THE PROBLEM

Cambodia’s HIV and TB programs face growing funding gaps as international donors pull back support as a result of USAID cuts and uncertainties surrounding continued Global Fund support, as well as Cambodia’s improving income status which requires donors to reduce their funding levels. Cambodia must proactively assess its readiness to continue delivering services currently funded by external partners, prioritize essential investments, and identify clear financing pathways for the near term. Cambodia must also formalize its capacity to contract civil society organizations (CSOs) and private actors to preserve continuity of services, as well as explore strategies for expanded domestic resource mobilization.

THE PHAROS SOLUTION

Pharos Global Health Advisors has been engaged to conduct a situation assessment of the Ministry of Health’s (NCHADS/CENAT) capacity to contract non-state actors for HIV and TB prevention, testing, treatment, and care services. Based on identified needs, Pharos will develop a joint HIV/TB sustainability and transition plan, including formalization of contracts and partnerships between the Cambodian government and non-state actors. This project will also examine risks and challenges in mobilizing additional domestic funding for HIV and TB, considering the country’s fiscal environment and government policies to integrate HIV and TB care into primary healthcare services and expand social health insurance.

This project, focusing on TB sustainability, was initially supported through funding from USAID, but work was put on hold after the US agency-wide funding freezes were announced in early 2025. The project was re-launched in July 2025 thanks to fresh funding from the Government of France via L’Expertise France. It builds on Pharos’s earlier pioneering work on the Cambodia HIV Sustainability and Transition Plan (2018). The inception and kick off report for the initial TB sustainability work is shown below.

The project is especially important for Cambodia because the country has made tremendous progress in fighting HIV (exceeding the global 95-95-95 goals and on the path to elimination of AIDS as a health threat) and TB (annual TB mortality decreased 45% between 2000 and 2022 and incidence declined 8.5% from 2015 to 2023) – gains that need to be preserved and deepened as the country lowers its dependence on outside funding.

Pharos will center its work around three main pillars:

Pillar I: Assessment and design of MOH’s (NCHADS/CENAT) strategy to contract non-state actors to deliver HIV and TB prevention, testing, treatment and care services. This includes a detailed assessment of current processes and capabilities for contracting non-state actors, mapping legal, policy, and budgetary strengths and gaps, providing recommendations to address identified gaps, and developing a roadmap to implement the proposed strategy.

Pillar II: Revision of HIV/TB transition and sustainability plans. These plans will focus on ensuring continued contracting of non-state actors and mobilizing increased domestic funds to address the expected withdrawal of outside financing over the next few years. Activities include reviewing existing HIV and TB strategies, projecting funding needs to 2030, and developing a joint HIV/TB transition and sustainability plan with proposed progressive absorption of funding by the state, a costing of the plan, and draft Standard Operating Procedures (SOPs) for formalizing contracts.

Pillar III: Capacity building for non-state actors. Pharos will review existing guidelines and develop new training materials to educate non-state actors on procedures for collaborating with the MOH on HIV and TB response programs.

LOOKING AHEAD

With extensive prior experience in Cambodia on HIV sustainability and a global track record in HIV and TB sustainability and transition strategies, Pharos is well-positioned to support Cambodia in navigating these critical transitions. The project aims to develop comprehensive, actionable roadmaps that will enable Cambodia to preserve its health gains and transition to a more sustainably financed, domestically owned HIV and TB response.

Status: Ongoing

Team Members Involved: Michael Elhardt, Premprey Suos, Joan Tallada, and Robert Hecht.

For more information, contact Robert Hecht at [email protected].