Colombia

THE PROBLEM

Colombia is an upper-middle income country with an HIV epidemic primarily concentrated among key populations including transgender women, men who have sex with men, homeless people, injection drug users, female sex workers, and prisoners. Despite great strides having been made in increasing access to HIV treatment and insurance coverage of treatment and testing, Colombia’s HIV response has been weakened by a decentralized health system and dependence upon external financing for prevention services, particularly for those dedicated to key populations. Although only 1% of Colombia’s HIV budget stems from the Global Fund, this external support comprises 45% of HIV prevention funding and over 90% of prevention services designated for key populations. Given its rising income status and declining burden of HIV, it is essential that Colombia prepare for its national HIV response for transition from Global Fund support.

THE PHAROS SOLUTION

Through the support of the Global Fund and in conjunction with our partners at Bitran y Asociados, Pharos developed an approach to conducting a Transition Readiness Assessment (TRA) and developing a Transition Roadmap for Colombia’s national HIV response. This project was carried out in conjunction with Pharos’ transition work with Bitran y Asociados in Ecuador and was informed by our past transition and sustainability work in Cambodia and the Dominican Republic. The TRA and Roadmap, which outline key risks to the sustainability of the HIV program through transition, the severity and probability of these risks, and mitigating actions Colombia can take, were developed through a three-phased approach:

Preparation Phase (April – May 2018):
Pharos coordinated a team of high-level international and local consultants with HIV expertise in the region as well as members of the core Pharos staff. The team began the assessment by conducting a desk review of key national documents and interviews with the Country Coordinating Mechanism (CCM) and the Global Fund. This phase involved gathering information regarding Colombia’s HIV epidemiological context, characteristics of the country’s governance, institutions, and human rights, as well as its response to HIV, with a focus on the health system and supply chain, information systems, prevention services, and program financing.

Transition Risk Assessment Phase (May -October 2018):
The Pharos team carried out its first country visit to interview key stakeholders including members of the CCM, civil society organizations (CSOs), as well as government officials of the Ministry of Finance, Health, and Education. Given Colombia’s complex institutional landscape, we also interviewed private stakeholders including insurers and social insurance managers at Gestarsalud, to gain a comprehensive understanding of the key challenges facing Colombia’s HIV response.

Information gathered during the first country visit, in conjunction with knowledge gained from the first phase of the project, was synthesized and used to identify preliminary transition risks to Colombia’s national HIV response and develop the TRA.

Our two HIV specialist, local consultants piloted a new methodology with representatives from CSOs to validate our preliminary findings. These workshops were held in Cali and Medellín.

The Pharos team conducted a second in-country visit to present, validate, and prioritize the preliminary transition risks through an intersectoral workshop held on October 23rd and 24th. This workshop was held in Bogota with stakeholders interviewed during the first visit and was used to validate and refine the preliminary risks and outline strategies country stakeholders could take to overcome these risks. During this phase, a new prioritization and validation methodology was piloted with positive reactions from participants.

Roadmap Phase (October 2018 – March 2019):
The Pharos team incorporated feedback from the second country visit to refine the TRA, which provided a detailed overview of Colombia’s HIV burden and response, as well as the key risks facing the sustainability of the program related to financing, provision of services, institutions and governance, human rights, and civil society.

Inputs from the CSO and intersectoral workshops guided the creation of the Transition Roadmap, which was also refined through the commentary of country stakeholders. The Roadmap outlines key, costed activities, responsible stakeholders, possible financing sources, monitoring indicators and a timeline for Colombia to improve the sustainability of its HIV program through transition. Multiple rounds of revisions from the CCM ensured country approval and ownership of the final products.

LOOKING AHEAD

In March of 2019, Pharos and Global Fund specialists will return to Bogota to participate in a series of meetings with the CCM, the Ministry of Health and multilaterals to finalize and operationalize the Transition Roadmap. With sufficient political support, leadership, and financing, Colombia’s HIV response can be improved and sustained through GF transition to reach the most vulnerable populations in the country.

Status: Ongoing, April 2018 – March 2019

Team Members Involved: Lindsay Palazuelos, Sandra Valderrama, Carlos Alvarez, Diana Gonzalez, Hannah Rees, Jose Gonzalez, and Robert Hecht

For more information, contact Diana Gonzalez at diana@pharosglobalhealth.com.