Working Group on Sustainable Financing



Background and Rationale

The newly configured UNAIDS/World Bank Economics Reference Group (ERG) will bring together senior health economists and other HIV experts to discuss strategies and provide advice for the global HIV response.  The goal of the ERG is to improve the efficiency, effectiveness, and sustainability of HIV programs in low and middle-income countries by generating knowledge and insights that improve decision-making for those programs globally and locally.  The ERG will operate primarily through three Working Groups to produce technical inputs in specific areas:

  • Costing and technical efficiency;
  • HIV allocative efficiency and effectiveness; and
  • Sustainable HIV financing.

These TORs are intended to guide the Working Group on Sustainable HIV Financing. The expansion of access to HIV treatment over the last decade, which is keeping more and more HIV-infected people alive, has made it increasingly imperative that countries and their external partners adopt long-term financing strategies for the global HIV response. While the number of new infections is declining, there are still nearly two million persons newly infected with HIV each year, requiring the continued investment of billions of dollars annually in robust prevention programs comprising a wide range of interventions. At the same time, fiscal pressures on donor governments, accelerating rates of economic growth in Africa and other developing regions, and a desire by some low and middle income countries to reduce their dependency on external funding for AIDS programs, are leading to rapid shifts in the overall dynamic of AIDS financing patterns and strategies.

Given these developments, there has never been a greater need for global AIDS financing policy leadership of the kind that the new Working Group can offer. The ERG’s Working Group on Sustainable Financing (WGSF) can play a vital role in generating the essential “global public goods” – including creating and sharing vital data, tools, and experiences with AIDS financing; advising policy options; and linking AIDS financing to the larger area of sustainable health financing, including the current moves by many countries to establish systems for Universal Coverage.


Under the auspices of the ERG, the WGSF will be a central forum for sharing ideas, setting priorities, suggesting areas for policy research and experimentation, and reviewing progress and challenges. The Working Group will provide strategic direction on the policy implications of this research and experimentation and will translate it into specific advice for action on issues related to the sustainability of the HIV response.


Proposed activities of the Working Group may include but are not limited to the following:

  • Reviewing and assessing evidence related to the sustainability of HIV responses, and suggesting to others or commissioning directly (dependent on budget availability) research in areas where there are knowledge gaps;
  • Proposing principles for shared financial responsibility and global solidarity for HIV responses;
  • Drafting review papers and policy briefs on various options for sustainable financing, including new and expanded sources of domestic funding as well as innovative types of external financing;
  • Helping developing prototypes for multi-partner country compacts between national governments and external financing partners, building on existing agreements,
  • Supporting the design of principles and analysis of options for country allocations formulas and processes by major funding institutions such as the Global Fund;
  • Designing improved methods and tools for monitoring  expenditures and financial performance by domestic and external funding institutions;
  • Documenting best practices and lessons learnt;
  • Contributing to the training of UNAIDS investment and efficiency advisors in key regions and countries, and to the building of the capacity of LMIC governments and policy institutions to design and implement sustainable financing programs; and
  • Participating in global and regional consultations on sustainable financing for Africa, Asia, Latin America, etc.


At various intervals throughout and at the end of the WGSF’s two-year initial lifetime, the Working Group will produce specific deliverables that flow from the activities listed above. While the initial plan and timeline for deliverables will be decided at the first meetings of the WG, the following are illustrative examples:

  • A literature review of existing evidence and analyses on the sustainability of the HIV response globally and in several priority countries, with conclusions on gaps in the research and in the translation of research into practical policy guidance for global health organizations and countries;
  • Policy research papers on different issues in sustainable financing, such as (a) how best to measure domestic effort and ascertain levels of national affordability; (b) innovative sources of domestic financing and how to harness them; (c) challenges of pooling external funding and extending the length and predictability of donor commitments; (d) how to make the case to national finance ministry officials for expanded domestic financing, from a sustainability perspective.
  • A report on a generic model for developing country government-(multi-) donor compacts, with an illustrative discussion of how the model would be tailored and tied to operational plans in specific countries;
  • Policy options papers on integrated approaches to improving the sustainability of HIV financing, including the incorporation of HIV prevention and AIDS treatment in benefits packages financed through national health insurance programs, and the use of supply side and demand-side instruments to fund AIDS interventions in order to improve access, efficiency, and quality;
  • Submission to a peer-reviewed journal of individual papers and potentially of a commissioned series on sustainable AIDS financing.

Reporting Lines and Expected Interactions

For the first two years of its existence, the Working Group on Sustainable HIV financing is a standing working group of the newly-formed ERG. As such, the chair of the Working Group (UNAIDS Secretariat) will provide periodic updates to ERG members, and prepare specific items for ERG consideration within one month before ERG meetings.

The Working Group on Sustainable Financing will be led by UNAIDS and will have a membership of a maximum 20 members, to ensure that it is a compact body. Invitation will be based on the technical qualifications of prospective members, and at the same time ensure that there is wide representation from low/middle income governments, multilateral organizations, bilateral agencies, non-governmental organizations, and academia.
Members will serve on the WGSF for a period of two years and will receive no remuneration for services (apart from reimbursement of costs related to WGSF meetings).

WG members will be expected to participate regularly in the WGSF meetings and conference calls.

WG members will not be disqualified from taking on work commissioned by the WG, provided that they are not involved in the selection of the persons/institutions contracted by UNAIDS on behalf of the WG.

Timeframe and Management of the WG

The Working Group on Sustainable Financing will operate for an initial period of two years, and will meet not less than once every six months during this time. As the responsible institution for the Sustainable Financing Working Group, within the new ERG structure, UNAIDS will set up and operate the WG’s secretariat, and will ensure that agendas, key readings, draft AIDS financing policy papers, etc., are circulated in advance of each meeting.  UNAIDS will also commission background analysis for the WG.  Materials on the WG and its activities will be posted on the ERG website to facilitate information sharing among members, and potentially to support public dissemination of key products.