Sustainable financing for HIV is possible

Health Cabinet Secretary Dr Cleopa Mailu

NAIROBI: Three weeks ago, Heads of State met at the 71st session of the UN General Assembly to deliberate on the status of HIV and AIDS globally. The global report on the gains made on HIV and AIDS treatment showed that by the end of 2015, 17 million HIV-positive individuals had been initiated on ARV treatment against a target of 15 million.

An even more ambitious target is to enrol 30million people, including 14.7 million in sub-Saharan Africa by 2020.
To achieve these goals, the world committed to raising the necessary $26billion by 2020 and Governments committed to increase domestic financing.

To illustrate this need in layman’s figures, the costs of delivering anti-retroviral therapy, primarily generics, is currently approximately $200 per person per year.

For the 940,000 Kenyans who are already enrolled in ARV programmes, the cost of purchase of ARVs, delivery and necessary laboratory tests per annum per HIV-positive individual is approximately Sh18.4 billion in the current financial year, which is nearly 30 per cent of the national Ministry of Health budget. With my ministry’s launch of the new HIV test and treat guidelines that aim to initiate all 1.5 million people living with HIV on treatment, this cost will double.

When treatment of opportunistic infections including cancers is included, the resource requirements are astronomical. It is for this reason that the Government is focused on both short and long-term strategies to secure sustainable health financing.

The first step is to make HIV treatment a part of social health insurance in the context of Universal Health Coverage.

Thus, the National AIDS Control Council (NACC) and the National Health Insurance Fund (NHIF) are currently exploring the feasibility, optimum packages, risk pooling and financing options that will make this approach viable with a plan to start implementation within 18 months.

The second is to capture the fragile window offered in the next five years to stem the rise in new infections. Data shows if this is not done, there will be a rebound of the epidemic in the 2020s. Thus, in the current financial year, we have allocated more resources to interventions in particular targeting adolescents and young people who accounted for 50 percent of the new infections in 2015.

The Maisha League has ambitious targets to reach 3 million in and out of young school people with HIV education and 1 million with testing and linkage to ARV treatment for those testing positive by December 1, 2016. The role of counties, most of who are launching their County AIDS Strategic Plans in local investments to supplement national government efforts, remains essential.

In the longer term, commodity security becomes a priority as Kenya aims to reduce dependence on donor financing for HIV. The current costs of HIV-related commodities including HIV test kits, ARVs, laboratory agents is approximately Sh22 billion in the financial year 2016/17 and are set to rise to Sh34 billion by 2018/19.

The urgency to increase manufacturing capacity of quality drugs by African countries, to promote the use of science and technology is captured in the African Union road map on shared responsibility and Global solidarity for AIDS, TB and Malaria Response and was deliberated at the sustainable financing meeting in the East African Community one week ago.

In taking leadership to this agenda, Kenya will in November 2016 host the East African Health Investment Summit, which aims to engage the private sector as a partner in health-care delivery and to inject the much-needed investments throughout the value chain of production and access to medicines.

Finally, the optimal long-term strategy is to have a national resource envelope that provides resources annually to fund HIV treatment and other health conditions.

A HIV fund that supplements exchequer resources is an imperative to provide funds for the proposed NHIF packages, purchase commodities from local manufacturers, invest in local research and priority interventions.