The Study Of Capital Raising, Distribution And Utilization In HIV/AIDS Prevention And Control In China

Global HIV/AIDS epidemic has become an important issue seriously affecting the Global health and socio-economic development. China's HIV/AIDS prevention and control situation has become more acute, and the government has increased financial input in HIV/AIDS prevention and control work. Meanwhile, international community's financial inputs for the prevention and treatment of HIV/AIDS have increased significantly. This effectively promotes HIV/AIDS prevention and treatment work.China AIDS Roadmap Tactical Support Project (CHARTS) aimed at developing an effective and coordinated strategy to deal with HIV/AIDS, speeding up the prevention and control of HIV/AIDS and long-term planning objectives of the United Nation's HIV/AIDS control in China to achieve the Millennium Development Goals. Sustainable and adequate funding is a prerequisite for the success of HIV/AIDS prevention and control. Efficient funding sources and rational allocation of funds play an important role in developing policy and response strategies to HIV/AIDS epidemic.In this study, the capital raising, distribution and utilization in HIV/AIDS prevention and control was explored through literature review, facility-based investigation and key informant interview. Resource needs for HIV/AIDS prevention and control in the next few years was estimated by the tool, Resource Need Model (RNM), developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS).The main findings and policy suggestions are as follows:1. China has substantially increase capital investment in HIV/AIDS prevention and control, and established a financing mechanism: government investment as the mainstay, sharing burdens, multi-channel funding. The central government has set up special funds for HIV/AIDS prevention and treatment in the annual central budget. Accordingly, local governments have arranged funds in the annual local budget. Raising capital in non-government organization has make progress, especially in international project, which has been the second largest amount of funding in the whole work. At present, funding from the central government and provincial government is huge and stable. They are in the dominant position in the whole work. Regional and county funding have some problems. They are insufficient and always delays. Fundings from international organizations and foreign governments are relatively large amount. However, many of them have a clear direction, so its sustainability is still difficult to expect. Other fundings are smaller quantity and instable. Raise funds through multiple channels faces a number of specific issues.2. From case study of two provinces we found: The main funding sources for HIV/AIDS were central and provincial finance. The fund of Province A was somewhat fairish in terms of total amount, but still very poor in terms of per capita owing to the large population. The fund for HIV/AIDS per capita in Province A was 0.43, 0.80 and 0.54 Yuan (RMB) in 2004, 2005 and 2006 respectively. In 2004, the total amount of fund for HIV/AIDS in Province B was in a low level and only 0.11 Yuan (RMB) per capita, because there was no support from central finance in this year. The fund per capita in Province B was 0.71 and 0.58 Yuan (RMB) in 2005 and 2006 respectively. Correlation analyses showed that local HIV/AIDS epidemic played the key role in allocating fund within the provinces; fund was not allocated simply according to local population size; and the financial transfer payment didn't function in fund allocation within provinces, i.e. the fund from central and provincial financing were not intensively allocated to the less or least developed cities and counties.3. Resource needs for response to HIV/AIDS epidemic in China from 2004 to 2010 were estimated using RNM model. The time series of the total resource needs and resource need for each intervention item were described. The success of the estimation of resource needs using RNM model provided a basis and some experiences for developing China's HIV/AIDS Resource Need Forecasting System.According to the estimation of RNM model, the total amount of resource needs for China's HIV/AIDS prevention and control in 2004 was 4.932 billion Yuan (RMB), and it will reach to 38.601 billion Yuan in 2010. The intervention item whose resource needs will increase most rapidly is condom supply, followed by workplace intervention, policy and administration, Man who has sex with man (MSM) intervention, voluntary counseling and testing (VCT), universal protection, sex workers intervention.4. Policy suggestions:At present in China, there exits a large gap between resource mobilized and resource needed in spite of increased funding and resource mobilization for HIV/AIDS by the government. The government financing was the stable source of HIV/AIDS funding occupying over four fifths of the total fund. Whereas the fund from city and county level governments was only a small proportion, in order to mobilize the responsibility of local government, the respective responsibilities of the central and local governments in response to HIV/AIDS epidemic, particularly in financing, should be clarified through legislation, regulation or policy documents with a pattern of good operability. In a decentralized finance system in China, local government should take the principal responsibility in HIV/AIDS financing , and the responsibility of the central government finance should be to ensure the financing in heavy epidemic and less or least developed provinces through finance transfer payment. The amount of fund from local government of different levels should be set clearly with a dynamic adjustability parallel to the epidemic situation. A simple idea is setting the minimum proportion of the HIV/AIDS fund over the local government financial revenue (or over the expenditure for public health), and this minimum proportion can be set with reference to the local finance capability of developed areas. The gap between fund needed and local financing capability of less or least developed areas could be filled by the central and provincial government through finance transfer payment: the financing unbalance between provinces could be adjusted by the central government through transfer payment and the unbalance within provinces could be adjusted by the provincial government though transfer payment.The budget of HIV/AIDS fund should be developed according to the epidemic situation and response strategy. For instance, HIV/AIDS is spreading from high risk groups to the general population, and the response strategy is transiting from focusing on treatment to focusing on prevention, so the proportion of fund for interventions aimed at general population should be increased accordingly.Applied researches, especially those on policy, strategy and planning, is an indispensable part of response to HIV/AIDS epidemic. The findings of such kind of researches can provide evidence-based suggestions for policy making and planning. A reasonable amount of fund for applied research on HIV/AIDS should be provided in order to encourage such researches and promote dispersing the findings.Scientific estimation of resource needs for response to HIV/AIDS epidemic provides the basis for the planning of resource mobilization and budget. It should be integrated into the strategic response to HIV/AIDS epidemic, both for the whole country and for each province.