Domestic contributions for HIV/AIDS prevention and treatment: how much is “fair”?
V. Wirtz1, O. Galarraga2, Y. Santa Ana Tellez2, S. Forsythe3
1National Institute of Public Health of Mexico, Center for Health Systems Research, Cuernavaca, Mexico, 2National Institute of Public Health of Mexico, Center for Evaluation Research and Surveys, Cuernavaca, Mexico, 3Futures Institute, Connecticut, United States
Background: To identify potential savings by using an allocation model of Global Fund (GF) resources, balancing countries' need with their access to official development aid (ODA), and what a country should reasonably be expected to contribute from its own available resources.
Methods: A model was constructed taking into account:
(a) the country's resource needs estimate (RNE) from UNAIDS,
(b) the total ODA, excluding funds from GF and
(c) the estimated “domestic fair contribution (DFC)”.
The latter was determined based on a country's gross national income (GNI) per capita, HIV prevalence, and the domestic contribution of countries with a similar GNI. The funding gap for each country receiving GF resources in 2007 was calculated by subtracting the sum of official ODA (excluding GF resources) and DFC from the RNE. According to the model, GF resources would only be allocated to those countries with a funding gap that cannot be covered with a country's own fair domestic contribution.
Results: Applying the model to 56 countries, the Global Fund could have saved US$ 281 million (54% of its total allocations) between 2005 and 2007. The largest savings could have been achieved for the case of South Africa, with a saving of 28.7%, followed by Tanzania (13.4%) and Russia (12.6%). GF could also have saved in the case of Swaziland and Croatia, for which allocated resources exceeded the funding gap.
Conclusions: The results suggest that important savings could be achieved if countries were required to contribute fairly on the basis of their income and other factors. By requiring that countries at least meet some minimum “fair contribution”, additional funds could be generated and a more equitable global resource allocation could be achieved.
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