Reviewed by Gorik Ooms and Josefien Van Olmen
This paper addresses the concerns about uncertain funding for the HIV AIDS response in low income countries by the international community. It is a useful article for people who work in that domain, but is also significant for people interested in global health governance and international financing of health care and systems. The authors explain how decisions on international funding for HIV AIDS response have been based on a ‘commodity approach’ that encouraged scaling up of numerous strategies in parallel, irrespective of their relative effects. Having observed the disadvantages of this strategy (and the diminishing availability of funds!), they propose an alternative in the form of a ‘strategic investment framework’. They argue that such an approach yields efficiency gains through community mobilisation and synergies between programme elements. They also make estimations about the cost and cost-effectiveness of the proposed framework.
The paper is hopeful, showing the funding universal access for ART and containing the epidemic is feasible, and could be affordable if global policy makers decide to assist individual countries in this endeavour.
However, the authors missed the chance to make a bridge between funding for HIV AIDS and funding universal access to health care. 1000 Euro to invest per lifeyear gained for a person with HIV AIDS cannot be spent on other interventions, which might as necessary or even more cost-effective. Although the High Level Meeting has raised the hopes for new funding, we believe that the proposal expressed in the paper can only be considered within a broader vision about global responsibility for health and for sustainable development.