Rapporteur reports
Leadership report by Rebecca Hodes
This session on global financing brought together the representatives of major AIDS donors and recipient countries to explore the challenges posed by the current global AIDS funding architecture.
Lesotho’s Minister of Health spoke cogently of the difficulties of working with donors, due to their insistence on introducing their own systems and projects. The effect on under-resourced health systems was described as a ‘tremendous strain’, leading to lower absorption of funds because of capacity constraints.
The Health Minister requested more committed partnerships, rather than consultants who remain in ‘recipient’ countries for a limited time. She spoke of donors’ complaints regarding slow implementation and lack of capacity, and joked of her nervousness at being seated in between the Global Fund and PEPFAR representatives, to laughter and applause from the audience. But the message was a serious one, as the Minister maintained that governments must also have the power to hold donors accountable, and to insist on donor programmes that are sustainable and aligned with other health projects.
The Ethiopian Health Minister spoke of how his state expects donors to commit to a minimum of three years of funding, and a preferred period of five to ten years in order to minimize transactions, ensure predictability, and sustain programmes.
The chair of the International AIDS Alliance pointed out that the majority of primary health expenditure in numerous states is ‘out of pocket’ – as orchestrated by the international community and by states themselves. He pointed to the emergence of a new term: ‘backloading’, applied to governments which piggyback on the public relations benefits of funding promises, but do not fulfil their promises. He emphasised that governments need greater ambition and targeting in national health plans, and that, with increased resources, accountability for outcomes, and civil society engagement, global health can be transformed. But without these, the multisectoral partership pioneered by health advocates, governments and funders regarding AIDS will break.
Mark Dybul from the US made a controversial request for a moratorium on meetings and documents from international agencies until the current targets have been achieved, to much audience applause.
Track E report by Mandeep Dhaliwal
Global Financial Architecture of AIDS response is a key issue of the conference. Cost of scaling up is too high for countries to do on their own. Confronted by overwhelming need and resources are not enough.
UA represents exciting ambition but challenges regarding ensuring:
- scale up of services contribute to HSS
- limitation of transaction costs for developing countries
Debate about Health Systems has been polarised and unhelpfully to place burden AIDS response. HS have been under funded for decades. Combine activism for UA and long term approaches to sustainable development.
HS should be defined by country specific responses – people are part of the system. Developing countries are managing complex expectations from donors and need predictability of resources. MOH need greater influence and ownership of donor funds for the health sector.
HS is important but multisectoral response is necessary for prevention otherwise we have unsustainable intervention.
GF is providing extremely flexible money to countries focusing on national strategy on g HIV TB Malaria together with necessary HS components.
Debate on integrating AIDS into PRS or MTEF to enhance alignment and sustainability. Bring lessons from AIDS, especially CS engagement, to provide comprehensive framework.
CS and WB agreed that out of pocket expenditure is unacceptable and ineffective. Effective financing starts with effective use of resources at national level. Requires increased government contribution to ensure sustainability.
CS concerned that keeping Public Private partnerships alive requires:
- additional resources
- greater ambition, better targets in health plans
- accountability - implies greater transparency and effectiveness in CS
Recommend moratorium on initiatives until we have met our commitments. Meet only to hold ourselves to account - esp on 0.7%.
Ensure that harmonisation and alignment is at country level.
Don’t move too fast to the ideal architecture – need to keep some exceptionalism to combat epidemics.
|