Health Financing

Ensuring Access and Protection: HIV/AIDS and Health Financing

Sound health financing policies ensure that people have access to basic health services and are protected from financial impoverishment associated with health-related costs. Sufficient financial resources are essential to the delivery of health services, and HIV/AIDS services are particularly resource-intensive. Improving health financing for HIV/AIDS is a key component of Health Systems 20/20’s health system strengthening activities worldwide.

For effective and transparent resource allocation, policymakers need to understand how much households, donors, and governments are spending on HIV/AIDS-related services. Experts from the Abt Associates-led Health Systems 20/20 project have worked with local teams in more than 50 countries to collect and report health expenditure data using National Health Accounts (NHA). The project and its predecessors have conducted 11 NHA subaccounts estimations focused on HIV/AIDS in five countries (Kenya, Malawi, Rwanda, Tanzania, and Vietnam). A future HIV/AIDS subaccounts estimation is planned for Namibia.

Results from these HIV/AIDS subaccounts have had tangible policy impacts. Health champions in Rwanda used results from the country’s first HIV/AIDS subaccounts analysis to increase government health spending and negotiate priorities for donor assistance. In Kenya, the Kenya Treatment Access Movement used data from the 2002 NHA subaccounts for HIV/AIDS to convince the government to establish a budget line-item for antiretroviral drugs, an important step toward securing local financing for antiretroviral treatment.

Country governments also need accurate information about the cost and sustainability of HIV/AIDS responses, as well as evidence-based projections of future scenarios, in order to scale up prevention, care, and treatment efforts. Health Systems 20/20 recently assessed the current costs of providing HIV/AIDS services through public sector facilities in Côte d’Ivoire. In Vietnam, Health Systems 20/20 is collaborating with Family Health International to evaluate the costs of an HIV/AIDS prevention and treatment program for individuals transitioning from a drug rehabilitation center. The project also developed the HIV/AIDS Program Sustainability Analysis Tool (HAPSAT), a computer-based tool for forecasting and analyzing the sustainability of HIV/AIDS programs. Using HAPSAT, Health Systems 20/20 assisted the Zambia Ministry of Health to quantify the current and projected costs and funding resources of their HIV/AIDS programs to estimate gaps. By 2011, moderate scale-up of HIV/AIDS programming will require US$ 405 million. The government of Zambia is now leading discussions with the Ministry of Finance, private sector, and donors to address the funding gaps to sustain HIV/AIDS services.