Namibia is globally recognized as having one of the strongest HIV treatment programs and is one of the few countries on course to meet its 90-90-90 goals, with 86% of all PLHIV 15-64 years aware of their status, 96% of those aware on antiretroviral treatment (ART), and 91% of those on ART virally suppressed. New HIV infections have also declined from over 10,000 annually in 2010 to less than 6,000 in 2018, and prevention of mother to child transmission is nearly universal, with over 95% of pregnant women living with HIV on ART.
Despite these impressive achievements, the future of Namibia’s AIDS epidemic remains uncertain. The two main funders, PEPFAR and the Global Fund, have indicated that they plan to draw down their support to focus on other countries with weaker programs, with PEPFAR funding declining up to 10% per year from 2020 to 2024 and Global Fund support likely only to continue through the next funding cycle (2021-2023) and ending thereafter. At the same time, the government has faced slow economic growth and severe fiscal constraints over the past few years, with limited signs of improvement in the near future. In all, total funding for HIV is expected to fall by almost 30% by 2025, compared to 2018 levels.
Given the large burden HIV still places on society and the growing urgency to counter declining donor funds, sustainability planning has increasingly become more integrated into the HIV response framework in Namibia. Policy makers see sustainability planning, both from a financial and programmatic angle, as the critical step to achieving HIV epidemic control and simultaneously making progress on other health priorities, such as expanding universal health coverage in a resource limited setting. An update of the Namibia Investment Case from the Investment Case 1.0 undertaken in 2015-2016 has been identified a critical input to developing the national sustainability plan, because it will explore what the required resource levels and funding gaps would be over the next 10 years under different assumptions of program targets, efficiency, and external and domestic financing.
The Ministry of Health and Social Services, with support from UNAIDS, requested Pharos to lead this update of the HIV Investment Case in Namibia, building on Pharos’s robust investment case expertise and recent experience in Tanzania. The overall objective of Investment case 2.0 (IC 2.0) was to analyze options for Namibia to achieve its HIV/AIDS targets and goals under uncertain and likely declining donor financing, and to make recommendations that can be used in the national HIV sustainability plan, the next national strategic framework annual budgets, and the operational plans of PEPFAR and the Global Fund. The IC 2.0 findings can also be used by Ministry of Health and Social Services to advocate with the Ministry of Finance for funds to fight AIDS.
In collaboration with Avenir Health, six investment scenarios — two target-driven and four resource-constrained transition– were defined and modelled to inform sustainability planning:
Given the anticipated decline in donor funds, a series of transition scenarios examined future possibilities for the Namibia HIV program based on varying countermeasures by the government.
Initial stakeholder consultations and feedback on this framework and scenarios were collected in July 2019. We conducted modeling and analysis in the fall of 2019, and a first draft of the investment case was presented in December 2019.
The final validation meeting for the IC 2.0, originally planned for spring 2020, had been delayed due to the strains of the Covid-19 pandemic. Despite this setback, the IC 2.0 framework and analysis will become even more critical as Namibia emerges from its Covid-19 response and both domestic and external resources for health are even more constrained. Pharos remains in communication with the Namibia UNAIDS office to support efforts to disseminate and present the IC 2.0.
Status: Completed, June 2020
Team Members Involved: Lindsey Hiebert, Steve Cohen, and Robert Hecht.
For more information, contact Robert Hecht at [email protected].