Joydeep Sen, Sustainable Financing Technical Advisor, EpiC India
Stephanie Turpin, Innovative Finance Advisor, FHI 360
As India works toward the goal of HIV epidemic control by 2030, a critical milestone in the global fight against HIV and AIDS, it faces a familiar challenge: how to sustainably finance its community-led HIV response. In India, the integration of the National AIDS Control Programme (NACP) with the National Health Mission (NHM) officially commenced in 2021. While significant progress is being made, full integration remains a work in progress under NACP Phase-V (2021–2026) and beyond. Full integration may present several challenges, including interdepartmental coordination to support community-focused interventions and the need to sustain trust with key populations (KPs). A key strategy to address these challenges is ongoing engagement through community-based organizations (CBOs), which play a central role in delivery of client-friendly HIV services within the existing government health system. However, many CBOs struggle to secure the financial resources they need, creating challenges for their long-term sustainability. To address this issue, it is essential to empower CBOs in governance systems and processes and to provide them with the necessary tools and resources to access diversified financing. This ensures that they can continue their critical work and effectively engage with government and other stakeholders to raise awareness about the importance of providing friendly and inclusive services for KPs and people living with HIV (PLHIV).
The current landscape for domestic HIV financing
India’s domestic finance landscape for the community-led HIV response is rich and varied. At the core is the Indian government’s commitment of approximately US$1.88 billion in domestic financing for HIV services for NACP Phase-V. In addition to the government’s leading role, many HIV organizations in India also receive corporate social responsibility (CSR) grants, private philanthropy support, donations from family foundations, and innovative finance for social enterprises. However, a recent study by Sattva Consulting under the PEPFAR- and USAID-funded Meeting Targets and Maintaining Epidemic Control (EpiC) project highlighted a concerning trend: over half of the Indian CBOs engaged in the HIV response rely on a single major funding source. This raises questions about the sustainability and resilience of these organizations. As international and domestic funding patterns shift and as the existing national health infrastructure is leveraged to provide HIV health services to KPs and PLHIV, India’s community-led HIV response need a more diverse and sustainable financial foundation to ensure that HIV services available in public health settings are community friendly and of high quality.
To achieve our goal of ending AIDS as a public health threat by 2030 global goals, there is an urgent need to increase sustainable financing for community-led responses. But it’s not just about money – it is also about investing value in the community for the community.
David Bridger, Country Director, UNAIDS India
USAID is committed to strengthening the sustainability of the HIV response. We support partner government leadership and vision in their HIV/AIDS programs, because we know that strong country ownership is critical to achieve and sustain epidemic control.
Michelle Lang-Alli, Director, Office of Health, USAID India
Exploring solutions
To address this funding challenge, EpiC recently hosted a consultation to envision future funding possibilities for the Indian community-led HIV response. This half-day event brought together CBO leaders, funders (including USAID and the private sector), UNAIDS, implementing organizations, and finance providers.
- Connecting CBOs with CSR: A panel discussion explored how to connect community-led organizations with growing CSR funds in India, which amounted to US$2.25 billion between 2014 and 2023, according to a study by Sattva Consulting. A frank dialogue between CBO and CSR leaders highlighted key challenges. HIV-focused CBOs struggle to secure CSR funding, as HIV programs are often not a priority for corporations. CSR leaders, meanwhile, find it difficult to identify CBOs that meet legally required compliance and reporting standards. This dialogue fostered mutual understanding, paving the way for collaboration to improve access to CSR funding and enhance the impact of CSR initiatives for both CBOs and corporations.
- The role of social enterprises: The event highlighted how social enterprises can contribute to a diversified revenue model for CBOs. An interview with Shyam Konnur, director of the Mist LGBTQ Foundation and its social enterprise QueerBazaar, provided real-world insights into his start-up journey. Konnur described the slow process of establishing Mist LGBTQ Foundation, which was self-funded during its first few years, and achieving rapid growth when it accessed grant funding.
- Scaling social enterprises: An investor panel discussed the types of investments for HIV-focused social enterprises to scale impact, including returnable grants, concessional loans, private investment, impact bonds, and CSR funding. Participants discussed how grant funding is the best fit for organizations in the ideation, business planning, and early start-up phases. More established organizations with reliable revenue flows can access a wider range of loan options. Blended finance, which utilizes philanthropic or concessionary funding to help de-risk private loans, can help organizations as they build their businesses and move toward profitability, bringing new sources of capital to HIV.
- The Social Stock Exchange: Attendees learned about India’s new Social Stock Exchange (SSE) and how CBOs might access funding through this innovative platform in the future. India’s SSE was established to provide a list of nonprofit organizations and provides an alternative fund-raising structure. The SSE is designed to channel funds to entities that create measurable social impact and differ from traditional stock exchanges, which focus solely on financial returns.
The road ahead
For India’s community-led organizations to thrive in the changing landscape, they must start experimenting with new funding models now. By diversifying funding models to include new revenue streams such as CSR grants, social enterprises, and private investment, these organizations can become more resilient and better equipped to promote the continuity and effectiveness of vital HIV and other services for KPs and vulnerable populations.
While the consultation was an important step forward, there is still much work to be done. The consultation highlighted several needs, notably the need for HIV CBOs to enhance their capacity, skills, and knowledge to effectively tap into diverse funding sources. Moving forward, the EpiC project plans to build on this momentum by continuing to provide direct support to CBOs as they seek to diversify their funding. This will include financing workshops, one-on-one coaching, and facilitating connections between CBOs and potential funders.
The road ahead may be challenging, but with continued dialogue, experimentation, and support, India’s HIV response can serve as a model of sustainable, community-led health care for the world.
Featured graphic: Key themes related to the financing of social enterprises, which foster autonomy, flexibility, and innovation, and are crucial for sustaining the HIV response among KPs. Image by Ipsita Divedi/EpiC India