8 FUNDING FOR HIV/AIDS PROGRAMMES
69. The quality and coverage of HIV/AIDS programmes
will be directly affected by the overall level of resources which
donors make available for this sector. A recent report by UNAIDS
states that, based on country-defined targets to achieve universal
access by 2010, funding of US$25.1 billion will be required for
the global AIDS response in developing countries in 2010. US$11.6
billion will be required for HIV prevention and US$7 billion for
treatment. It is expected that one-third of the funding will come
from developing countries' domestic public sources and that external
sources will provide the remaining two-thirds. It is anticipated
that one-third of the funds will be used to finance multi-sectoral
programmes, one-third will be directed to strengthening health
systems and the remaining third will go towards HIV specific health
programmes.[120]
The impact of the global economic
downturn
70. At the Gleneagles G8 Summit in 2005 EU member
states pledged to allocate 0.7% of Gross National Income (GNI)
to Official Development Assistance (ODA) by 2015, with an interim
target of 0.56% by 2010. EU countries aimed to double their ODA
between 2004 and 2010 from €34.5 billion to €67 billion.[121]
The G8 countries also pledged significantly to reduce HIV infections
in Africa and to work with WHO, UNAIDS and other international
bodies to develop and implement a package of HIV prevention, treatment
and care, with the aim of moving as close as possible to universal
access to treatment for all who need it by 2010.[122]
In 2008, the United Kingdom was the second largest donor
to AIDS programmes, contributing 12.6% of the total disbursements.
The United States accounted for more than half (51.3%), the Netherlands
6.5%, France 6.4% and Germany 6.2%. Norway and Sweden each contributed
2.0%.[123]
71. UNAIDS acknowledges that the global economic
downturn has forced governments and civil society to re-examine
their development assistance allocations. It notes the International
Monetary Fund's forecast that world economic growth would fall
from 5.2% in 2007 to 0.5% in 2009, but calls for long-term sustainable
financing for HIV programmes to be secured.[124]
72. The DFID Minister restated in his oral evidence
the Government's pledge to commit 0.7% of GNI to ODA and said
that, despite the economic downturn, the UK was committed to maintaining
its spending programme. However, he pointed to the "threats
that have been posed by funding decisions of other countries"
who were "starting to shy away from commitments that they
have made". To address this, the G8 had published for the
first time in July 2009 an interim accountability framework which
showed progress of individual countries towards the G8 commitments
on development expenditure, including health spending. The Minister
told us that the UK, supported by the Canadian presidency of the
G8, would be pushing for a specific target on HIV/AIDS spending
from 2010.[125]
73. The Government has reiterated its commitment
to meet the target of allocating 0.7% of Gross National Income
to Official Development Assistance, despite the impact of the
global economic downturn. However, other countries are reneging
on the pledges they have made. HIV/AIDS remains a serious development
challenge and we are concerned about the impact that reduced development
assistance funding will have on HIV/AIDS programmes. It is very
disappointing that the 2010 target for universal access will be
missed by a wide margin. This must not be compounded by failure
to maintain the levels of support for HIV/AIDS programmes agreed
by the international community.
74. We support the Government's intention to work
with Canada, when it holds the G8 presidency in 2010, to press
donor countries to specify and publicise their targets for HIV/AIDS
funding. We recommend that the Government set an example to its
G8 partners by specifying, in response to this Report, what the
UK's HIV/AIDS annual expenditure targets will be from 2010 and
how this funding will be allocated.
The Global Fund to fight AIDS,
TB and Malaria
75. The Global Fund to fight AIDS, TB and Malaria
describes itself as a unique global public/private partnership
dedicated to attracting and disbursing additional resources to
prevent and treat HIV/AIDS, tuberculosis and malaria. It says
that this partnership between governments, civil society, the
private sector and affected communities represents a new approach
to international health financing. The Global Fund works in close
collaboration with other bilateral and multilateral organisations
to supplement existing efforts to tackle the three diseases. Since
its creation in 2002, the Global Fund has become the main source
of finance for programmes to fight AIDS, tuberculosis and malaria.
