make sure that the new financing mechanism is fully synchronized with economic growth and that HIV investments yield returns in the form of higher social benefits. BioMed Central 2014-09-16 /pmc/articles/PMC4171544/ /pubmed/25224636 http://dx.doi.org/10.1186/1471-2458-14-956 Text en © Katz et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Katz, Itamar
Routh, Subrata
Bitran, Ricardo
Hulme, Alexandra
Avila, Carlos
Where will the money come from? Alternative mechanisms to HIV donor funding
title Where will the money come from? Alternative mechanisms to HIV donor funding
title_full Where will the money come from? Alternative mechanisms to HIV donor funding
title_fullStr Where will the money come from? Alternative mechanisms to HIV donor funding
title_full_unstemmed Where will the money come from? Alternative mechanisms to HIV donor funding
title_short Where will the money come from? Alternative mechanisms to HIV donor funding
title_sort where will the money come from? alternative mechanisms to hiv donor funding
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171544/
https://www.ncbi.nlm.nih.gov/pubmed/25224636
http://dx.doi.org/10.1186/1471-2458-14-956
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