How do we fund the ‘end of AIDS’ in MICs?

As delegates gather for the UN Financing for Development Conference in Ethiopia, we examine what can be done to improve financing for HIV services in middle income countries.

In February 2015, at the Nairobi launch of a new global initiative to end the AIDS epidemic among adolescents, President Uhuru Kenyatta announced that Kenya will lead by example by increasing domestic resources for the AIDS response and improving HIV prevention, treatment, essential health care and counselling services for adolescents.

However, a new report launched this week in Addis Ababa – Who Pays for Progress? The role of domestic resource mobilisation and development assistance in financing health raises significant questions about whether this will be possible.

Who pays for progress? Copyright RESULTS UKThe report, written by RESULTS UK in conjunction with our Linking Organisation KANCO (the Kenyan AIDS NGO Consortium), the World AIDS Campaign International, and the ACTION Global Health Advocacy Partnership, examines what can be done in Kenya to bring additional funding into the health sector.  Its findings in relation to HIV are stark.

Financing healthcare in Kenya


The report states that 70% of the Kenyan HIV/AIDS budget is provided by donors through Overseas Development Assistance (ODA).  But there is growing concern that the country will lose access to this ODA given its new lower middle-income country (LMIC) status, resulting in a gradual drop in funding for all health programmes.

In June 2015, President Kenyatta called on African leaders to move away from dependence on ODA and therefore raise the percentage covered by domestic resources. However, according to Steve Lewis, author of the report: “It is only possible to achieve equitable access to health with both an increase in domestic resources and an increase in development assistance (ODA).”

The report points out that it takes time to scale up domestic spending and it does not always cover the need. Whilst Kenya has  increased its domestic HIV spending in recent years, new scientific progress shows that in the next five years the country would ideally expand ARVs / anti-retroviral drugs to much greater numbers of people. Assessing figures from, a Lancet published study  the report shows  that even using the most optimistic domestic resource mobilisation scenario - with a tripling of funding allocated to HIV and AIDS - Kenya would still only be funding 66% of its AIDS budget, leaving an unmet need of 34%.

These figures are gloomy given the context of the current HIV epidemic in Kenya.  According to UNAIDS, among the general population HIV prevalence has stabled to about 5.6%, but among groups of people most at risk of HIV prevalence rates are considerably higher: for people who inject drugs and men who have sex with men, the figure is just over 18% but amongst sex workers it rises to 29%.

“In the long run, all Kenyans would be happy to see a time when the country does not need aid,” said Allan Ragi, director of KANCO. “But at present, if ODA falls then we will be unable to deliver essential healthcare to the most needy.”

The report analyses the contributions of major health donors and makes suggestions for ways of increasing domestic funding for public health in Kenya. It concludes that both sources will continue to be a vital part of the development landscape in Kenya, at least for the short and medium term.

Beyond 2015: financing equitable access to health in MICs


At the Financing for Development conference this week, we can expect loud calls from civil society for donors and multilateral organisations to make credible financial commitments towards the new sustainable development goals (SDGs). But, like Kenya, it’s also vital that middle-income countries with large HIV epidemics begin to share greater responsibility for achieving better health outcomes for their own citizens.

The research that RESULTS has produced on Kenya helps to make this case.  Alliance Linking Organisations in Namibia, Peru & Malaysia are similarly monitoring their government’s political and financial commitments to HIV so they can call on them to scale up domestic resource mobilisation.  One such piece of financial modelling was conducted recently in Malaysia by the Ministry of Health and the Malaysian AIDS Council.  It estimates that a short-medium term increase in financing of $420M over 7 years (both donor and domestic income sources) could reduce new HIV infections by 90% - to 750 - by 2021. 

Delivering the ‘end of AIDS’ by 2020 will require governments and donors to work together to move away from a reliance on aid. A full set of recommendations for the government of Kenya and for donors appears in the RESULTS UK report and could be applied elsewhere.

Side events at the UN Financing for Development conference

The Alliance is supporting two side events in Addis Ababa this week:

  • Monday 13 July: 18.15 pm,  Who Pays for Progress?  The role of domestic resource mobilisation and donor aid for health financing in Africa (RESULTS, KANCO, World AIDS Campaign and ACTION Global Health Advocacy Partnership).  More information from Laura Kerr at RESULTS UK.  Allan Ragi and Evelyn Kibuchi from KANCO will be in attendance

  • Wednesday 15 July: Beyond 2015: financing equitable access to health (Africa Civil Society Platform for Health, GFAN, Action for Global Health, Stop AIDS Alliance, GAVI CSO Constituency, ACTION Global Health Advocacy Partnership).  More information from Sara Ferrand at the Alliance. Evelyn Kibuchi will be speaking at this event.

To follow the decisions at Addis as they happen follow Steve Lewis from RESULTS UK on @owstonlewis, or the Alliance on @theaidsalliance