Presentations of objectives of aspirational donor interventions, promotion of national health system strengthening efforts, and dichotomy of successful and equitable UA to ART scale up with one that underlines mass social inequity.

IHP+ aims to enhance coordination to achieve health MDGs through harmonised in country effort.  Building on existing structured to provide results orientated finance

Raising expectation for more predictable funding.  Difficulties in disconnect between international agency and bilateral central offices and country staff and concerns that CS at country level are not supported to engage in compact negotiation.

National health care scale up in China due in great part to GDP growth. Average life expectancy expanded.  5 years ago only 30% had social health insurance now 80%. Total health expenditure 5% of GDP. SARS cost and lessons learned on access and equity.  Vision for health reform in China acknowledges health is a fundamental human right.

Rwanda experience of operating Community Based Health trust operates at:

Sector level – voluntary contribution of the population

District level – critical for function pooled risk

National level – MOH 13% of budget; public and private insurance  

83% on Community Health Insurance  

55% are paying with their own money

Impact increased uptake of systems, improvements in MH.

Mexico is a good model of management of state financed ART scale up. 37% of population uninsured but 98% PLWH insured. UA to ART. Challenges for stability: inefficient planning and purchasing; poor link with prevention and other health promotion programmes.  Need clear advice from international orgs for price based on GDP and allow public  finance of high speciality service. Need to use international procurement efforts for generics but pharma has blocked access.

Debates in South Africa about the response to AIDS have diverted crucial energy from key task of combating the epidemic.   Massively unequal access to health care with rich people paying into private system. To reach the national UA targets will require one third of the financing of the global response to AIDS.  Could be mitigated if they could draw 

on the entire health system but can only rely on a third of it – the chronically underfunded public system. Health system is a social institution and levels of inequity demonstrate lack of solidarity.