DevEx's John Alliage Morales has a fascinating report out today from Vietnam, where rapidly improving standards of living have vaulted the country up the usual U.N. and World Bank prosperity lists. The problem is, international assistance programs that used to help Vietnam's government buy medicine are starting to get rolled back as the country demonstrates more and more capability to handle its own public health programs. Timing the transition of those aid rollbacks is an inexact science. DevEx found that Vietnam's ability to provide services specifically for HIV/AIDS prevention and treatment are faltering because the international aid pullback has come too fast and been too sharp. Right now, about 70 percent of Vietnam's HIV/AIDS programs are funded by foreign assistance.
A report commissioned by various U.N. agencies last year found that countries with growing middle classes were funding most of their own AIDS-related health and prevention program costs.
DevEx's investigation highlighted a U.K. decision to pull 6.2 million pounds—about nine and a half million dollars—from Vietnam's AIDS programs by 2016. The money isn't being cut entirely from London's foreign aid budget; it's designated for the world's 28 poorest nations, and Vietnam no longer qualifies. And the U.K. isn't the only one, apparently. The U.N.'s office on AIDS expects all foreign assistance to Vietnam on AIDS to reach zero by 2020.
A report commissioned by various U.N. agencies last year found that countries with growing middle classes were funding most of their own AIDS-related health and prevention program costs. But the transition was not easy, and that a shortfall of some $7 billion for such programs worldwide still existed as of 2011. To put that in perspective, the global spending total for AIDS-related programs, including domestic programs and internationally-funded assistance efforts, amounted to $16.8 billion in 2011. Of that, just under half—$8.2 billion—has come from international aid each year since 2008. Still, the U.N. research found that domestic spending on efforts to combat the virus—that means countries paying for their own AIDS-related programs—has surpassed the amount funded by international aid: "Domestic investments have surpassed global giving in 2011," according to the report. "Low- and middle-income countries invested US$ 8.6 billion in 2011. While countries are tipping the balance, international assistance still remains critical and indispensable in the short and medium term."
Several of the so-called "BRIC" countries (Brazil, Russia, India, China) have successfully taken on most of the expense of their domestic AIDS prevention and treatment programs. Brazil funds almost all its own expenses, according to the U.N. study. China's at 80 percent, and India hopes to hit 90 percent soon. Other middle-class nations have had similar success. South Africa funds 80 percent of its AIDS program itself and has "quadrupled its domestic investments between 2006 and 2011."
Seven of every 10 dollars spent on AIDS-related programs globally are for medication, particularly expensive antiretroviral therapies, the U.N. found. Brazil, South Africa, China, India, and Russia are close to paying those expenses themselves. Others aren't quite there yet. In the Vietnamese case, foreign assistance for AIDS programs is expected to reach zero by 2020, giving Hanoi six and a half years to find alternative sources, domestic or otherwise.