Botswana Advocacy paper on Resource Mobilisation for HIV and AIDS

Transcription

1 Republic of Botswana Botswana Advocacy paper on Resource Mobilisation for HIV and AIDS Page 1 June 2012

2 1.0 Background HIV and AIDS remains one of the critical human development challenges in Botswana. The epidemic has negatively impacted human capital, reduced economic productivity and continues to threaten investments and savings as national and household resources are diverted to providing comprehensive response, particularly in quality treatment, care and support. Life expectancy at birth decreased from 65.3 years in 1991 to years for the general population (women 57.3 and for men) in 2012 as a result of HIV and AIDS. Over the past decade the country has embarked on strategic interventions and activities to address the epidemic, but despite these actions, new infections continue to be reported. The incidence of HIV is currently estimated at 1.5% translating into approximately 15,000 new infections per year. The estimated HIV prevalence among the general population was 17.6% 2 which translating to approximately 350,000 people living with HIV infection and HIV prevalence among women and men being 20.4% and 14.2% respectively. However the prevalence rate among women aged 15 to 49 years of age attending anti-natal care services was estimated 30.4% 3. The main drivers of the epidemic consist of individual risk factors that include multiple concurrent partners, low male circumcision, low condom use, sexually transmitted infections. Other drivers that facilitate spread of the epidemic include contextual and structural drivers, that is, socio-cultural norms and values, gender inequality and low status of women, income inequality, poverty and wealth, human rights, stigma and discrimination and distribution of health services. Despite the statistics highlighted above, significant and positive interventions employed have yielded good results towards achievement of the country targets on Universal Access. The percentage coverage of the treatment programme is 92.8% of HIV positive pregnant women receiving a complete course of ARVs to reduce the risk of mother to child transmission stands at 94. 3% which is actually above the global elimination target of less than 5% mother to child transmission. The new national target is to actually eliminate mother to child transmission and to make sure that the child lives to celebrate his or her 5 th birthday and beyond and that maternal mortality is further reduced from the 190/100,000 to achieve Millennium Development Goals 4, 5, and 6 outcomes. 1 CIA World Fact book, BIAS III 3 Ministry of Health, 2011 Page 2

3 2.0 Fiscal Space and Financing HIV and AIDS The impact of HIV and AIDS is also a challenge to growth; estimates suggest that HIV and AIDS could be reducing annual GDP growth rates by up to 1% a year (relative to what would have prevailed in the absence of HIV and AIDS), even with the widespread roll-out of anti-retroviral therapy (ART) 4. These negative impacts stems from low productivity, lose of skilled manpower, skills shortages, and reduced investment in both the public and private sectors. In addition the global financial crisis, which not only has put a question mark alongside the scope of future donor flows but evidently also curtails domestic financial capacity, the question of sustainable HIV and AIDS funding has become acute. The success of the treatment programmes, care and support has added more funding requirement challenges in the last five years. On ethical grounds, HIV and AIDS programme particularly treatment, care and support has created a life-long entitlement of HIV positive citizens from the government. With most national policies to fight HIV and AIDS working towards improved access to comprehensive services to achieve the goal of zero new infections by 2016 which has also been adopted as a global goal, the Government of Botswana faces increasing financial responsibilities. As financial challenges into the future continue to pose a threat to HIV and AIDS gains that have been made, there is a dire need to proactively mobilise additional resources for the national response to HIV and AIDS. How then will the government be able to raise additional resources realising that it s already spending well above 10% of GDP on the health sector, and for HIV and AIDs contributes 70% of the of total funding. A quick review of options for creating fiscal space for additional financial resources for HIV and AIDS may include; 4 Jefferis, K, Kinghorn, A, Siphambe, H & Thurlow, J (2007) The Economic Impact of HIV/AIDS in Botswana, (report prepared by Econsult Botswana for UNDP and NACA) Page 3

4 increased overall spending by government (resulting in more borrowing) which on its own is a difficult choice to implement based on existing legislative fiscal limitations; resource reallocation from other sectors to HIV and AIDS which is a difficult option considering all sectors are already under pressure; active resource mobilisation to increase resource base towards HIV and AIDS is an immediate requirement. 3.0 Resource Needs for HIV and AIDS Resource needs for HIV/AIDS is defined as the cost of providing access to treatment and care, for all, those infected by the virus, cost of preventative measures to reduce the incidence of HIV and cost of activities directed at mitigating the impact of the virusagainst the infected and affected. Resource needs also encompass the cost of necessary structures and systems for implementation of all such interventions. Table1. National Operational Plan (NOP) Resource Needs Priority Area NOP Annual Resource Needs (BWP million) 2012/ / / /16 Total (BWP) Prevention of New HIV Infections 256,159, ,820, ,578, ,208, ,766,508 Systems Strengthening 10,721,195 19,634,815 10,769,875 15,079,995 56,205,880 Strategic Information Management 34,788,970 15,477,810 8,034,460 40,854,320 99,155,560 Treatment, Care and Support 2,125,187,110 2,179,180,279 2,198,018,187 2,154,808,011 8,657,193,587 Grand Total 2,426,856,962 2,471,113,060 2,428,400,701 2,411,950,812 9,738,321,535 Page 4

