Organization of Eastern Caribbean States

THE PROBLEM

Because of their rising national incomes and relatively low HIV and TB burdens, the six countries of the Organization of Eastern Caribbean States (OECS) – Antigua, Dominica, Grenada, St. Kitts & Nevis, St. Lucia, and St. Vincent & the Grenadines – are fast approaching transition from Global Fund assistance. The Global Fund is the last major international health donor operating within the region, and upon its departure, the six OECS countries must manage their national HIV and TB programs solely with local resources and personnel. This upcoming transition is expected to increase certain key risks to the disease control programs in these six countries; ongoing threats include limited fiscal space for health, suboptimal progress towards 90-90-90 HIV treatment goals, fractured outreach programs to key vulnerable groups, inadequate monitoring and evaluation of programmatic outcomes, and a resurgence of TB in certain locations.

In order to facilitate a smooth transition from Global Fund assistance, the six OECS countries are seeking to develop a comprehensive plan to assume increasing domestic investment in their HIV and TB programs, sustaining and extending the gains in epidemic control that they have already achieved.

THE PHAROS SOLUTION

At the request of the Global Fund and in partnership with the OECS Secretariat’s HIV/TB Elimination Project Office (HTEP) and the OECS Regional Coordinating Mechanism (RCM), Pharos is developing a set of Sustainability Strategies to support the OECS countries in preparing for the expected decline in Global Fund assistance and progressing towards the goals of HIV and TB elimination. The results from this Sustainability Strategies assessment will be used to create a workplan for the OECS states to address the major risks to the sustainability of their national HIV/TB programs and enhance their readiness for transition to a fully domestic-led HIV/TB response.

This Pharos project is being conducted in three phases:

Phase 1 (December 2019 – February 2020): In this preparatory stage the Pharos team conducted a review of literature and preliminary interviews with country and regional stakeholders. Based upon this research the team drafted a preliminary list of sustainability challenges, risks, and opportunities to be validated though conversations with the Global Fund, the RCM, and other informants.

Phase 2 (March 2020 – April 2020): The Pharos team completed its first mission to the OECS region in early March 2020, conducting additional interviews. At the end of the mission, the team refined its matrix of key risks and solutions and discussed these with the HTEP and RCM Chair. Following the mission, Pharos completed a draft of the Sustainability Strategies report and presented it to the Global Fund and HTEP.

Phase 3 (May 2020 – June 2020): In the final phase of the project, the Pharos team will seek input to the report from government and civil society stakeholders from all six countries to validate and prioritize the transition risks and proposed solutions. This process will help to build consensus on a feasible workplan to implement the main recommended actions. These deliverables are expected in Summer 2020.

LOOKING AHEAD

It is vital for the six OECS countries to commit to implementing the Sustainability Strategies in order to maintain and progress in HIV/TB epidemic control and prepare for the Global Fund’s withdrawal from the region. This can be done by incorporating the main recommended actions of the Sustainability Strategies into national HIV/TB strategic plans and budgets and into the next (and possibly final) regional grant from the Global Fund to the OECS.

Status: Ongoing

Team Members Involved: Devyn Rigsby, Sandra McLeish, Catalina Gutierrez, and Robert Hecht

For more information, contact Robert Hecht at roberthecht@pharosglobalhealth.com.

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