Is the backlash against AIDS-specific funding justified? An examination of the health systems impacts of AIDS spending and a critical review of proposed alternative funding methods

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University of Cape Town

This paper responds to the recent backlash against AIDS-specific funding by setting out the key claims and examining the evidence to determine which criticisms are justified, and which are not. The backlash against international funding for AIDS has taken a number of forms, with some suggesting that the extent of the problem (the HIV epidemic) has been exaggerated and others arguing that UNAIDS programme efforts have been misdirected. A key claim however, is that AIDS-related funding has undermined health systems in developing countries. A primary contributor to the backlash has been Roger England, who asserts that the international AIDS response has produced “the biggest vertical programme in history” and that this funding “could be more effective if used to strengthen public health” (England, 2007: 344). The reasoning behind this argument has been that the sheer scale of international funding for AIDS has not only been unwarranted, but that it has damaged health systems in developing countries by diverting resources from other areas of the health sector (see argument summarised in Nattrass and Gonsalves (2009: 1)). Ultimately the recommendation is that AIDS-specific funding must be curtailed and the resources instead channelled through sector-wide general budget arrangements to support health systems more generally and to allow domestic priorities to direct spending decisions.