1. Christoph Hamelmann
UNDP RBEC Regional Team Leader
HIV, Health and Development
A Comprehensive
Approach to Sustainable
Financing of National HIV
Responsesc
c
UNDP Global Fund Partnership Meeting
Istanbul, 16-17 June 2014

2. From ‘Getting to Zero’ to ‘End AIDS’
UNAIDS:
Getting to Zero Strategy
Get to Zero
• new infections
• AIDS related death
• Discrimination

3. Investment Framework
UNAIDS/UNDP:
Critical Enablers and
Development Synergies for
Strategic Investment

4. Investing for results. Results for people
UNAIDS:
Investing for results

5. Country Specific Investment Case
UNAIDS:
Investing for results

6. Example output: Improved HIV response
Net savings
(through treatment and
hospitalization costs
averted)
$600 million
Current
programme
85,000
Resource needs for
business as usual over
the next decade (based
on current plan)
Total
number of
new
infections
averted
$600 million
98,000
Total
number of
DALYs
averted
Optimal programme
Costs required over the next
decade for optimal investment
of resources (accounting for
enhanced investments and
efficiency gains)
$900 million
135,000
Total number
of new
infections
averted
176,000
Total number
of DALYs
averted
1,165
Cost /
infection
averted

7. Global Fund NFM Investment Strategy

8. Question Approach Objective
1.What is the
socio-economic
and development
context?
• Key macroeconomic indicators, not only
GDP, but also distribution of incomes,
unemployment, poverty, government
revenue, debt and budget deficit
• Human development index
• Gender equality index
• Key demographic indicators including age
dependency ratios
Understand and quantify
country’s capacities,
challenges, priorities and
potential opportunity costs
during transition processes,
in absolute and relative
((sub-)regional) terms
2.What are the
priority health
challenges?
• Key health indicators
• MDG 4, 5, 6 status and progress
Understand and quantify
country’s health priorities,
progress in addressing
them and potential
opportunity costs in the
health sector during
transition processes, in
absolute and relative ((sub-
)regional) terms
3.How is the health
system
organized?
Descriptive overview of key stakeholders at
national, regional and municipal levels, their
responsibilities; governance and key
regulatory frameworks
Understand system
structure and functions
relevant for transition
process

9. Question Approach Objective
4.What are the
health financing
mechanisms and
how big is the
health budget?
• Key health financing indicators
• Descriptive overview of health financing
mechanisms, stakeholders and relevant
processes
Understand country’s
health financing
mechanisms and processes
relevant for transition;
Evaluate health budget in
absolute and relative terms
considering public/private
mix, social protection
5.What are status,
trends and key
features of the
HIV epidemic?
• Key HIV epidemic indicators
• Key HIV service coverage indicators
• Focus on key populations (concentrated
epidemic)
‘Know your epidemic’
6.What is the
national HIV
response?
• Descriptive analysis of
a) the legal framework and regulations
b) the organizational structure and
stakeholder
• Quantitative analysis of external funding
• Qualitative and quantitative analysis of
a) GF grant objectives, SDA, activities
b) related GF budgets and implementers
‘Know your response’;
Quantify the dependencies
on external resources; If
the GF is by far the single
largest funder, understand
the grant’s detailed
programme components,
budget components and
implementers as the

10. Question Approach Objective
7.Does the legal
and regulatory
framework (and
capacities) allow
for outsourcing
to NGOs of
critical preventive
and treatment
interventions to
key populations?
• Detailed analysis of the type, role and
budget of NGOs under the GF grant
• Analysis of contracting mechanisms of
NGOs by government and contracting
capacities
• Evidence of effective service linkages
between public sector and NGO services
• Evidence of effectiveness and efficiency of
NGO services particularly for key
populations
Governments appreciate
the critical role of NGO
services for key population
in concentrated epidemics;
NGO contracting
mechanisms and capacities
are (put) in place during
the transition process to
domestic financing
8.Does the legal
and regulatory
framework (and
capacities) allow
for accountable
and transparent
ARV procurement
at competitive
prices?
• Comparative analysis of national ART
guideline and WHO 2013 guideline
• Qualitative and quantitative analysis of
treatment regimens (by INNs and
products) and their prices under the GF
grant
• Analysis of ARV IP and registration status
recommended under national and Who
2013 guidelines
• Analysis of national procurement
mechanisms for essential medicines
Optimize ART guidelines,
ARV procurement
mechanisms and prices
during the transition
process

