Funding barriers to ensure universal access to TB and HIV care and control in Myanmar

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!