Kazakhstan can achieve ambitious HIV targets despite expected donor withdrawal by combining improved ART procurement mechanisms with allocative and implementation efficiencies

Background Despite a non-decreasing HIV epidemic, international donors are soon expected to withdraw funding from Kazakhstan. Here we analyze how allocative, implementation, and technical efficiencies could strengthen the national HIV response under assumptions of future budget levels. Methodology We used the Optima model to project future scenarios of the HIV epidemic in Kazakhstan that varied in future antiretroviral treatment unit costs and management expenditure-two areas identified for potential cost-reductions. We determined optimal allocations across HIV programs to satisfy either national targets or ambitious targets. For each scenario, we considered two cases of future HIV financing: the 2014 national budget maintained into the future and the 2014 budget without current international investment. Findings Kazakhstan can achieve its national HIV targets with the current budget by (1) optimally re-allocating resources across programs and (2) either securing a 35% [30%-39%] reduction in antiretroviral treatment drug costs or reducing management costs by 44% [36%-58%] of 2014 levels. Alternatively, a combination of antiretroviral treatment and management cost-reductions could be sufficient. Furthermore, Kazakhstan can achieve ambitious targets of halving new infections and AIDS-related deaths by 2020 compared to 2014 levels by attaining a 67% reduction in antiretroviral treatment costs, a 19% [14%-27%] reduction in management costs, and allocating resources optimally. Significance With Kazakhstan facing impending donor withdrawal, it is important for the HIV response to achieve more with available resources. This analysis can help to guide HIV response planners in directing available funding to achieve the greatest yield from investments. The key changes recommended were considered realistic by Kazakhstan country representatives.sch_iih12pub4673pub

How Aids Changed Everything - MDG 6: 15 Years, 15 Lessons Of Hope From The Aids Response

The AIDS targets of Millennium Development Goal (MDG) 6 -- halting and reversing the spread of HIV -- have been achieved and exceeded, according to this report. Released in Addis Ababa, Ethiopia, on the sidelines of the Third International Conference on Financing for Development, the report demonstrates that the response to HIV has been one of the smartest investments in global health and development, generating measurable results for people and economies. It also shows that the world is on track to meet the investment target of US$22 billion for the AIDS response by 2015 and that concerted action over the next five years can end the AIDS epidemic by 2030.The report celebrates the milestone achievement of 15 million people on antiretroviral treatment -- an accomplishment deemed impossible when the MDGs were established 15 years ago. It also looks at the incredible impact the AIDS response has had on people's lives and livelihoods, on families, communities and economies, as well as the remarkable influence the AIDS response has had on many of the other MDGs. The report includes specific lessons to take forward into the SDGs, as well as the urgent need to front-load investments and streamline programs for a five-year sprint to set the world on an irreversible path to end the AIDS epidemic by 2030

Cross-sectoral co-financing: Taking a multi-payer perspective in the financing and economic evaluation of structural HIV interventions

Background: Global HIV resource needs estimates are ever-increasing. There is growing interest in creating domestic fiscal space and prioritising the most cost-effective interventions. Concurrently, structural drivers and barriers are undermining the efficiency of HIV programmes to deliver on ambitious treatment and prevention targets. Yet, limited HIV resources are being channelled to interventions addressing these upstream factors. Conventional priority-setting and financing frameworks that only consider HIV outcomes and budgets, are further hampering investments in structural interventions that tend to be implemented in other sectors, for other objectives. Opportunities to factor in synergies with non-HIV investments tend to be missed, due to a lack of data on their multiple outcomes; the dominance of single outcome economic evaluation frameworks; and weak incentives for joint financing between sectors. The aim of this thesis is to develop and explore the application of a novel methodological approach for both fiscal space analysis and economic evaluation that considers multiple intervention benefits and multi-sectoral payers. Methods: The research uses a mixed methods approach, including case studies, econometric analysis, economic evaluation, and qualitative interviews, with data from selected countries in sub-Saharan Africa. Results: A ‘co-financing’ approach is developed for factoring non-HIV benefits and payers in HIV resource allocation. It is compared to other economic evaluation approaches, and to a unisectoral conceptualisation of cost-effectiveness thresholds. This approach is then used to explore the potential for creating fiscal space for HIV through co-financing of health system and broader development investments. Co-financing is also applied to the economic evaluation of a food support intervention for people initiating antiretroviral therapy. Finally, the institutional feasibility of adopting a co-financing framework in real-world HIV resource allocation is investigated from the perspective of policy-makers in Tanzania. Conclusion: Co-financing across sectors and budgets could optimise resource allocation and prevent welfare loss, but it will require strong cross-sectoral coordination and institutional incentives

Food for All

This book is a historical review of international food and agriculture since the founding of the international organizations following the Second World War, including the World Bank and the Food and Agriculture Organization of the United Nations (FAO), the World Food Programme (WFP) and into the 1970s, when CGIAR was established and the International Fund for Agricultural Development (IFAD) was created to recycle petrodollars. The book concurrently focuses on the structural transformation of developing countries in Asia and Africa, with some making great strides in small farmer development and in achieving structural transformation of their economies. Some have also achieved Sustainable Development Goals (SDGs), particularly SDG2, but most have not. Not only are some countries, particularly in South Asia and sub-Saharan Africa, lagging behind, but they face new challenges of climate change, competition from emerging countries, population pressure, urbanization, environmental decay, dietary transition, and now pandemics. Lagging developing countries need huge investments in human capital, and physical and institutional infrastructure, to take advantage of rapid change in technologies, but the role of international assistance in financial transfers has diminished. The COVID-19 pandemic has not only set many poorer countries back but starkly revealed the weaknesses of past strategies. Transformative changes are needed in developing countries with international cooperation to achieve better outcomes. Will the change in US leadership bring new opportunities for multilateral cooperation

Food for All

This book is a historical review of international food and agriculture since the founding of the international organizations following the Second World War, including the World Bank and the Food and Agriculture Organization of the United Nations (FAO), the World Food Programme (WFP) and into the 1970s, when CGIAR was established and the International Fund for Agricultural Development (IFAD) was created to recycle petrodollars. The book concurrently focuses on the structural transformation of developing countries in Asia and Africa, with some making great strides in small farmer development and in achieving structural transformation of their economies. Some have also achieved Sustainable Development Goals (SDGs), particularly SDG2, but most have not. Not only are some countries, particularly in South Asia and sub-Saharan Africa, lagging behind, but they face new challenges of climate change, competition from emerging countries, population pressure, urbanization, environmental decay, dietary transition, and now pandemics. Lagging developing countries need huge investments in human capital, and physical and institutional infrastructure, to take advantage of rapid change in technologies, but the role of international assistance in financial transfers has diminished. The COVID-19 pandemic has not only set many poorer countries back but starkly revealed the weaknesses of past strategies. Transformative changes are needed in developing countries with international cooperation to achieve better outcomes. Will the change in US leadership bring new opportunities for multilateral cooperation