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

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.