In the last decade, many countries in Latin America and the Caribbean have experienced economic growth with a simultaneous reduction in their HIV burden. Consequently, the Global Fund’s “Sustainability, Transition and Co-financing policy” requires that these countries should develop plans to achieve the sustainability of their National HIV Responses and to prepare for eventual transition towards full national financing. Starting in early 2018, Pharos has been working in three countries of the region where the Global Fund is investing in the HIV response with special focus on key populations (men having sex with men, transgender persons, sex workers, injecting drug users, migrants): the Dominican Republic, Colombia and Ecuador. The different realities in the three countries are striking but they face similar transition and sustainability challenges in three main areas: service delivery, financing and governance.
To solve these challenges and building on our core team’s experience with transition from Cambodia and prior work with Gavi and PEPFAR, our methodology in the 3 countries follows a similar approach:
We set up high-level teams including local consultants with HIV expertise in the countries where we work and members of the core Pharos team with experience in the LAC region and program management. The work starts with a desk review of the key national and regional documents, plus interviews with the Global Fund and key country stakeholders to draft a preliminary set of risk hypotheses.
First country visit:
We travel to the countries to interview and facilitate focus groups with the main stakeholders: the CCM, CSOs, government officials of the Ministry of Finance and the Ministry of Health, think thanks, and other bilateral and international agencies.
Second country visit:
After synthesizing the HIV Response epidemiological, financial and programmatic status and challenges in the country, we go back to the countries to present the main risks that emerged from the background review and the first country visit. Moreover, we organize workshops with the main stakeholders to validate and prioritize the identified risks and to outline the main strategies that would help the country to overcome those risks in the near future.
We deliver a Transition Readiness Assessment (TRA) or Sustainability and Resilience Strategy (SRS) Report to the country which includes a roadmap with the specific strategies and activities that the country needs to carry out in the upcoming years. The roadmap is informed by the key lessons of the project and inputs from the workshop participants. All the products are validated by the key stakeholders to guarantee country ownership and achieve our client’s satisfaction.
The Sustainability and Resilience Strategy for the Dominican Republic
In collaboration with the National HIV Council, the Sustainability and Transition Commission in the DR, Pharos is using its global expertise to facilitate the development of the Sustainability and Resilience Strategy Report for the DR that will contain the main risks to sustainability of the HIV Program and the specific strategies and activities needed to mitigate those risks. This Sustainability Strategy will be part of the new National Strategic Plan for HIV/AIDS 2019-2023 and will include a solid roadmap to guide the country to achieve sustainability in the next five years. Many lessons will be extracted from this experience and we expect this work to be a useful tool for the country stakeholders and for other countries.
Building on our work with local stakeholders in these LAC countries, and with the appropriate leadership, political support, advocacy efforts, and investment in innovative co-financing mechanisms, LAC countries have an opportunity to strengthen their HIV programs to reach the most vulnerable groups and meet the 90-90-90 goals. The analytical and consultation tools being honed in these countries may have application more widely in other transitioning countries. It may also be possible to harvest wider lessons that could be useful to the Global Fund, other global health initiatives, and middle income countries in other regions that face similar challenges.
Status: Ongoing January – July 2018
Team members: Diana Gonzalez, Robert Hecht, Claudia Valdez