Funding barriers to ensure universal access to TB and HIV care and control in Myanmar
The time is now! Turning the tide on drug-resistant TB and TB/HIV co-infection in Myanmar 22-23 August 2013
Presentation outline Background to funding environment and budgets Funding available for TB and HIV/AIDS Funding gaps for TB and HIV/AIDS Funding situation on MDR-TB Call for Action and Resolutions Who should pay for universal access to TB and HIV services Next steps
Background During the last 10 years funding for TB and HIV/AIDS control has increased dramatically The government spent 2% of its GDP on health in 2011 but commitments are increasing Majority of funding comes from out-of-pocket payment by households and external partners Despite the increase in funding there are huge gaps to reach universal access to TB and HIV/AIDS services Myanmar is among the lowest recipients of Official Development Assistance in the world receiving a fraction of what neighboring countries receive Universal access to TB and HIV/AIDS care is hampered by the weak health system and infrastructure/communication
Background - current strategies and plans National Strategic Plans for TB and HIV/AIDS are available for 2011-2015 Development of new strategic plans is needed for 2016-2020 New comprehensive budgets are needed based on latest policy guidelines
Funding for TB control, 2002-2015 40
35
30
US$ million
25
20
15
10
5
0 2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
TB notifications
Technical collaboration for TB control 160000
140000
120000
100000
80000
60000
40000
20000
0
Funding for HIV/AIDS control 60,000 53,709 50,000
40,128 40,000
29,825
30,000
21,138 20,000 15,191 11,193 10,000 5,639 2,527 17
121 484
0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
People receiving ARV, 2007-2012 coverage in 2012 about 43%
Major donors • Fund on HIV/AIDS in Myanmar • Global Fund • Three Diseases Fund • Three MDGs Fund • JICA • Total • International NGOs (MSF)
Funding gaps for TB control, 2011-2015 50 Gap
• Total needs for 2011-2015 are US$ 186 million • The funding gap is US$ 48 million • BUT: updates are needed for infection control and laboratory strengthening • The most important shortfall is for MDR-TB management
Available funding
45 40 35
US$ million
30 25 20 15 10 5 0 2011
2012
2013
2014
2015
Funding gaps for HIV/AIDS control, 2013-2015 – total needs US$ 264 million Domestic resources, 5 External resouces (non-Global Fund), 47
Funding gap, 92
Global Fund, 121
Main gaps: - Prevention - Harm reduction - Social support and crosscutting issues
Funding situation for MDR-TB 4,000
3,500
• MDR-TB scale-up plan includes management of 9,300 patients from 2011-2015 • Resources are committed to manage only 2,900 patients during the same period • Shortfall in funding is about US$ 35 million • With current pace only 9% of MDR-TB cases will have access to treatment by 2015 (38% in scale-up plan)
MDR-TB scale-up plan Funding availability
MDR-TB patients to be enrolled
3,000
2,500
2,000
1,500
1,000
500
0 2011
2012
2013
2014
2015
Call for Action and Resolutions • • • •
Beijing call for Action on MDR-TB and XDR-TB, 2009 World Health Assembly resolution, 2010 UNGASS resolution on HIV/AIDS Post-2015 Development Agenda
A NEW GLOBAL PARTNERSHIP: ERADICATE POVERTY AND TRANSFORM ECONOMIES THROUGH SUSTAINABLE DEVELOPMENT The Report of the High-Level Panel of Eminent Persons on the Post-2015 Development Agenda (2013)
The benefits of investing in health outweigh the costs. Every $ 1 spent generate $ 30 for TB and $ 12 for HIV through improved health and increased production.
Who should pay for universal access to TB and HIV services • Patients/households: No – catastrophic health expenditures • Government • Global Fund • Three MDGs Fund • Bilateral agencies • UNITAID • Development banks • Private sector
Conclusion Significant resources need to be mobilized to achieve and sustain universal access to quality TB and HIV care and control The Government needs to increase its contribution to health care Resource mobilization from the Global Fund, Three MDGs Fund, bilateral donors, and development banks must continue Additional technical and development partners need to support the fight against TB and HIV in coordination with the Myanmar Health Sector Coordinating Mechanism Funding for TB and HIV/AIDS control is not enough as activities need to go hand in hand with bold health system policies/development, alleviation of social and economic determinants and intensified research investments
Thank you for your attention!