Domestic public spending on AIDS among low- and middle-income countries
D. Loncar1, B.-G. Hanne2, J.A. Izazola3, C. Aran1, B. Gobet1, P. De Lay4, C. Avila1
1AIDS Finance and Economic Division, UNAIDS, Geneva, Switzerland, 2Accenture, Oslo, Norway, 3Executive Director, National AIDS Programme, Mexico City, Mexico, 4Deputy Executive Director, UNAIDS, Geneva, Switzerland
Background: Analysis of trends in regional domestic public spending provides national authorities and international donors with a better understanding of government investment with respect to HIV. Tracking HIV expenditures also provides evidence and informed guidance to allow governments to implement the “know your epidemic/know your response” approach.
Methods: We analyzed panel data from 2001 to 2007 using 338 reported country years. Interpolation and extrapolation were applied to fill in missing data points. A log linear regression model identified both Gross National Income (GNI) and HIV prevalence as statistically significant independent predictors of domestic public spending. A fixed effects model was then used to predict domestic public spending in 135 low- and middle-income countries.
Results: Low- and middle-income countries spent a cumulative total of US$ 31.3 billion from domestic public sources from 2000 to 2009. Of this total, 25.1 % (US$ 7.57 billion) was spent in sub-Saharan Africa, 28% (US$ 8.43 billion) in Latin America, 17.9% (US$ 5.39 billion) in South-East Asia and 10.2% (US$ 3.06 billion) in Eastern Europe and Central Asia. Domestic spending showed a relative increase of 363% during the ten-year period. Per capita spending in 2009 was US$ 1.38 in countries with low-level epidemics and US$ 1.87 in countries with generalized HIV epidemics. An estimated additional US$ 10 billion was spent through domestic private sources (private firms and households) for the same period.
Conclusion: Despite huge income disparities, sub-Saharan Africa and Latin America devoted significant domestic resources to financing AIDS-related activities, the former under the pressure of high demand and a high disease burden, the latter perhaps facilitated by their developed health systems. Long-term, self-sustaining financing can only be achieved through a robust analysis of trends in domestic financing, economic growth and an appropriate mix of donor assistance and domestic spending.
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