Trends in National Spending on HIV/AIDS Prevention and Control in Thailand from 2008 to 2013

Background: HIV/AIDS infection has been the major contributor for mortality and burden of disease among Thais for decades. Studies on burden of diseases in Thailand show the increasing DALY loss from HIV/AIDS from 1999 to 2004, but a decreasing trend in 2009 due to the nationwide implementation of the policy on universal access to anti-retroviral therapy in 2006. Objective: To describe trend in magnitude, proportion of domestic and international financing sources, and financial resources allocated for HIV/AIDS prevention and control in Thailand from 2008 to 2013, and to identify factors contributing to effective financial management and monitoring system. Methods: With the application of Guide to Produce National AIDS Spending Assessment (NASA) 2009, a two dimensional matrix of financing sources and beneficiary population by healthcare function was produced. Comprehensive literature review and compilation of secondary data on actual expenditure on HIV/AIDS where available, from relevant financing agencies and institutes were carried out. The most up-to-date country’s GDP for 2010-2013 were retrieved from the website of the National Economic and Social Development Board (NESDB) of Thailand. Total Health Expenditure for 2008-2011 was retrieved from the National Health Account (NHA) database, and the total health expenditure for 2012-2013 were estimated based on the historical growth of Thailand’s total health expenditure. Results: Total expenditures on HIV/AIDS increased significantly from 230.9 million USD in 2008 to 282.9 and 287.3 million USD in 2012 & 2013, respectively. During this 6-year period, spending on HIV/AIDS was highest in 2011 as 330.7 million USD. The share of expenditures on HIV/AIDS as percentage of total health expenditure (THE) increased from 1.9% in 2008 to 2.4% and 2.2% of THE in 2012 and 2013 respectively. The amount of total AIDS spending per capita ranged from 3.3 to 5.1 USD per capita during the studied period. Domestic funding accounted for the majority of the HIV/AIDS financing in Thailand, but most of the spending was emphasized on care and treatment. During 2009-2013, only 13% to 17% of total AIDS expenditure in Thailand was spent on prevention activities. In 2012 and 2013, it was found that only 11% of total spending on prevention was spent on prevention activities for key population including sex workers, MSM, and people with intravenous drug use (PWID). It is noteworthy that most preventive programs, particularly prevention for key populations including sex workers, MSM, and PWID, were mainly contributed by the Global Fund (GF) and other international resources. Domestic resources were mainly allocated for universal access to ART, and care and treatment activities. Conclusions: Thailand has shown its attempt to be self-reliant in combating HIV/AIDS. Nevertheless, care and treatment expenditures overshadow prevention, and most of the preventive programs, particularly prevention for key populations were mainly financed by international financing sources, especially Global Fund. For better efficiency and future cost savings, more investment in prevention programs is essential, especially due to the declining support from international funds. Thailand should mobilize more domestic resources for financing prevention activities, particularly on key populations.