Abstract #379  -  From Emergency Relief to Sustained Response: Examining the Role of the Private Sector in Financing HIV/AIDS Services
Authors:   Presenting Author:   Ms. Sara Sulzbach - Abt Associates
Additional Authors:  Ms.  Susna  De, Dr.  Wenjuan Wang,
Aim: Global financing for HIV/AIDS has reached unprecedented levels in recent years, fueled by three major donors. Over $13 billion dollars were mobilized to fight the disease in 2008, credited with saving the lives of millions of people living with HIV (PLWHIV). A relatively unexamined aspect of the global response to HIV/AIDS is the role of the private sector. As the response evolves from an emergency response to a sustained effort, understanding current and potential contributions of the private sector is critical. This paper examines the role of the private sector in HIV/AIDS financing, assessing trends over time. In particular, it analyzes the effects of the influx of donor funding, first felt at the country level in 2004, on private sector contributions.
Method / Issue: We analyzed National Health Account (NHA) HIV subaccounts data for five African countries: Kenya, Malawi, Tanzania, Rwanda and Zambia. NHA HIV subaccounts provide comparable data on the flow of HIV/AIDS funding, from source to use. We compare expenditure data on HIV/AIDS health care from 2002 and 2006, adjusting for inflation.
Results / Comments: In terms of HIV/AIDS funding sources, the relative private sector share, including households and private companies, decreased significantly in all five countries. Whereas in 2002 average private contributions accounted for 27 percent of all HIV/AIDS health expenditures, in 2006 they accounted for 12 percent, suggesting that donor funding may be crowding out private contributions. Similar reductions in public sector contributions were observed in three of the five countries. NGOs are increasingly controlling the largest share of HIV/AIDS resources relative to other stakeholders, comparing 2006 levels to 2002 levels. In all five countries, private entities are managing fewer HIV/AIDS resources since the donor influx, and the government management role also appears to be diminishing. On the whole, out-of-pocket (OOP) spending by PLWHIV has decreased over the four-year period, with the exception of Malawi, evidence of increased access to free or subsidized HIV/AIDS services. The majority of HIV/AID funds were spent in the public sector. However, a considerable amount is spent at private facilities, primarily fueled by OOP payments. Spending in private pharmacies and traditional healers has largely declined from 2002 to 2006; conversely, OOP spending at private hospitals increased.
Discussion: Our findings suggest that the influx of donor funding has led to decreased private contributions for HIV/AIDS. In the case of decreased OOP payments by PLWHIV, this is a positive finding, and indicates decreased burden of financing for this vulnerable population. However, the apparent displacement of both local government and private investment, and overall lack of engagement of the private sector, raises concerns about the sustainability of HIV/AIDS programs over the long term. As the characterization of the global HIV response shifts from emergency relief to sustainable programs, continued exploration of the role of the private sector, in financing and delivering HIV/AIDS services, is warranted.
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