NAMIBIA INVESTMENT CASE

NAMIBIA INVESTMENT CASE

OUTLINE Why an Investment Case for HIV Response in Namibia? Investment Scenarios Can we achieve Fast Track and End AIDS as public health threat by 2030? Can we afford it? Efficiencies: can we do better? Front-load resources: when, where, for whom and how much? Commit and Implement the Namibia Investment Case

Annual HIV incidence, prevalence and mortality, % of adults 15-49 years REMARKABLE ACHIEVEMENTS HIV prevalence (Goals projection) HIV prevalence (2015 AIM) HIV Incidence HIV/AIDS Mortality ANC surveillance (mean) DHS 15-49y 20 15 10 5 Launch of HIV control program Launch of ART program 0

INVEST ON HIV RESPONSE FOR BETTER HEALTH Investments on HIV response have improved health outcomes Cost Effective: HIV response prevents a death at a cost of about US$ 20,000, or a cost per life year saved at about US$ 1,000 - one-sixth of GDP per capita Behaviour change and the public ART program has been an investment in social equity: providing access to those who would have not benefited if public investments on HIV response were not made

KEY QUESTIONS What would be the impact if we continue at the same rate of implementation? How can we maximise the efficiency of resource allocation and utilization? What will it take to achieve Fast Track? How can we secure an effective and sustainable response? Who will fund the resource needs?

INFORMING The update of the government policies and commitments, including policy shifts Increase allocations for HIV combination prevention Adopt the Treat All policy Revision of the NSF and operational plans Donors policies and contributions and the contribution of the civil society, communities and private and other sectors.

INVESTMENTS SCENARIOS: IMPACT AND COSTS ARE CONSIDERED FOR AT LEAST 15 YEARS Constant Coverage Scenario: coverage rates of HIV/AIDS-related services remain at their 2015 levels NSF Scenario: scaling-up of the HIV response with NSF targets(through 2018) and under the policy on male circumcision (through 2020). Treatment coverage rises to 80 and 85 percent (men and women respectively)(at a CD4 eligibility threshold of 500). Maximum Scenario: reach Fast Track in Namibia, scale up combination prevention and adopt Treat All and takes into account the potential efficiency gains Maximum Scenario without efficiency gains (Max-TE): excluding the improved outcomes from improved adherence and viral suppression, as well as the costs of achieving them.

IMPACT ON HIV EPIDEMIC

IMPACT ON LIFE EXPECTANCY

Improved HIV response by 2020 2030 Constant Scenario Resource needs for business as usual over the next decade (based on constant scenario) Maximum Scenario Costs required over the next fifteen years for optimal investment of resources (accounting for enhanced investments and efficiency gains) 2020: US$ 232.4 million 2030: US$ 320 million 2020: US$ 274 million 2030: US$ 331 million Total number of new infections Total number of deaths averted Total number of new HIV infections averted by 2030: 67,701 Total number of deaths averted by 2030: 20,440 New HIV infections AIDS-related deaths 2020 2030 2020 2030 2020 2030 2020 2030 9005 8787 4036 4637 4943 2242 2862 2492

FINDINGS The costs of the HIV and AIDS response increases in each of the scenarios: because of life-long commitment to provide treatment Efficiencies will likely be generated and reduce the funding gap by: targeting the high transmission and low performance area; adopting service delivery modalities that rapidly expand coverage and adherence; negotiate the costs of viral load, and adopting the most costeffective testing kits; test and offer scenario provides savings by eliminating pre-art costs Invest in addressing the social contexts that hamper access to services such as stigma, discrimination and gender-based violence. Savings occur in the NSF and Maximum scenarios in synergies with development sectors, reflecting lower costs of support to people living with HIV (because there are fewer) and of support to AIDS orphans The lowest costs by 2030 (US$ 382 million) occur in the Maximum scenario, illustrating the potential financial gains from a test and treat strategy. To achieve the highest impact and the lowest cost by 2030, Namibia will need to frontload investments by 2020 With AIDS spending at around 1,5 percent of GDP, and declining (relative to GDP) in all scenarios by 2030, the financing of the AIDS response does not raise any fundamental macro or fiscal stability issues for Namibia. If the government increases the investments on HIV now, it will save lives and future costs

NEXT STEPS Questions Comments Endorse the findings, select the investment scenario to implement in dialogue with partners, private sector, civil society and communities Dialogue with the Ministry of Finance, National Planning Commission and other decisionmakers to advocate for increased domestic resources to front load investments by 2020 potentially in line with the Maximum scenario UNAIDS and partners can support discussions, including negotiations to reduce the viral load prices.