Bridging the Gap Between Health and Finance: How Can Finance Ministries Support a Sustainable HIV Response?

“Achieving an AIDS-free world by 2030 will require dedicated efforts today.” 
—Assistant Secretary Toloui

Since the authorization of the President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, the world has seen tremendous accomplishments in the fight against HIV/AIDS. We’ve managed to transform the disease from a death sentence into a manageable chronic illness. Since 2005, AIDS-related deaths have dropped 29 percent worldwide. In a similar timeframe—between 2003 and 2015—the number of people receiving HIV treatment in low- and middle-income countries increased from 300,000 to 13.7 million. But looming challenges remain: my colleague, Mead Over, suggests the HIV/AIDS population, and thus the accompanying fiscal challenge, is likely to double every 28 years in the world’s poorest countries; HIV/AIDS programs are forecasted to grow (the US already provides about two-thirds of all international spending on HIV/AIDS and in some countries, the US share of total spending on HIV/AIDS remains extremely high). And bridging the gap between the health and fiscal worlds, which all too often fail to speak the same language, may be more important than ever.

At our recent event, “How Can Finance Ministries Support a Sustainable HIV Response?” representatives from PEPFAR and the US Department of Treasury came together to discuss an innovative partnership between them and with finance ministries around the world. The partnership aims to improve the coordination and productivity of resources devoted to combatting HIV/AIDS in low- and middle-income countries, and to strengthen the long-term feasibility of these efforts.

The PEPFAR-Treasury partnership focuses on providing technical assistance to governments on overall resource mobilization and public finance management. It aims to promote:

1. Stronger public financial management of precious health resources
2. Improved engagement and coordination between health and finance ministries
3. Effective mobilization of domestic resources over time in close collaboration with donors

Support from the US Department of Treasury and its Office of Technical Assistance (OTA) is demand-driven, and OTA only works with governments that are committed to reform. This is a tactic to promote country-ownership and self-reliance with the goal of sustainable impact. As Laura Trimble, associate director for Budget and Financial Accountability at OTA explained during the event, OTA works side-by-side with its partners. Decisions are made based on close collaboration between advisors and partners so that OTA advisors can work towards practical demand-driven policy recommendations and changes. There is great hope that with its experience in improving the budget process, increasing expenditure transparency, bolstering human capacity, and linking to system-wide improvements, the US Department of Treasury will offer great skills and expertise to this collaborative effort against HIV/AIDS.

What does this partnership mean for the future of HIV/AIDS programs?

The routinization of this partnership could help normalize and encourage the collaboration of the health and finance sectors to save lives and address diseases beyond HIV/AIDS. Ambassador Birx hopes to see this partnership lead to better data analysis that can help link investment to impact. In the short-term, the impacts of high levels of fiscal uncertainty and the high likelihood of funding cuts in the US still need to be addressed. Throughout the discussions, there was consensus that more needs to be done to improve the efficiency of HIV/AIDS programs, but there was uncertainty about what exactly that entails.

In their policy brief for the White House and the World series, Mead Over and Amanda Glassman made three policy recommendations to increase HIV prevention and adherence to treatment that could prove effective and efficient in the near-term:

1. Experiment with impact-based agreements to align policy, funding, and actions to drive progress towards an AIDS transition, with attention to rights and gender issues.
2. Measure what matters—new infections and AIDS-related mortality—to achieve maximum value for spending through better targeting and alignment of financial support with countries’ own financial commitments and progress on prevention and treatment.
3. Create incentives for co-financing by committing to a floor of support in hard-hit countries and developing matching funds for each additional person tested or on treatment.”

As this PEPFAR-Treasury partnership continues and develops towards long-term achievements in the movement towards epidemic control of HIV/AIDS, PEPFAR may want to consider implementing some of these policy suggestions above in order to accelerate the impact of the partnership. Altogether, these changes provide realistic hope that HIV infections will finally fall below the number of AIDS-related deaths and bring about greater epidemic control.