11. Scenarios for the transition process towards
sustainable financing of national HIV
responses
Scenario 1: ‘Maintaining status quo’
• maintaining current investment mix under current budget
ceiling
Scenario 2: ‘optimizing efficiencies, maintaining current budget’
• Assuming improved allocative and technical efficiencies during
the transition to domestic financing mechanisms: optimized
investment mix under current budget ceiling
Scenario 3: ‘Achieving universal coverage’
• Building on scenario 2, but scaling-up to universal coverage for
prevention and treatment intervention for key populations: the
rights-based investment case

12. Scenario 1 outputs: ‘Maintaining status quo’
• Identification of detailed budget slots of domestic financing
mechanisms who would need to absorb current external
funding; determination of absolute and relative amounts
• Feasibility assessment for transition to domestic financing
• Information for strategic decisions on phased-in approach of
domestic financing, for example under co-financing
requirements
• Model estimates for epidemic impact in mid-(2020) and long-
(2030) perspective
• Model estimates for impact on service coverage for essential
interventions with focus on key populations

13. Objective 1: To reduce high-risk sexual and
injecting behaviors among populations most
vulnerable to HIV infection including injecting
drug users; sex workers; and men who have sex
with men.
Sub-total: US $ 2,310,337
Objective 2: To reduce high-risk behaviors
among other populations at-risk of HIV infection
including migrants and their wives; and young
people by scaling up their coverage by
comprehensive quality prevention.
Sub-total: US $ 1,174,124
Objective X...
CENTRAL LEVEL
Sub-total: US $ 26.1 million
& US $2,192,073 would need to be allocated
additionally for transition from GF: 8.4%
MUNICIPALITY LEVEL
Sub-total: US $ 58.7million
& US $ 2,446,512 would need to be allocated
additionally for transition from: 4.2%
Objectives of GF HIV grant State budget for health
Grand total: US $ 143.5 million
& US $ 7,084,098 would need to be allocated
additionally for transition from GF: 4.9%
Grant total: US $ 7,084,098
US $ 462,067 (20%)
US $ 924,125 (40%)
US $ 234,824(20%)
US $ 469,650 (40%)
REGIONAL LEVEL
Sub-total: US $ 58.7 million
& US $2,1446,512 would need to be allocated
additionally for transition from GF: 4.2%US $ 469,650 (40%)
US $ 924,125 (40%)
Scenario 1 Example: Mapping of transition
towards domestic financing mechanisms

14. Scenario 2 outputs: ‘Optimizing efficiencies,
maintaining current budget’
• Model outputs for optimzed allocative investment mix under
the ‘Getting to zero’ objectives (new infections, DALY) and
current budget ceiling
• Targets for reasonable technical efficiency gains
• Model estimates for epidemic impact in mid-(2020) and long-
(2030) perspective
• Model estimates for impact on service coverage for essential
interventions with focus on key populations

15. Scenario 3 outputs: ‘Achieving universal
coverage – the rights-based investment case’
• Model outputs for service increase of key prevention and
treatment interventions to universal coverage by 2020 including
cost estimates
• Comparative analysis under current national ART guideline and
adaptation to WHO 2013 guideline
• Model estimates for epidemic impact in mid-(2020) and long-
(2030) perspective

16. Lessons learnt so far
• Country driven processes is critical, including a joint UNCT
approach
• UNDP can make major contributions, particularly in countries
with UNDP GF PR-ship
• Data required are available, but spread over many sources
• A well-trained technical team and standardized tools are
essential
• A substantial reduction of dependencies on external funding
appears feasible for a number of countries
• Transitioning to domestic financing of national HIV responses
offers strategic investment opportunities under national and
(sub-)regional perspectives
• A rights-based investment case is attainable under shared
responsibilities

17. Thank You!
christoph.hamelmann@undp.org
Twitter: @cahamelmann