Katz Itamar, Routh Subrata, Bitran Ricardo, Hulme Alexandra, Avila Carlos
Abt Associates, 4550 Montgomery Ave, Suite 800 North, Bethesda, MD 20814, USA.
BMC Public Health. 2014 Sep 16;14:956. doi: 10.1186/1471-2458-14-956.
Donor funding for HIV programs has flattened out in recent years, which limits the ability of HIV programs worldwide to achieve universal access and sustain current progress. This study examines alternative mechanisms for resource mobilization.
Potential non-donor funding sources for national HIV responses in low- and middle-income countries were explored through literature review and Global Fund documentation, including data from 17 countries. We identified the source, financing agent, magnitude of resources, frequency of availability, as well as enabling and risk factors.
Four non-donor funding sources for HIV programs were identified: earmarked levy for HIV from country budgets; risk-pooling schemes such as health insurance; debt conversion, in which the creditor country reduces the debt of the debtor country and allocates at least a part of that reduction to health; and concessionary loans from international development banks, which unlike grants, must be repaid. The first two are recurring sources of funding, while the latter two are usually one-time sources, and, if very large, might negatively affect the debtor country's economy. Insurance schemes in five African countries covered less than 6.1% of the HIV expenditure, while social health insurance in four Latin American countries covered 8-11% of the HIV expenditure; in Colombia and Chile, it covered 69% and 60%, respectively. Most low-income countries will find concessionary loans hard to repay, as their HIV programs cost 0.5-4% of GDP. Even in a middle-income country like India, a US$255 million concessionary loan to be repaid over 25 years provided only 7.8% of a 5-year HIV budget. Earmarked levies provided only 15% of the annual HIV funding needs in Zimbabwe and Kenya. Debt conversion provided the same share in Indonesia, but in Pakistan it was much higher - the equivalent of 45% of the annual cost of the national HIV program.
Domestic sources of funding are important alternatives to consider and might be able to replace donor HIV funding in specific country contexts, coupled with effective prioritization and efficiency measures. Successful resource mobilization design and implementation require close collaboration with other sectors, particularly with the Ministry of Finance, to make sure that the new financing mechanism is fully synchronized with economic growth and that HIV investments yield returns in the form of higher social benefits.
近年来，用于艾滋病项目的捐助资金趋于平稳，这限制了全球艾滋病项目实现普遍覆盖并维持当前进展的能力。本研究探讨了资源筹集的替代机制。
通过文献综述和全球基金文件，对低收入和中等收入国家国家艾滋病应对措施潜在的非捐助资金来源进行了探索，包括来自17个国家的数据。我们确定了来源、融资机构、资源规模、可得频率以及促成因素和风险因素。
确定了艾滋病项目的四个非捐助资金来源：国家预算中专门用于艾滋病的税收；诸如医疗保险等风险共担计划；债务转换，即债权国减少债务国的债务，并将至少一部分减免额用于卫生领域；以及国际开发银行的优惠贷款，与赠款不同，优惠贷款必须偿还。前两者是经常性资金来源，而后两者通常是一次性来源，而且如果数额非常大，可能会对债务国经济产生负面影响。五个非洲国家的保险计划覆盖的艾滋病支出不到6.1%，而四个拉丁美洲国家的社会医疗保险覆盖了艾滋病支出的8 - 11%；在哥伦比亚和智利，分别覆盖了69%和60%。大多数低收入国家会发现优惠贷款难以偿还，因为其艾滋病项目成本占国内生产总值的0.5 - 4%。即使在像印度这样的中等收入国家，一笔2.55亿美元、需在25年内偿还的优惠贷款仅提供了其5年艾滋病预算的7.8%。专门税收在津巴布韦和肯尼亚仅提供了年度艾滋病资金需求的15%。债务转换在印度尼西亚提供了相同的份额，但在巴基斯坦则高得多——相当于国家艾滋病项目年度成本的45%。
国内资金来源是需要考虑的重要替代方案，在特定国家背景下可能能够取代捐助方的艾滋病资金，同时采取有效的优先排序和效率措施。成功的资源筹集设计和实施需要与其他部门密切合作，特别是与财政部合作，以确保新的融资机制与经济增长完全同步，并且艾滋病投资能以更高的社会效益形式产生回报。
