Effects of GFATM on Georgias Health System Development

1
Effects of GFATM on Georgias Health System
Development

• Sustainability of GFATM program supported
  activities in Georgia
• Dublin, Ireland,
• November 22, 2007 year
• Natia Rukhadze,
• Ketevan Chkhatarashvili
• Curatio International Foundation

2
GFATM Grant Portfolio
3
Key Issue Emerging from Research

• GFATM funding is major contributor towards
  HIV/AIDS and TB financing
• GFATM helped improve the service delivery to HIV
  and TB patients
• Sustainability is the major concern for all
  interviewed by the study

4

• Context of Health Care and GFATM
• Financing in Georgia

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Total Health Care Spending During 2001-2005
Share of GF from total Donor Funding 1.8
Share of GF from total Donor Funding 36.8

• The role of State Budget in financing health care
  has been growing slowly since 2001
• The role of donor funding decreased from 12.1 in
  2002 to 2.8 of THE in 2005

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Volume of Total Health expenditure during
2001-2005

• THE increased from below 500 million Gel in 2001
  to 650 million in 2005
• Donor financing declined while private spending
  and State Budget financing grew

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Total Spending on TB During 2001-2005
GF Contribution was 37 out of total external
funding
Source National Health Accounts/TB sub-account
(CIF/Abt Associates/Care International)
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Volume of Total TB Expenditure During 2001-2005
Source National Health Accounts/TB sub-account
(CIF/Abt Associates/Care International)
While external funding was increasing over years,
State Budget financing for TB also grew but at a
slower pace
9
State funding for TB during 2005-2007
State budget for TB prevention and treatment
programs in GEL (2005 -2007)
Volume of State funding for TB has increased from
4,615,000 GEL in 2005 to 4,981,600 GEL in 2007,
however treatment was prioritized over the
prevention
10
Structure of Expenditures on HIV/AIDS during
2001-2005) Source Ministry of Labor, Health and
Social Affaires
GF became major source of financing HIV/AIDS
activities in Georgia starting from 2004
11
Volume of HIV/AIDS Expenditure During 2001-2005)
While GFATM contributed most funds for HIV/AIDS,
Government funding stood at the same level over
the years
Source Ministry of Labor, Health and Social
Affaires
12
State funding for HIV/AIDS during 2005-2007 years

State budget for HIV/AIDS prevention and
treatment programs in GEL (2005 -2007)

• Volume of state funding has increased for
  HIV/AIDS in 2006, however it was twice decreased
  in 2007 year.
• Treatment is prioritized over the prevention for
  HIV/AIDS too.

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• Epidemiological situation with regard of
• HIV/AIDS and TB
• in Georgia

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EPIDEMIOLOGICAL SITUATION for HIV/AIDS
Number of HIV new cases per year (2002 - 2006)
Source National HIV/AIDS Center.

• HIV/AIDS prevalence remains low (total of 1431
  registered cases), however increasing trend is
  observed over the years (prevalence 3.7 in 2004 -
  5.5 in 2005, incidence rate 11.6 in 2004 -15.3 in
  2005)
• Epidemic is concentrated in HRGs (60.7 of cases
  are IDUs), however detection rate remains low

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EPIDEMIOLOGICAL SITUATION for TB
All registered TB cases (per 100 000 population)
Source NTP Data base.

• Georgia stands at a 4th place among FSU
  courtiers by TB prevalence
• 4290 new registered TB cases in 2005 96
  incidence rate per 100,000 population
• Total 6696 registered TB cases in 2005 146
  prevalence rate per 100,000 population)

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Results of GFATM Funding (indicators achieved in
HIV/AIDS component)
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Results of GFATM Funding (indicators achieved in
TB component)
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Main positive impact of GFATM on HIV and TB
national response

• GF financing has not replaced public funding but
  was additional
• Additional funds from GF helped to
• Achieve universal access to ARV therapy for all
  registered AIDS patients (total of 299) - since
  December 2004 country
• Introduce Methadone Substitution Therapy in the
  country (2 centers are already operational in the
  capital city, another 1 will be opened in Batumi
  next year)
• Decentralize HIV treatment capacity at the
  sub-national level
• Start-up of MDR TB treatment

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Impact of GFATM gradual phase out
GF Investment cost
Funding Gap
State Resources
GF Recurrent cost
10-15 years period
GF funding period
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Issues to Consider

• Macro-economy of Georgia will not allow replacing
  GF funds with State Budget funds in an immediate
  future.
• Rapid withdrowal GF financing will certainly have
  detrimental effect on HIV/AIDS and TB epidemic.
• GFATM should develop policy for gradual phase out
  and reduction of its funding levels planned for
  10-15 years.