The Global Fund, provider of the lion’s share of money for Cambodia’s $12 million-a-year HIV treatment and prevention program, has told the government it expects it to begin footing more of the bill itself, a push that is prompting worries among local health-care providers.

“We foresee the need for the Cambodian government to make a bigger contribution on HIV,” a Global Fund spokesman said. “The exact amount of available Global Fund funding will not be known until the allocation period starts in early 2017.”

However, the director of the government’s National Centre for HIV, Ly Peng Sun, said it was unlikely the government would be in a position to take on a significant share of the financial burden.

“[According to] government calculations, by 2030, the government would still only be able to provide half of what the Global Fund provides now,” he said.

“Cambodia is still a poor country, and we don’t have the means to cover all the costs.”

He added that the government was in the dark about the Global Fund’s plans after the current funding agreement ends.

“We do not know if the Global Fund will continue funding after 2017,” he said. “But we don’t expect it to stop funding completely, that is too brutal.”

As HIV rates fall to relatively low levels and Cambodia inches toward lower-middle income status, the health sector’s biggest aid donor is apparently reassessing where it puts Cambodia in its order of priorities.

“My understanding is the Global Fund has funding limitations,” said Choub Sok Chamreun, director of HIV NGO Khana. “They see the Cambodian economy is growing, and they think that the government should start taking responsibility for these costs.”

He added that in meetings with NGOs and the government, the Global Fund had said it would not commit to a monetary figure beyond two years from now. “The Global Fund does not have a clear budget after 2017 for Cambodia, because it has to focus on countries that have a bigger HIV problem.”

The consequences for people living with HIV could be catastrophic, Chamroeun added.

“There are about 57,000 on HIV treatment right now, and it will be a nightmare if the Global Fund pulls out and the government does not fill the gap,” he said. “How could [patients] pay for treatment themselves when the majority of people living with HIV are poor?”

Country director for UNAIDS in Cambodia, Marie-Odile Emond, was equally concerned.

“We have no funds secure for HIV treatment after 2017,” she said. “If the current funding dried up, treatment would end and thousands of people would die.”

Emond added the Global Fund had already reduced funding.

“A two-year Global fund grant started in early 2014,” she said. “But because of a shortfall of Global Fund income internationally, we had to stretch the two years’ funding to cover four years, up until 2017.”

However, Emond said there were signs the government may be willing to make up any future shortfall.

“We had to make quite drastic cost savings, so we asked the government for extra funding of the HIV program, and they contributed $3.7 million over three years up to 2017 in addition to the Global Fund money,” she said.

She added that the government also appeared to be seriously considering paying for health personnel in public facilities beginning in 2018, costs currently met by aid donors.

Cambodia’s success in encouraging people to take HIV tests had not only reduced the prevalence of the disease, Emond said, but resulted in a large number of people needing relatively costly drugs for the rest of their lives.

“These people will need treatment for 30 or more years in some cases,” she said. “And we have estimated the cost of treatment alone is $14 million per year, a figure that is unlikely to fall for at least the next five years.”