HIV Spending as a Share of Total Health Expenditure

HIV Spending as a Share of Total Health Expenditure: An Analysis of Regional Variation in a Multi-Country Study.

Amico P, Aran C, Avila C (2010) PLoS ONE 5(9): e12997

HIV has devastated numerous countries in sub-Saharan Africa and is a dominant health force in many other parts of the world. Its undeniable importance is reflected in the establishment of Millennium Development Goal No. 6. Unprecedented amounts of funding have been committed and disbursed over the past two decades. Many have argued that this enormous influx of funding has been detrimental to building stronger health systems in recipient countries. This paper examines the funding share for HIV measured against the total funding for health. A descriptive analysis of HIV and health expenditures in 2007 from 65 countries was conducted. Comparable data from individual countries was used by applying a consistent definition for HIV expenditures and total health expenditures from national health agencies to align them with National AIDS Assessment Reports. In 2007, the total public and international expenditure in low and middle income countries for HIV was 1.6 percent of the total spending on health, while the share in sub-Saharan Africa was 19.4 percent. HIV prevalence was six-fold higher in sub-Saharan Africa than the next highest region and it is the only region whose share of HIV spending exceeded the burden of HIV disability adjusted life years. The share of HIV spending across the 65 countries was quite moderate considering that the estimated share of deaths attributable to HIV stood at 3.8 percent and disability adjusted life years at 4.4 percent. Several high spending countries are using a large share of their total health spending for HIV health, but these countries are the exception rather than representative of the average sub-Saharan Africa country. There is wide variation between regions, but the burden of disease also varies significantly. The percentage of HIV spending is a useful indicator for better understanding health care resources and their allocation patterns.

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Editors’ notes: The National AIDS Spending Assessment (NASA) tool developed by UNAIDS applies standard accounting methods to reconstruct all transactions, following the money from the source right through to the beneficiaries. NASA organises financial flows into six areas: financing sources, agents, providers, production factors, HIV spending categories, and beneficiary populations. Its biggest failing is that it does not capture out-of-pocket spending or private insurance expenditures so for this comparative analysis these were removed from the National Health Accounts data sets. In the context of the continuing debate about vertical versus horizontal health financing, this analysis examines whether HIV is receiving a disproportionate share of resources and finds that, if anything, HIV is underfunded globally. HIV has a 1.6% share of overall health spending despite contributing 3.8% of deaths and 4.4% of disability adjusted life years. The only region with higher spending patterns is sub-Saharan Africa but HIV prevalence and population size predicted over 58% of HIV health expenditures and only a few countries may be ‘overspending’ on HIV. Evidence on the extent to which HIV financing has health system strengthening spin-off benefits through training staff, building infrastructure, improving supply chains, etc. would increase the ‘evidence-informed’ part of the debate.