It has approved funding of US$15.6 billion for more than 572 programmes
in 140 countries. The Global Fund provides a quarter of all international
financing for AIDS globally, two-thirds of TB funding and three-quarters
of malaria funding.[126]
76. DFID's AIDS Strategy reiterated the funding commitment
first made in September 2007, to allocate £1 billion over
the seven years to 2015 to the Global Fund.[127]
The UK allocation in 2008 was £50 million and in 2009 rose
to £115 million.[128]
The UK Consortium told us that the long-term nature of this commitment
was exemplary, but believed that the amount was insufficient given
that the Global Fund announced in July 2009 a budget shortfall
of about US$3 billion for programmes planned for 2010.[129]
The Minister emphasised the benefit to the Global Fund of the
predictability which the UK's commitment provided. He believed
that there was "a lobbying exercise" to be carried out
in terms of encouraging other countries to increase their pledges.
Whilst the UK, as a leading contributor to the Fund, could attempt
"to leverage in more support" from other G8 countries,
he believed that "we are not in a position to tell others
to pay their fair share" and that there was a role for civil
society to put pressure on governments to "fulfil the payment
of what is only seen as a fair share towards the Global Fund".
Mr Foster also believed that the Global Fund should make its
funding "work better, to make it more effective on the ground".
[130]
77. The US$3 billion funding shortfall announced
by the Global Fund to fight AIDS, TB and Malaria will affect its
ability to deliver vital HIV/AIDS programmes. The UK's long-term
funding commitment is commendable but, as a leading contributor
to the Fund, the UK also has a responsibility to press other countries
properly to support the Fund. The UK should take every opportunity
to convey to international partners the importance of substantial
and predictable allocations to the Fund and the serious consequences,
including deaths, which will result from countries reneging on
their funding pledges.
Working with other donors
78. In our inquiry last year, the Minister told us
that a significant factor in DFID's decision to give such weight
to funding health systems had been the need to balance vertical—or
disease-specific—funding from other donors.[131]
One of the major contributors to vertical funding for HIV/AIDS
is the US President's Emergency Plan for AIDS Relief (PEPFAR)
which provided US$19 billion to support national AIDS responses
between 2004 and 2008. In July 2008 the US Congress passed an
Act that allocated a further US$48 billion over a five-year period
for combating HIV/AIDS, TB and malaria.[132]
US$39 billion is for HIV/AIDS, US$4 billion for tuberculosis and
US$5 billion for tackling malaria. The Act also increased the
US Government's contribution to the Global Fund to US$2 billion
per annum. [133]
79. Many AIDS organisations have welcomed the new
US Administration's willingness to move away from some of the
more controversial aspects of PEPFAR, particularly in relation
to prevention. These included restrictions placed on prevention
programmes that did not promote abstinence, monogamy, fidelity,
and partner reduction. President Obama's election pledge of "best
practice, not ideology" and his decision to overturn the
controversial "global gag rule" have encouraged
hopes for positive changes to PEPFAR policy.[134]
During his election campaign, Mr Obama pledged to increase PEPFAR
funding to US$50 billion by 2013. However, the President's global
health initiative, announced in May 2009, has been criticised
for undermining this commitment by extending the time-frame for
its delivery to six years rather than five. Concerns have also
been expressed by international AIDS activists over the President's
budget request for only US$366 million in new money for PEPFAR
for the financial year 2010. They have said that this will result
in a shortfall in funding which will have severe health consequences,
including significantly reducing the number of people who receive
vital HIV/AIDS treatment.[135]
80. Last year, we recommended that the UK Government
take "an early opportunity" to discuss with the new
US Administration potential areas of co-operation on HIV/AIDS
work, if it should indicate a change in its approach to development
funding.[136] DFID
told us that regular bilateral engagement between the UK Government
and all branches of the US Government would be "stepped up
to take advantage of the possible opportunities that the US administration
presents" in the hope of achieving greater alignment between
UK and US policy on AIDS prevention, treatment and care.[137]
In evidence this year, the Minister welcomed the changes that
had been made to PEPFAR and the budget commitments on global health.
He said that the focus on broader health issues was now more in
line with DFID's approach, including in child and maternal health
and family planning, which would benefit HIV/AIDS programmes and
would enable a closer working relationship between DFID and USAID
"on the ground".[138]
81. Alastair Robb, Senior MDG Results Adviser at
DFID, provided us with an example of the closer working relationship
at country level. In Kenya PEPFAR was operating "less vertically",
and was working with DFID and the national government through
partnership agreements that were "consistent with overall
AIDS and health strategy". He believed that this "indicates
their commitment to working better and achieving wider sets of
outcome".[139]
82. We welcome the prospect of closer collaboration
between the UK and the US on HIV/AIDS work which the relaxation
of some of the restrictions on the operation of the President's
Emergency Plan for AIDS Relief (PEPFAR) offers. The two countries
are leading donors in this area and joint working, which includes
developing country governments, is an effective approach to tackling
HIV/AIDS which we recommend DFID pursues wherever possible.
