Birungi, Charles; (2020) Reconciling the irreconcilable? An application of economics to long-term fiscal sustainability of the HIV/AIDS response in Uganda. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This Ph.D. aims to propose a pragmatic approach to the long-term fiscal sustainability of the HIV and HIV response in Uganda. It is motivated by the fact that whereas financing of the HIV response has been among the dominant economic development issues over the last years, it now faces an uncertain outlook. Using a mixed-methods research approach, this Ph.D.’s empirical, theoretical, and methodological contributions improve our understanding of the economics (and politics) of achieving fiscal sustainability of HIV responses. Empirically, I found that Uganda will not “end AIDS” by 2030 despite projected significant reductions in AIDS deaths and new HIV infections by 68% and 80% respectively between 2010 and 2030 under a scale-up strategy, the Fast-Track approach. From a fiscal perspective, the corresponding direct and indirect HIV-induced contingent fiscal liabilities range between 150% and 200% of GDP (in 2015 terms). To cope with these fiscal quasi-liabilities implied by the national HIV response, a novel analytical framework for achieving fiscal sustainability of HIV responses is proposed and, through a proof-of-concept, validated in this Ph.D. Theoretically informed and relying on a set of core principles, behavioral economics-inspired, explicit political analysis and, game-theoretic approaches, I empirically assess the likely evolution of future public spending and revenues through analytic policy simulations and conclude that the fiscal space created from applying this novel and pragmatic approach could meet the above-mentioned HIV-induced contingent fiscal liabilities estimated at US$ 24 billion by 2030. This Ph.D. also explores political economy considerations regarding long-term funding for the HIV response. This Ph.D. hopes to contribute to technically sound and politically achievable approaches to addressing HIV-related long-term fiscal challenges in Uganda and, more broadly, toward literature on the political economy of fiscal sustainability.

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