Financing HIV Programming: How Much Should Low Middle Income Countries their Donors Pay?

Abstract

Global HIV control funding falls short of need. To maximize health outcomes, it is critical that national governments sustain reasonable commitments, that international donor assistance be distributed according to country needs funding gaps. We develop a country classification framework in terms of actual versus expected national domestic funding, considering resource needs donor financing. With UNAIDS World Bank data, we examine domestic donor HIV program funding in relation to need in 84 low middle income countries. We estimate expected domestic contributions per person living with HIV (PLWH) as a function of per capita income, relative size of the health sector, per capita foreign debt service. Countries are categorized according to levels of actual versus expected domestic contributions, and resource gap. Compared to national resource needs (UNAIDS Investment Framework), we identify imbalances among countries in actual versus expected domestic donor contributions: 17 countries, with relatively high HIV prevalence and GNI per capita, have domestic funding below expected (median per PLWH $143 $376, respectively), yet total available funding including from donors would exceed the need ($368 $305, respectively) if domestic contribution equaled expected. Conversely, 27 countries have actual domestic funding above the expected (medians $294 $149) but total (domestic+donor) funding does not meet estimated need ($685 $1,173). Across the 84 countries, in 2009, estimated resource need totaled $10.3 billion, actual domestic contributions $5.1 billion actual donor contributions $3.7 billion. If domestic contributions would increase to the expected level in countries where the actual was below expected, total domestic contributions would increase to $7.4 billion, turning a funding gap of $1.5 billion into a surplus of $0.8 billion. Even with imperfect funding resource need data, the proposed country classification could help improve coherence and efficiency in domestic international allocations.