Chronic conditions such as diabetes, cancers and heart disease are gradually displacing infectious diseases as the greatest health problem in lower-income countries. The HIV / AIDS crisis bears a number of clinical and practical similarities to this new challenge, providing a useful case study when determining effective strategies. A new literature review by Philip Stevens, the first in a three-part series, examines what can be learned from the global response to HIV / AIDS – and reveals some costly mistakes that should not be repeated.This paper is an attempt to see what lessons for the funding of chronic disease can be drawn from the international response to HIV/AIDS. It reviews the recent academic literature relating to the trade-offs and cost effectiveness of prioritising treatment over prevention; the suitability of donor funding for financing long-term care; the role of private philanthropy; and the impact of HIV funding on healthcare systems and the wider economy.
Amongst the lessons drawn from the literature is the need to prioritise prevention or risk unsustainable future funding gaps for treatment, as is currently happening for HIV/AIDS; the need to de-link funding for chronic diseases from politics to avoid capture by activist and other lobby groups; and the need to explore ways of establishing functioning private risk-pooling and health markets in lower-income countries in order to ensure chronic disease treatment is financially sustainable. Future papers will examine the related issues of production and delivery of medicines.
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