Financing the HIV response in sub-Saharan Africa from domestic sources: Moving beyond a normative approach
Financing the HIV response in sub-Saharan Africa from domestic sources: Moving beyond a normative approach
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DOI：
10.1016/j.socscimed.2016.09.027
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发表时间：
2016-11-01
影响因子：
5.4
通讯作者：
Vassall, Anna
中科院分区：
文献类型：
--
作者：
Remme, Michelle;Siapka, Mariana;Vassall, Anna
尽管人们对艾滋病的终结持乐观态度，但艾滋病毒的应对需要持续的资金投入。鉴于国际援助力度有限，各国承担这一责任的意愿和能力将是获得艾滋病毒护理的关键。本文考察了扩大公共艾滋病毒筹资的潜力，以及政府已经在多大程度上利用了这些选择。我们开发并比较了规范方法和经验方法。首先，根据撒哈拉以南非洲受艾滋病毒影响最严重的14个国家的数据，我们估计，公共艾滋病毒筹资的潜在增长来自经济增长、一般收入增加、卫生和艾滋病毒优先事项的增加，以及来自更多非传统和创新来源，包括借款、卫生专项资源、提高效率和补充非艾滋病毒投资。然后，我们采用一种新的实证方法来探索哪些选择最有可能转化为有形的公共融资，基于对92个低收入和中等收入国家政府在2008至2012年间最近一次艾滋病毒支出的横截面计量经济学分析。如果未来五年同时利用所有财政来源，这14个国家的公共艾滋病毒支出可能从每年30.4亿美元增加到108.4亿美元。这可以满足南非、博茨瓦纳、纳米比亚、肯尼亚、尼日利亚、埃塞俄比亚和斯威士兰的资源需求，但还不到其余国家需求的一半。我们的经验结果表明，在现实中，可以创造的财政空间甚至更少(减少了一半以上)，而且只能来自更传统的来源。国际融资也可能挤占公共融资。撒哈拉以南非洲大多数受艾滋病毒影响的低收入国家即使采取非常大胆的措施，也无法在中期为艾滋病毒产生足够的公共资源。未来几年将需要相当大的国际融资。艾滋病毒资助者将需要参与更广泛的卫生和发展筹资，以提高政府的收入和效率。(C)2016年提交人。爱思唯尔有限公司出版。
Despite optimism about the end of AIDS, the HIV response requires sustained financing into the future. Given flat-lining international aid, countries' willingness and ability to shoulder this responsibility will be central to access to HIV care. This paper examines the potential to expand public HIV financing, and the extent to which governments have been utilising these options.We develop and compare a normative and empirical approach. First, with data from the 14 most HIV affected countries in sub-Saharan Africa, we estimate the potential increase in public HIV financing from economic growth, increased general revenue generation, greater health and HIV prioritisation, as well as from more unconventional and innovative sources, including borrowing, health-earmarked resources, efficiency gains, and complementary non-HIV investments. We then adopt a novel empirical approach to explore which options are most likely to translate into tangible public financing, based on cross-sectional econometric analyses of 92 low and middle-income country governments' most recent HIV expenditure between 2008 and 2012.If all fiscal sources were simultaneously leveraged in the next five years, public HIV spending in these 14 countries could increase from US$3.04 to US$10.84 billion per year. This could cover resource requirements in South Africa, Botswana, Namibia, Kenya, Nigeria, Ethiopia, and Swaziland, but not even half the requirements in the remaining countries. Our empirical results suggest that, in reality, even less fiscal space could be created (a reduction by over half) and only from more conventional sources. International financing may also crowd in public financing.Most HIV-affected lower-income countries in sub-Saharan Africa will not be able to generate sufficient public resources for HIV in the medium-term, even if they take very bold measures. Considerable international financing will be required for years to come. HIV funders will need to engage with broader health and development financing to improve government revenue-raising and efficiencies. (C) 2016 The Authors. Published by Elsevier Ltd.