African HIV Financing Scorecard - 2019
In the past 20 years, national governments, global funders and civil society have made significant progress in expanding access to life-saving antiretroviral treatment and prevention options in the fight against HIV.Almost sixty percent of people living with HIV are now accessing antiretroviral treatment, and new infections have been reduced by almost 50% since 1996. But at the same time that great progress has been made, so we see that contributions by international donors have flatlined even though there is a US$5 billion gap in the resources needed to achieve the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90–90–90 targets. These targets which are to diagnose 90% of all HIV-positive persons, provide antiretroviral therapy for 90% of those diagnosed, and achieve viral suppression for 90% of those treated by 2020 need to be achieved if we are to control the HIV epidemic. Currently, low- and middle-income countries contribute approximately 56% of the global resources for HIV, but the investment by countries varies and a significant 20% global funding gap remains, which leaves the HIV response in a precarious position.
As a result of this situation, in early 2019 the Society for AIDS in Africa began an evidence-based advocacy campaign that focusses on this resource gap that exists, with the aim of meeting the UNAIDS 2020 and 2030 targets in Sub-Saharan Africa.
As part of this campaign, a group of African and global HIV advocates and activists have developed a strategy for creating and implementing such an advocacy campaign. The campaign has developed this African HIV Financing Scorecard in partnership with Accountability International (previously AIDS Accountability International) as a means to analyse the existing funding, interrogate the gaps in required funding, and provides evidence-based advocacy messaging for action by the various stakeholders involved. The Scorecard tracks current country investments in HIV treatment and prevention in order to shed more transparency on the topic. It also examines existing frameworks and funding in general, as well as looks at the current use of innovative financing and what sources for funds might exist. The report then delves into partnerships with business and public-private partnerships and impact investment and the potential role these tools can play in financing the HIV response. The report also examines what corporate social responsibility programmes and individual philanthropists are currently doing to finance the response to HIV. Other sources such as diaspora remittances are also interrogated so as to create understanding on how they may be a potential source of finance.
The next section then goes on to look at the current situation in each country and how the countries are faring in their current HIV response. This provides both an indication of what has been done to date, what political will currently exists and what issues still need to be addressed. Identifying priority areas for funding is vital if funding will remain limited. This then also provides a starting block for a discussion on the cost to end the epidemic in each of the African countries. The report then goes on to examine current programme spending patterns, existing sources of health financing, and expenditure on clinical trials. The report also examines the role of International Development Partners and Civil Society, looking into a variety of HIV finance issues in that arena, such as international funding for HIV, finance for HIV research, loss of African funds to illicit outflows, funding of the Global Funds Country Coordinating Mechanisms and accountability around those grants. Next, we look into the state of transparency, openness and democracy in each of the countries as a means to locate the dialogue in the broader landscape of accountability, transparency and anti-corruption.
The report ends with findings from the research and a list of recommendations that were collectively developed during a workshop “Consultative >Meeting for Scorecard Validation on HIV Financing in Africa” held in Accra from 15th to 17th October 2019. These findings and recommendations inform the SAA campaign, as well as the work of others in designing policy reform and making the case for sustained and increased investment.
Increasing domestic investment on HIV treatment and prevention will require a regional coordinated, evidence-based advocacy campaign and partnership, and the Society for AIDS in Africa sees this African HIV Financing Scorecard as a first but critically important step in the broader campaign which aims to increase domestic funding for HIV programming. This program is well suited to SAA’s strength in policy analysis and advocacy as SAA is an independent organization devoted to transparency and accountability and whose work is respected by a wide range of global stakeholders. We hope that this research, our findings and recommendations provide evidence to start a discussion, across many stakeholders, on what and how we can sustainably, inclusively and accountably finance the final stages of the HIV epidemic in Africa.