Funding AIDS programmes in the era of shared responsibility:an analysis of domestic spending in 12 low-income and middle-income countries

摘要

Background As the incomes of many AIDS-burdened countries grow and donors’ budgets for helping to fi ght theuddisease tighten, national governments and external funding partners increasingly face the following question: what isudthe capacity of countries that are highly aff ected by AIDS to fi nance their responses from domestic sources, and howudmight this aff ect the level of donor support? In this study, we attempt to answer this question.udMethods We propose metrics to estimate domestic AIDS fi nancing, using methods related to national prioritisationudof health spending, disease burden, and economic growth. We apply these metrics to 12 countries in sub-SaharanudAfrica with a high prevalence of HIV/AIDS, generating scenarios of possible future domestic expenditure. Weudcompare the results with total AIDS fi nancing requirements to calculate the size of the resulting funding gaps andudimplications for donors.udFindings Nearly all 12 countries studied fall short of the proposed expenditure benchmarks. If they met theseudbenchmarks fully, domestic spending on AIDS would increase by 2·5 times, from US$2·1 billion to $5·1 billionudannually, covering 64% of estimated future funding requirements and leaving a gap of around a third of the totalud$7·9 billion needed. Although upper-middle-income countries, such as Botswana, Namibia, and South Africa, wouldudbecome fi nancially self-reliant, lower-income countries, such as Mozambique and Ethiopia, would remain heavilyuddependent on donor funds.udInterpretation The proposed metrics could be useful to stimulate further analysis and discussion around domesticudspending on AIDS and corresponding donor contributions, and to structure fi nancial agreements between recipientudcountry governments and donors. Coupled with improved resource tracking, such metrics could enhance transparencyudand accountability for effi cient use of money and maximise the eff ect of available funding to prevent HIV infections and save lives.