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Financing HIV Programming: How Much Should Low- And Middle-Income Countries and their Donors Pay?


  • Omar Galárraga
  • Veronika J Wirtz
  • Yared Santa-Ana-Tellez
  • Eline L Korenromp


Global HIV control funding falls short of need. To maximize health outcomes, it is critical that national governments sustain reasonable commitments, and that international donor assistance be distributed according to country needs and funding gaps. We develop a country classification framework in terms of actual versus expected national domestic funding, considering resource needs and donor financing. With UNAIDS and World Bank data, we examine domestic and donor HIV program funding in relation to need in 84 low- and middle-income countries. We estimate expected domestic contributions per person living with HIV (PLWH) as a function of per capita income, relative size of the health sector, and per capita foreign debt service. Countries are categorized according to levels of actual versus expected domestic contributions, and resource gap. Compared to national resource needs (UNAIDS Investment Framework), we identify imbalances among countries in actual versus expected domestic and donor contributions: 17 countries, with relatively high HIV prevalence and GNI per capita, have domestic funding below expected (median per PLWH $143 and $376, respectively), yet total available funding including from donors would exceed the need ($368 and $305, respectively) if domestic contribution equaled expected. Conversely, 27 countries have actual domestic funding above the expected (medians $294 and $149) but total (domestic+donor) funding does not meet estimated need ($685 and $1,173). Across the 84 countries, in 2009, estimated resource need totaled $10.3 billion, actual domestic contributions $5.1 billion and actual donor contributions $3.7 billion. If domestic contributions would increase to the expected level in countries where the actual was below expected, total domestic contributions would increase to $7.4 billion, turning a funding gap of $1.5 billion into a surplus of $0.8 billion. Even with imperfect funding and resource-need data, the proposed country classification could help improve coherence and efficiency in domestic and international allocations.

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  • Omar Galárraga & Veronika J Wirtz & Yared Santa-Ana-Tellez & Eline L Korenromp, 2013. "Financing HIV Programming: How Much Should Low- And Middle-Income Countries and their Donors Pay?," PLOS ONE, Public Library of Science, vol. 8(7), pages 1-11, July.
  • Handle: RePEc:plo:pone00:0067565
    DOI: 10.1371/journal.pone.0067565

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    References listed on IDEAS

    1. Kenneth C Shadlen, 2012. "The Mexican Exception: Patents and Innovation Policy in a Non-conformist and Reluctant Middle Income Country," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 24(2), pages 300-318, April.
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    4. Lordan, Grace & Tang, Kam Ki & Carmignani, Fabrizio, 2011. "Has HIV/AIDS displaced other health funding priorities? Evidence from a new dataset of development aid for health," Social Science & Medicine, Elsevier, vol. 73(3), pages 351-355, August.
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    Cited by:

    1. Olivier C. Sterck, 2018. "What goes wrong with the allocation of domestic and international resources for HIV?," Health Economics, John Wiley & Sons, Ltd., vol. 27(2), pages 320-332, February.
    2. Sterck, Olivier, 2016. "Natural resources and the spread of HIV/AIDS: Curse or blessing?," Social Science & Medicine, Elsevier, vol. 150(C), pages 271-278.
    3. Remme, Michelle & Siapka, Mariana & Sterck, Olivier & Ncube, Mthuli & Watts, Charlotte & Vassall, Anna, 2016. "Financing the HIV response in sub-Saharan Africa from domestic sources: Moving beyond a normative approach," Social Science & Medicine, Elsevier, vol. 169(C), pages 66-76.

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