5 As indicated in Table 1 above Botswana needs about BWP billion (USD 1.3 billion) to finance the entire HIV and AIDS national response to achieve the targets for On average, this translates to approximately BWP 2, 4 billion per year or USD 342 million. This estimation is based on current prices of goods and services, inflation and other costs. (USD1=BWP 7). 3.2 Estimated Financing gap (from Resource needs in NOP) Table2. Financing gap NOP Resource Needs (BWP million) 2012/ / / /16 Total (BWP) Resource Needs (NOP) Projected resources available* 2,426,856,962 2,471,113,060 2,428,400,701 2,411,950,812 9,738,321, ,490, ,541, ,987, ,108,473 3,246,128,282 *Funding gap 1,487,366,258 1,625,571,426 1,667,413,230 1,711,842,339 6,492,193,253 *Projections based on 2011/2012 final budgets and donor policy changes Table 2 above presents the financing gap for the period 2012/13 to 2015/16. The financing gap stands at approximately P1,5 billion in 2012/13 and reaching P1.7 billion in 2015/16. For most of the period the financing gap is close to 1% of GDP. Based on the financing gap indicated above in Tabkle2 it is evident that to sustain and maintain the current levels of achievement in the response to HIV and AIDS and at the same time reach the targets set out in the National Operational Plan an aggressive resource mobilisation strategy needs to be put in place. Page 5

6 4.0 HIV and AIDS Programmatic Gaps and Challenges Gaps and Challenges Prevention, Treatment, Care and Support High proportion of males engaging in MCP 11,2% Low Condom use 39,6% Low coverage on Most at Risk Populations (e.g. sex workers, drug users, MSM etc.) Low partner tracing rate- 30% Low SMC coverage - 15% of the (national target 80%) Limited number of full time professional counsellors High proportion of health workers not trained in Routine HIV Counselling and Testing In adequate district lab capacity for active screening Inadequate involvement of CSO/FBO/NGO/Private Sector ( partners ) in the national response Low coverage of children and adolescents Inequity in Testing and Counselling service coverage in the districts/regions HIV prevalence rate of 30.4% in pregnant women (SS 2011) Weak Infant follow-up, testing and initiation on HAART Low coverage of Triple ARV prophylaxis for HIV infected pregnant women 5/29 districts (17%) High incidence of unplanned pregnancies among HIV+ women Inadequate integration of SRH with PMTCT Inadequate community based follow up of clients Of the 634 facilities only 232 facilities offer ART High proportion of patients seeking test and treatment late Low treatment coverage for children & adolescents (22%)services (HR, counselling, adherence, treatment) Support Required Design, production and flighting of mass media products Support for capacity strengthening of Civil Society and private sector organisations for effective service delivery Funds for strengthening condom distribution systems Procurement of condoms Male circumcision kits Construction and equipment of laboratories at district level and training of laboratory personnel Support for service providers to reach more people for counselling and testing Test kits and reagents Resources for Integration of SRH into HIV programmes and training of health personnel in service integration Antiretroviral Drugs Funds for service providers to increase awareness among HIV+ women on repeat pregnancies, testing and counselling, follow ups at community level Community mobilisation and participation Page 6

7 4.2 Systems Strengthening (Health and Community) Gaps and Challenges Equity and access to HIV care services Multiple information and M&E systems that are not linked (paper and electronic) Inadequate capacity for TB/HIV and Multi-drug resistant Tuberculosis (MDT) Inadequate financial resources to conduct planned research and evaluations Inadequate capacity for integrated service delivery Inadequate expertise in forecasting and quantification at facility level (PSM) Weak coordination mechanism in service delivery Lack of sound referral system between facilities and community Poor programme management capacity among Civil society organisations Low national human resource capacity: number and skill (national response higly depended on development partner supported HR) Low services coverage (limited villages as per funding availability) Inadequate coordination of partners at district level Limited resource mobilisation capacity hence over reliance on development partner funds Weak linkages between NGOs and their networks and among networks and public sector institutions Limited mainstreaming of HIV and AIDS and related cross cutting issues into sectoralmandates 5.0 Conclusion Support Required Resources for training health care workers and other service providers in ARV treatment, MDR -TB management, surveillance and monitoring, procurement and supply chain management at district and facility level Funds for research and evaluation of interventions Strengthening of district level coordination and management of HIV and AIDS programmes Resources for establishment of a sound referral systems at community, district, and national level Resources for strengthening civil society organisations capacity in HIV and AIDS service delivery (financial management, monitoring & evaluation, governance & programme management and resource mobilisation) Resources for training both professional and lay counsellors Resources for strengthening systems for gender, human rights, stigma reduction and post exposure prophylaxis at district & community level Strengthening integration of services Given the high number of people living with HIV/AIDS and their prolonged life expectancy through the introduction of ART, the financial burden of the National AIDS response is expected to remain high in the medium to long term. Page 7

8 The financing gap in meeting the HIV and AIDS resource needs is estimated to reach P 1.7 billion The economic crisis has resulted in the deterioration of the fiscal position of Botswana and to this end different opportunities for increasing resources to HIV and AIDS need to be explored as a matter of urgency. In order to meet the financing gap, mobilisation of additional resources is required, and to this end, Botswana is developing its comprehensive Resource Mobilisation Strategy with the view to increase level of resources from its traditional partners as well as to identify new partners both internally and externally. Development partners exhibiting in providing support to the country be it hard cash, material or technical support for implementation of the HIV and AIDS national response is welcome. Once interest has been expressed to support, detailed proposals will be developed that are inline with the requirements and potential areas of support. It is expected that solid agreements and or memorandum of understanding agreements will be made that detail the scope of support, and targets to be achieved. Page 8