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Today isThursday,19October,2017

Uganda AIDS Commission

We can sustain financing for HIV amid competing priorities

Published in the Observer on 12/July/2017

If the current efforts in local resource mobilisation for HIV/Aids work in Uganda are sustained, the country will very soon be able to provide quality drugs and interventions to all those that need them, making our target of ending Aids by 2030 achievable.

HIV programmes in Uganda remain largely funded by donors, but going forward, they will increasingly have to be funded through domestic sources.

Recent records show that although the government has been increasing its contribution to the epidemic, more than 68 per cent of the spending for the national responses comes from Aids development Partners, 20 per cent from out of pocket (families), 11 per cent from the government and one per cent from the private sector.

Currently, the rising HIV programme costs to meet increased treatment targets as the pandemic matures within a landscape of shrinking donor support is a reality for many low- and middle-income countries.

The key question that many are grappling with in countries including Uganda currently is: how can sustainable funding towards HIV be guaranteed in light of competing public priorities, substantial current investments towards HIV and a backdrop of declining external funding?

The Uganda Aids Commission, working with key stakeholders, has developed a resource mobilization strategy that proposes various approaches to mobilizing local resources including: i) increased government allocation for health and HIV/Aids; ii) Innovative approaches like levies; iii) Efficiency savings by exercising frugality with available resources; and iv) Development partner contributions.

In order to respond to the challenges faced in realising sustainable, domestic financing for HIV/Aids, parliament in July 2014 passed an HIV and Aids prevention and control law which provides for the establishment of the Aids Trust Fund.

The purpose of the fund is to secure a predictable and sustainable means of procuring goods and services for HIV and Aids counselling, testing and treatment.

The monies of the fund shall consist:

- Two percent of the total tax revenue collected from levies on beers, spirits or waragi, soft drinks and bottled water;
- Tax revenue from any other taxable item as may be identified by the minister responsible for finance from time to time;
- Grants, monies or assets donated to the fund through the minister responsible for finance or assets donated to the fund by any foreign government, international agency or external body of persons, corporate or unincorporated; or

- Money received by the fund by way of voluntary contributions.

The regulations are currently being reviewed by parliament and, once approved, will provide a basis for operationalizing the fund. Apart from the Aids Trust Fund, the private sector in Uganda recently launched their strategy of raising local resources for HIV and Aids work – the One Dollar Initiative.

The initiative is now mobilizing businesses and individuals to raise local resources as the only sustainable way of supplementing government’s efforts in this sector.

We all need to be reminded that fighting HIV is not a charity action but an investment; this is why both private sector and government must share responsibility as a public good.

Within this effort of local resource mobilization, we need to be reminded that ongoing efforts in funds mobilisation for HIV and Aids work can no longer be sufficient without parallel positive results and increased efficiency in their use.

Improving efficiency is about preventing more new infections and saving more lives by doing the right thing for the right populations, as well as delivering quality services at the lowest cost.

Uganda Aids Commission will soon release a new efficiency study that shows that considerable resources spent on HIV and Aids work are still being wasted through leakages, inefficient combinations of interventions, and sub-optimal use of medicines and human resources.

Efficiency savings to maximize the use of available resources, although complex to achieve and takes time to filter through the budget process will, therefore, be adopted to demonstrate that the HIV subsector can offer good value for money in a resource-limited setting like Uganda.

Increased attention needs to be placed on prioritising those interventions with proven effectiveness resulting in the best patient and population-level outcomes within the resources available.

To this end, Uganda Aids Commission established the partnership mechanism and this arrangement has delivered significant efficiency gains in terms of reducing duplication.

The recently-launched Presidential Fast Track Initiative on Aids seeks to ensure a value-for-money work ethic in the way both domestic and international funds are allocated and spent – thereby freeing up resources identified from efficiency gains and reinvesting them in critical and prioritised programmes that will enable Uganda have an Aids-free generation by 2030.

The author is acting director general Uganda Aids Commission (Dr. Nelson Musoba)

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