Collin Mangenah

The looming donor pullback threatens to unravel the commendable progress made so far in the fight against HIV/AIDS. To ensure financially sustainable service delivery modalities that do not leave anyone behind, a sustainability tower consisting of proven strategies, guidelines, products, tools and interventions will be critical.

Successful transition will require clearly articulated transition plans and key stakeholder participation. In addition to donors, national government and local level experiences are essential as we work on a transition framework for sustainability. Lessons can be learnt from countries such as Brazil, itself a middle income country where 500,000 people are on ART on 100% Federal Government funding. Elements of a sustainable model from Ukraine include advocacy for local funding, removal of legal impediments, introduction of new financing models and decentralisation of services to primary health care providers. In Vietnam the sustainable financing of the HIV response is premised on integration of donor funded treatment into the public health system. A period of financial and technical support will also be necessary to assure implementation, adaptation and quality. Encouragingly results of PEPFAR’s Sustainability Index and Dashboard (SID) 3.0 demonstrate that countries are making progress towards a sustainable response to the epidemic.

Shufang Zhang (Global Fund, Switzerland) summed up the session by highlighting the need to ensure sustainability of health system financing. In-order to successfully transition to new funding mechanisms accurate cost analyses will be critical to help understand costs and funding requirements and budget better for programmes both from the national and donor perspectives. It is critical to plan early and to ensure everything can be in place in the short time left. Data will be key to keep us all on track and to see how we are getting better at sustainability over time.