THE PROBLEM

As countries experience economic growth and move to middle-income status, external aid for health declines and countries must work towards domestically-funded programs. In Cambodia specifically, external financing for their HIV/AIDS response has rapidly declined in recent years, standing at about $15 million in 2017, and is expected to continue to fall. The impressive achievements of fewer new infections, widespread initiation of ART, and increasing rates of viral suppression (close to 90% for each indicator, against the global goals of “90/90/90”) may be at risk unless the Royal Government of Cambodia and other national stakeholders take steps to address the decline in external financing and preparing for the eventual transition to a domestically funded program.

THE PHAROS SOLUTION

In collaboration with UNAIDS and the Sustainability Technical Working Group in Cambodia, Pharos has conducted a Transition Readiness Assessment to support Cambodia in addressing declining external financing and prepare for eventual transition, while sustaining the gains achieved and driving toward its targets for HIV elimination by 2025. The results from this Assessment were used to develop a Roadmap of priority actions to be taken to address the major risks to sustainability and thus create a smooth pathway to transition.

The Pharos project was carried out in three phases:

Phase 1 (August 2017- October 2017): In the first phase of the project, members of the Pharos team visited Cambodia to examine issues relating to external support, programmatic and epidemiological context, future financing options, the institutional environment, human rights, CSOs and integration of health information systems and services. Through semi-structured key informant interviews, small group meetings, and a preliminary desk review of relevant literature, key transition risks emerged.

Phase 2 (November 2017- March 2018): The risks identified in Phase 1 were further explored during a second in-country mission, supported by in-depth data collection and analysis. Pharos conducted financial analyses to predict the future financing needs of the HIV/AIDS response and possible gaps in the ability of the government to fund the response in coming years. At the end of the second mission, the Sustainability Technical Working Group convened and scored the thirteen identified risks based on their potential severity and their probability of occurring.

Phase 3 (March 2018- July 2018): In the third phase of the project, the Transition Readiness Assessment was used to develop a Sustainability Roadmap. Pharos facilitated a workshop of national and international stakeholders in May 2018 in Phnom Penh and identified mitigating actions to be taken by partners to ensure a successful transition from a primarily externally financed program to a domestically financed program. The Roadmap was finalized in July 2018.

LOOKING AHEAD

With the proper preparation as assisted by this engagement, Cambodia should be able to implement the Roadmap by the end of 2018. Key steps are required, for example, to expand government funding for HIV prevention and AIDS treatment and to continue to contract with Civil Society Organizations to reach key populations such as men having sex with men, female sex workers, and injecting drug users.

Cambodia is one of the first countries to develop an HIV transition roadmap. The approach pioneered in Cambodia may be applicable to other middle-income countries facing transition from donor health aid.

Status: Completed

Team Members Involved: Carl Schutte, Dave Burrows, Markus Haacker, Kelly Flanagan, and Robert Hecht.

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