The private sector role in HIV/AIDS in the context of an expanded global response: expenditure trends in five sub-Saharan African countries
A relatively unexamined aspect of the global HIV response is the role of the private sector in financing HIV/AIDS services. This paper examines trends in private sector financing, management and resource consumption related to HIV/AIDS in five sub-Saharan African countries: Kenya, Malawi, Rwanda, Tanzania and Zambia.
The progression of the HIV epidemic, coupled with the evolving nature of the global HIV response from emergency to sustainability, suggests that the private sector may play an expanded role in meeting HIV/AIDS needs in the future. Nevertheless, findings indicate that:
- private sector contributions decreased in all countries except Tanzania
- with regards to managing HIV/AIDS funds, private for-profit entities are managing fewer HIV/AIDS resources since the donor influx
- the majority of HIV/AIDS funds were spent in the public sector; an amount was spent at private facilities, largely fuelled by out-of-pocket (OOP) payments
- OOP spending by people living with HIV decreased, with the exception of Malawi.
The authors point that the reduction in private sector investment and engagement raises concerns about the sustainability of HIV/AIDS programmes over the long term, particularly in light of current global economic crisis.
- several factors support the need for an increased role for the private sector in the HIV response
- there is an increased political will on the part of global HIV initiatives to seriously consider the private sector as a partner in achieving universal access goals
- better integration of the private sector into the overall health system could reduce duplication, ensure greater sustainability of service provision and ultimately lead to improved health outcomes.