Action on domestic resource mobilisation is essential to end AIDS

UNAIDS and WHO are concerned that the pandemic will result in increased HIV infections, and is exposing weaknesses in health systems that are struggling to cope with the extra finances needed to address the pandemic.

For HIV advocates trying to mitigate the wider impact of depleting donor funding, Global Fund transitions and lack of political will to address the HIV prevention crisis, the pandemic couldn’t have come at a worse time. And as countries strive to implement universal health coverage by 2030, it will be crucial for HIV advocates to better understand domestic health budgeting mechanisms.

For example, how are health insurance schemes formulated to ensure that marginalised people have access to the services they want and need? What must communities do to influence these processes and hold governments accountable for budget spend?

Community-based organisations are well positioned to advocate for the health needs of marginalised people. But recent analysis of financing to help end AIDS by 2030 says there needs to be a rapid scale-up of funding for effective HIV programmes. However, programmes targeting population groups most affected by HIV received only 2% of all HIV funding, even though these key populations accounted for over half of all new infections.

Demystifying domestic resource mobilisation

Community based organisations tireless efforts to advocate for health rights for marginalised people can be diminished by lack of knowledge around HIV health financing and how to effectively advocate around national and regional budgets. This can limit the engagement and influence they have with governments and other decision-makers. With many competing priorities, not least the COVID-19 pandemic, it is critical to understand and focus on including the needs of marginalised and key populations in health financing decisions.

With resources for HIV reducing globally, countries must support sustainable programming through domestic resource mobilisation. Countries in transition from low to middle income status face further cuts from international funding sources and domestic resource mobilisation is seen as a ‘pathway’ to sustainable HIV health financing.

Under our Partnership to Inspire, Transform and Connect the HIV response programme in four countries – Indonesia, Kenya, Nigeria and Zimbabwe – our partners are working with marginalised people, including: people who use drugs; lesbian, gay, bisexual and transgender people; and adolescent girls and young women. And we have been building the capacity of our partners to effectively influence how governments allocate resources. The focus is on advocating for increased budget to work with marginalised people in local, regional and national contexts.

Developing budget advocacy tools

National organisations are also taking a focused approach to improve access to resources for marginalised people by developing a tailored curriculum and advocacy tools, using country analyses, which includes a review of the HIV health financing landscape and laws and policies that affect resourcing. These will support partners to develop the skills they need to influence national budgeting processes.

For example, in Nigeria, partners are focusing on national health insurance reform and a push towards universal health coverage. Kenya and Zimbabwe have conducted roundtable meetings with key stakeholders to influence and advocate for improved budget considerations for HIV, key populations and adolescent girls and young women. In Indonesia, after a training-of-trainers the curriculum will be rolled out in seven provinces.

This unique country-focus approach to develop the materials, tools and training is an opportunity to introduce difficult concepts to public debate on national budgets. It uses the language and landscape that community activists live and work in, to shape understanding of the national budgeting process and outline how to advocate for increased resources for marginalised people.

Next steps for community activists

Community activists can use budget advocacy to:

• Become active and learn how the decision-making system works and how to participate in policy and budget development and enactment.
• Improve the efficiency of the resources that are already available.
• Improve transparency and accountability.
• Raise issues around public spending and health – engage and work with the media and other community groups and activists.
• Increase the share of the overall budget and prioritise programmes within the health budget for key population and marginalised groups.

We need to look to continue supporting health advocates and communities and enable them to confidently participate and strategise for greater inclusion in funding decisions and driving change.