Financial Implications of HIV/AIDS in South Africa – the role of the Business Sector

Findings from aids2031 costing & the efforts of the National AIDS Spending Assessment

9 June 2011Silindile Shezi, CEGAA

Acknowledgement to: Teresa Guthrie, Robert Hecht, Yogan Pillay, Mark Blecher, Kelsey Case

The South African Scenarios

1.Narrow NSP by 20112.Expanded NSP by 20213.Hard Choices by 2015

Baseline (maintaining 2009 coverage as comparator)

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Estimated Epidemiological Impact

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Adult (15+yrs) HIV Prevalence (2000–2031)

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Infant HIV-related Deaths (1993 –2031)

Key points from the Epi-projections

1. Only the expanded NSP will halve the new infections, as per the NSP goal, but only by 2020.

2. Compared to Baseline, the expanded NSP will avert nearly 6,000 infections in total by 2031, where as continuing with the current NSP will only avert 3,000 – half!

3. With increasing treatment coverage, HIV prevalence is unlikely to reduce below 10%, best case scenario.

4. Numbers on treatment will continue to grow, up to 3million by 2018, but thereafter will start to decrease with the expanded NSP & the expanded prevention efforts.

5. PMTCT will significantly reduce infant mortality, in all scenarios since same coverage.

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Estimated Resource Requirements

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Total HIV/AIDS Costs by Scenario (2009-2031, ZAR Billions)

12DRAFT-do not copy or disseminate

NB. These estimations include all sectors and all sources of funding

Expanded NSP – Programme Disaggregation (ZAR billions)

14DRAFT-do not copy or disseminate

Cost Implications

1. With Expanded NSP costs will double from 2010 to 2021 (but will be significantly reduced with new tender prices, should allow for all on at 350CD4 – greater prevention effects)

2. But thereafter they start to decrease significantly. Treatment taking 60% by 2020, but thereafter reducing.

3. Largest proportion will be DOH responsibility for the delivery of public ART – therefore important to increase the role of businesses in provision of ART and PMTCT.

4. Workplace programmes, especially business sector programmes, are important for other prevention interventions.

5. The role of NGOs could be expanded.

Sustainable Funding Sources?

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Sources of Financing for HIV/AIDS in SA• The current SA NASA is collecting the previous years' spending trends of all sectors (public, external & private).

• No comprehensive database of external sources (some from Burlington (2009).

• No database of business sector CSI activities (some from Trilogue)• Budgetary allocations show national spending, conditional grants

to provinces & some provincial voted allocations – limited disaggregation.

• OOPE – unknown.• Development partners appear uneasy to share their longer-term

commitments to HIV/AIDS in SA?• DPs also struggle to provide year-specific expenditures by

province.• Business sector is not willing to share their expenditure

for the NASA process.• Therefore impossible to measure the projected financing gap.

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SA Public HIV/AIDS Budget Allocations (2006/07-2012/13)

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Rough Questimate of Total Resource Gap (for all actors, not only public)

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SA DOH Budget Allocations for HIV/AIDS (ZAR millions)

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Rough Guestimate of public ART shortfall, assuming 90% coverage by 2015

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Importance of the National AIDS Spending Assessment (NASA)

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Objectives of NASA in South Africa

For the years 2007/08, 2008/09 & 2009/10, to identify in each province:

All the sources (public, external and private) of financing for HIV/AIDS and TB

The providers of the HIV/AIDS and TB servicesThe activities services delivered – and their

alignment with the PSP prioritiesThe beneficiaries of the services

In order to make recommendations for the improved targeting of funds and efficiency of spending, according to the provincial priorities.

DRAFT - DO NOT DISSEMINATE.

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Estimating & Securing Resource Requirements1. Using estimates of the future costs of an expanded NSP

2. Comparing current spending per intervention More detailed and accurate financing gaps can be

calculated Sustainable resources mobilised

This requires all partners to: • participate more actively in the achievement of the

Expanded NSP• be transparent & accountable about their past, current

and future funding activities• Improve the tracking of expenditure of businesses for

HIV/AIDS.

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SANAC, PACs, HASTs, etc

UNAIDS

Mark Blecher, National Treasury

Drs Pillay & Mbengashe (NDOH)

aids2031 Steering Committee

Gesine Meyer-Rath & Lawrence Long, BU/HERO

Kelsey Case, Imperial College London

John, Lori & Steve, Futures Institute

Leigh Johnson, UCT

Susan Cleary, UCT

Steve Cohen, SDC

All the DoH departments that provided data

The teams at CEGAA and Results for Development Institute

Acknowledgements

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