Dr. Ann Phoya�Amref Health Africa

Refocusing HIV finance in closing HIV equity gaps in Africa

• Dependency on external funding. Mostly, development partner driven financing. 
• Countries allocating less than 15% of their national budgets towards health.
• Limited capital investments in HIV – limited funds for infrastructure, technology investments and research and development.
• Imbalance between prevention and treatment activities.
• Limited involvement of the private sector in Africa.
• In 2021, funding available for HIV programs in Africa was US$8 billion short
• HIV organizations facing serious funding gaps. UNAIDS had US$44.5 million gap in 2022
• Global fund, one of the main financiers for HIV program, has reduced its support in several countries in Africa

HIV financing situation in Africa

• Geographically, Sub-Saharan Africa remains most heavily affected by HIV globally accounting to 2/3 of those living with HIV.

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• Poor and high disease burdened countries impacted by heavy debt repayments done mostly to G-20 countries.

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• Worse still, richer countries have cut aid for global health. This is not the time to step away but to step up. 

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• A study in 46 African countries showed a positive relationship between HIV prevalence and income disparity.

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• Equity gaps in access to HIV services
• Rural vs urban
• Young people, mostly sexually active, but with limited access to services
• Marginalized groups – Sex workers, LGBTI having access challenges in Africa

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Inequalities in HIV response and financing

• Is our funding reaching the most vulnerable?
• Zooming in on Adolescents alone
• 80% of adolescents living with HIV reside in sub Saharan Africa
• 800,000 adolescents living with HIV are not on life-saving antiretroviral treatment
• Adolescents and young women accounted for 25% of new HIV infections
• 6 in 7 new infections in adolescents were among girls
• Whilst addressing funding inequalities, we need to also address the inequalities at program level

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Inequalities in our targeting processes

Fully financed HIV response will bring in multiple gains to Africa: 

• Lead to sustained economic gains 
• Enhance education outcomes, especially for young women and girls
• Reduce gender inequalities 
• Increase livelihoods and health, especially for adolescents and young women. 
• Every PLHIV would have access to high-quality antiretroviral therapy (ART)
• Empowered communities with PLHIV and key pop fully participating in development
• Respect of human rights and legal protection

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Fully HIV financed HIV response - Ideal

We can learn from each other – South to South.

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• South Africa’s Health Insurance Scheme that integrates HIV funding into broader health financing

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• Rwanda’s integration of HIV services into Primary Health Care

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• Tanzania’s successful direct health facility financing and community based insurance programs

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Outstanding financing models in Africa

• Accelerate public-private partnership in HIV response in Africa.
• Countries to prioritize health financing, especially for HIV response. 
• Aid to focus on capital investments and equipment in HIV response. 
• Time to implement tried and tested approaches.
• Establishment of compulsory universal health insurance
• Private sector engagement
• Financial protection – increase health insurance programs  
• Public financial management: Imposing taxation on social services, food products, drinks, and mobile phone bundles 
• Debt swap agreements/Buy-Down arrangements. 
• Yet to be explored further – remittance and diaspora bonds, social and development impact bonds, and risk and credit guarantees.

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What needs to be done on HIV financing

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• A strong framework for procuring HIV commodities with African countries collaborating.
• Think integration – this will promote health system inefficiencies in service delivery, procurement, and oversight. 
• Think sustainability – donor funding for Malaria, TB, and even HIV is already decreasing. We need to act, and this conference can set the pace.

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What can we do differently

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Thank you!

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