The implications for HIV/AIDS
programmes of DFID's White Paper
83. DFID published its new White Paper, Eliminating
World Poverty: Building Our Common Future in July 2009. Some
witnesses believed that the White Paper was further evidence of
an already apparent reduction in the priority DFID gives to HIV/AIDS.
They believed that this had been demonstrated by the lack of clear
funding commitments for HIV in the AIDS Strategy, DFID's strong
criticism of vertical funding programmes and a reduction of the
number of staff in DFID's AIDS and Reproductive Health Team. They
were concerned that this was likely to have a significant impact
on DFID's capacity to drive the Strategy forward and to continue
to play a leading role in global HIV policy discussions.[140]
Marie Stopes International was clear that the White Paper did
nothing to allay these concerns: "Whilst the [White Paper]
makes reference to HIV/AIDS, it does not specifically address
the challenge of HIV/AIDS in humanitarian settings or fragile
states."[141]
84. When we put this to the Minister, he told us
that "DFID is as committed as ever to working on HIV/AIDS"
and that he would "counter any argument that we were de-prioritising
HIV/AIDS". He said that the level of DFID's funding allocations
to HIV/AIDS programmes was a clear indication of its commitment.[142]
He did however acknowledge that other important health issues,
particularly maternal health, were "getting a greater share
of attention" and taking the focus away from HIV/AIDS in
the press and in terms of lobbying.[143]
85. Part of the "new approach" set out
in the White Paper is a greater focus on fragile states: DFID
says that it will "allocate at least 50% of all new bilateral
country funding to fragile countries."[144]
The Minister drew attention to the need for HIV/AIDS programmes
in fragile and conflict-affected countries, where women were often
the victims of violence and where health services frequently collapsed,
feeding the spread of HIV and preventing proper treatment.[145]
86. The focus in the DFID White Paper on fragile
states provides an opportunity for the Department to strengthen
its HIV/AIDS programmes in those countries and to work with others
to ensure that effective prevention and treatment programmes are
available to those affected by conflict, particularly women who
are often the victims of sexual violence. It is vital, however,
that this change of emphasis in DFID's priorities does not affect
future funding for core HIV/AIDS activities in other developing
countries. We recommend that DFID, in response to this Report,
provide us with information on how HIV/AIDS funding will be broken
down between fragile and conflict-affected states and other country
programmes.
120 UNAIDS, What
Countries Need: Investments needed for 2010 targets, 2009,
p 7. The remainder of the $25.1 billion is required for the following:
orphans and vulnerable children $2.5 billion; programme support
costs $3.7 billion; prevention of violence against women $0.3
billion. Back
121
G8 Gleneagles communiqué, Annex II Back
122
G8 Gleneagles communiqué, 18 d, p 22 Back
123
The Henry Kaiser Family Foundation, Financing the response to
AIDS in low- and middle-income countries: International assistance
from the G8, European Commission and other donor Governments in
2008, July 2009 Back
124
UNAIDS, What Countries Need: Investments needed for 2010 targets,
2009, p 11 Back
125
Q 54 Back
126
http://www.theglobalfund.org Back
127
Achieving Universal Access, p 51 Back
128
Q 40 Back
129
Ev 73, 82 Back
130
Q 40 Back
131
Twelfth Report of Session 2007-08, HIV/AIDS: DFID's New Strategy,
HC 1068-I, para 12 Back
132
Tom Lantos and Henry J Hyde, United States Global Leadership Against
HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008 Back
133
http://www.avert.org/pepfar.htm Back
134
The 'global gag rule' is the policy which prevented all US non-governmental
organizations which received federal funding from promoting abortion
services in other countries; see http://www.avert.org/pepfar.htm Back
135
http://www.avert.org/pepfar.htm Back
136
Twelfth Report of Session 2007-08, HIV/AIDS: DFID's New Strategy,
HC 1068-I, para 13 Back
137
First Special Report of Session 2008-09, HIV/AIDS: DFID's New
Strategy: Government Response to the Committee's Twelfth Report
of Session 2007-08, HC 235, p 1 Back
138
Q 61 Back
139
Q 62 Back
140
Ev 82 Back
141
Ev 64 Back
142
Q 58 Back
143
Q 59 Back
144
DFID, Eliminating World Poverty: Building our Common Future, Cm
7656, July 2009, p 71 Back
145
Q 60 Back
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