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Table 1 Summary of potential strategies for additional financing of HIV programs

From: Where will the money come from? Alternative mechanisms to HIV donor funding

Options Financing sources Financing agents Recurring funding source Examples of magnitude/feasibility
Earmarked levy or additional taxation for HIV Domestic, private Ministry of Finance Yes • Zimbabwe – 15% of the requested annual funding from the Global Fund for 2014–2016. • Kenya – 15% of the estimated cost of the 2012/13 national HIV response.
Concessionary loans for HIV programs Domestic (when the loan is repaid) Ministry of Finance No • India – A US$255 million concessionary loan to this middle-income country provides 7.8% of the 5-year HIV budget and is to be repaid over 25 years. • Low middle-income countries – Most will find concessionary loans hard to repay, as their HIV programs cost 0.5-4% of GDP.
Debt conversion External Ministry of Finance No • Indonesia – Debt conversion mobilized US$35.5 million for health programs, the equivalent of 15% of the funding needed for the national HIV response of US$241 million. • Pakistan – Debt conversion was the equivalent of 45% of the annual cost of the HIV program. However, HIV prevalence in Pakistan is very low (<0.1%), and with it the required financial resources.
Risk-pooling schemes and special social assistance programs covering HIV services Domestic, public and private Health insurance entities Yes • Social health insurance (SHI) schemes provide 60% of the HIV funding of Chile, and 69% in Colombia; the proportion is substantially lower in the following: El Salvador 10%, Paraguay 11%, Peru 9%, and Uruguay 8%. • Kenya, Malawi, Namibia, Tanzania, and Zambia – Private insurance is less than 6.1% of the national HIV expenditure. • Rwanda – In this low-income country, a health insurance scheme was financially supported by the Global Fund.