Ani Shakarishvili, MDUNAIDS Country Coordinator in Ukraine

AIDS 2012, Washington, DC – 23 July, 2012

Ensuring the financial sustainability of the national AIDS response in a low-middle income country with the growing HIV epidemic: is it feasible in the next few years in Ukraine?

Overview

Context Money now: from where? for what? Money in the future: predictability? how

much more needed? Possible solutions Is it feasible?

Context

Low-middle income country with growing and fragile economy: GDP per capita $2,974 (2010)

Growing HIV epidemic:

• most severe in Europe: estimated 0.8% HIV prevalence (15-49 yrs)

• highly concentrated in key populations at risk: PWID (22% HIV prevalence), FSWs (9%), MSM (6%)

National HIV response scaling up with some pockets of success (PMTCT, young/recent PWID)

Changing political environment, yet some openness around social issues at national and local levels

Health care reform slow, with only some benchmarks

Source: Ukrainian AIDS Centre

Annual AIDS expenditures (in USD) by programme areas and sources of financing – 2009-2010

US

D m

illio

ns

Total 2009: USD 65.4 M

Total 2010: USD 72.8 M

Source: Ukraine National AIDS Spending Assessments, 2009 and 2010

Number of patients on ART and contribution of the state budget and the Global Fund – 2003-2011

ART coverage of the estimated needs in selected countries, 2010

> 80%

60% - 79%

40% - 59%

Congo

Guyana

Lesotho

20% - 39%

Algeria

India

Lithuania

0% - 19%

Egypt

Tajikistan

Ukraine

Brazil

Ethiopia

Romania

Botswana

Rwanda

Slovakia

Cost (in USD) of 1st and 2nd line ARV regiments – 2008-2010

Reported number of persons receiving opioid substitution treatment and the national targets – 2008-2016

Source: Ukrainian Institute of Public Health Policy Research, 2011

National AIDS Plan – 2013 target

Current need

USD 11M from the GF R6 (2007-2012)

GF R10

Annual future financial allocations for HIV by source and the annual financial gap (in USD) – 2012-2015

Funding gap: USD 138M

Source: National Operational Plan 2011-2013; Ukraine Gap Analysis Report, 2010

Financial sustainability - possible solutions (1)

Increasing domestic investments: Programmatic priorities Equitable resource distribution

Policy and practical initiatives aimed at reduction of costs per client: Radical changes and optimization of procurement Efficient service delivery modalities (cost and

implementation efficiencies) HIV service integration and decentralization:

- Across HIV interventions- Synergies with other vertical and non-HIV programmes- Into primary care

Still required donor-funding commitments (post Y2015!) Alternative modalities of financing:

Cost-sharing arrangements ??? National health and social insurance ??? Taxation ??? Facilitating public-private partnerships ???

Financial sustainability - possible solutions (2)

Is it feasible?

Total health expenditures, percent (%) of GDP – 2007-2010

Per

cent

Health expenditure per capita (current USD) – 2007-2010

US

D

Only 0.7% of health expenditures go towards HIV in Ukraine!

Financing Service delivery Institutional Human resources Social sustainability

Sustainability

Acknowledgements

Co-authors:• Kateryna Sharapka

UNAIDS Ukraine

• Dr. George Gotsadze Curatio International Foundation

• Alexei Ilnitski UNAIDS Ukraine

• Prof. Natalia Nizova Ukrainian AIDS Centre

• Oleksandr Zhyhinas Ukrainian AIDS Centre

Other colleagues:

• Paolo Belli The World Bank

• Dr. Volodymyr Kurpita All-Ukrainian Network of People Living with HIV

• Robert Greener UNAIDS Geneva

Thank you!

Дякую!