Ani Shakarishvili, MDUNAIDS Country Coordinator in Ukraine
AIDS 2012, Washington, DC – 23 July, 2012
Ensuring the financial sustainability of the national AIDS response in a low-middle income country with the growing HIV epidemic: is it feasible in the next few years in Ukraine?
Overview
Context Money now: from where? for what? Money in the future: predictability? how
much more needed? Possible solutions Is it feasible?
Context
Low-middle income country with growing and fragile economy: GDP per capita $2,974 (2010)
Growing HIV epidemic: • most severe in Europe: estimated 0.8% HIV
prevalence (15-49 yrs)• highly concentrated in key populations at risk: PWID
(22% HIV prevalence), FSWs (9%), MSM (6%)
National HIV response scaling up with some pockets of success (PMTCT, young/recent PWID)
Changing political environment, yet some openness around social issues at national and local levels
Health care reform slow, with only some benchmarks
Source: Ukrainian AIDS Centre
Annual AIDS expenditures (in USD) by programme areas and sources of financing – 2009-2010
US
D m
illio
ns
Total 2009: USD 65.4 M
Total 2010: USD 72.8 M
Source: Ukraine National AIDS Spending Assessments, 2009 and 2010
Number of patients on ART and contribution of the state budget and the Global Fund – 2003-2011
ART coverage of the estimated needs in selected countries, 2010
> 80%
60% - 79%
40% - 59%
Congo
Guyana
Lesotho
20% - 39%
Algeria
India
Lithuania
0% - 19%
Egypt
Tajikistan
Ukraine
Brazil
Ethiopia
Romania
Botswana
Rwanda
Slovakia
Cost (in USD) of 1st and 2nd line ARV regiments – 2008-2010
Reported number of persons receiving opioid substitution treatment and the national targets – 2008-2016
Source: Ukrainian Institute of Public Health Policy Research, 2011
National AIDS Plan – 2013 target
Current need
USD 11M from the GF R6 (2007-2012)
GF R10
Annual future financial allocations for HIV by source and the annual financial gap (in USD) – 2012-2015
Funding gap: USD 138M
Source: National Operational Plan 2011-2013; Ukraine Gap Analysis Report, 2010
Financial sustainability - possible solutions (1)
Increasing domestic investments: Programmatic priorities Equitable resource distribution
Policy and practical initiatives aimed at reduction of costs per client: Radical changes and optimization of procurement Efficient service delivery modalities (cost and
implementation efficiencies) HIV service integration and decentralization:
- Across HIV interventions- Synergies with other vertical and non-HIV programmes- Into primary care
Still required donor-funding commitments (post Y2015!) Alternative modalities of financing:
Cost-sharing arrangements ??? National health and social insurance ??? Taxation ??? Facilitating public-private partnerships ???
Financial sustainability - possible solutions (2)
Is it feasible?
Total health expenditures, percent (%) of GDP – 2007-2010
Per
cent
Health expenditure per capita (current USD) – 2007-2010
US
D
Only 0.7% of health expenditures go towards HIV in Ukraine!
Financing Service delivery Institutional Human resources Social sustainability
Sustainability
Acknowledgements
Co-authors:• Kateryna Sharapka
UNAIDS Ukraine
• Dr. George Gotsadze Curatio International Foundation
• Alexei Ilnitski UNAIDS Ukraine
• Prof. Natalia Nizova Ukrainian AIDS Centre
• Oleksandr Zhyhinas Ukrainian AIDS Centre
Other colleagues:• Paolo Belli
The World Bank
• Dr. Volodymyr Kurpita All-Ukrainian Network of People Living with HIV
• Robert Greener UNAIDS Geneva
Thank you!
Дякую!