Are Current Global HIV/AIDS Targets Reasonable?

Presenter: Mark Pearson, HLSP Institute

Abstract

Public spending on health in low income countries remains extremely low and well below levels considered necessary to provide a basic package of essential services.

Despite this considerable emphasis is still placed on the need to ensure countries are able to deliver an essential package of heath services costing anything upwards of $35 per head (CMH 2001, Millennium Project 2005).

There is currently a fierce, and increasingly polarised, debate between those who argue that too little is currently being spent on HIV/AIDS and that what is being spent is contributing significantly to the development of health systems as a whole and those who argue that too much is being spent on HIV/AIDS (in relation to other priorities) and that this is serving to undermine rather than support health systems development. (MacKellar 2005 and Shiffman 2007 ).

The paper will consider the extent to which increased donor funding for HIV/AIDS might be squeezing out other areas of donor spend and what the the implications of this are. It will also consider the extent to which this is likely to continue in future. given that UNAIDS has recently argued that spending on HIV/AIDS should be quadrupled by 2015 and the US Government has announced a large increase in future commitments. This paper looks at what this would mean from a country perspective (country specific estimates are due to be made available shortly) and asks whether such levels of spending are affordable it the light of likely levels of funding for health care and whether they appear justified in the light of other competing priorities.

It further assesses the longer term implications of such support in terms of the impact on fiscal space at the country level. The paper will make the case for resource based rather than needs based planning and for carrying out comprehensive sector wide costing estimates not disease specific ones. The paper will use data on donor disbusements and commitments from the DAC Creditor Reporitng System database and use a range of scenarios to model likely future fiscal space at the country level in coming years