As is endemic across many countries in the Latin American and Caribbean region, Ecuador faces an exceedingly high HIV prevalence rates among key populations: men having sex with men, sex workers, prisoners and transgender women. To reach them, the government needs to invest more in targeted HIV services. However, over the past several years the country’s economy has been negatively affected by declining oil prices, prompting the adoption of austerity policies that have put pressure on public funding allocated to the HIV response. While only 10% of Ecuador’s HIV spending comes from the Global Fund, these resources are important in funding efforts by the Government and civil society organizations (CSO) to reach key populations. These efforts could be jeopardized by the expected reduction in external financing as Ecuador prepares for transition from the Global Fund and moves toward domestic self-sufficiency in the next 5-10 years.


At the request of the Government and Country Coordinating Mechanism and with the support of the Global Fund, Pharos’s partners at Bitran y Asociados, backed by Pharos core staff, conducted an HIV Transition Readiness Assessment (TRA) and developed a Transition Roadmap. Bitran y Asociados designed an innovative conceptual framework based on the World Bank Flagship course in health reform, which allowed Ecuador to link sustainability risks to short, mid-term and long-term objectives and to policy actions to mitigate these risks.

Preparation Phase (April – May 2018): The team consisting of two national consultants and two international experts gathered and reviewed documents and carried out interviews to identify sustainability risks in the areas of HIV governance, institutions and human rights, service delivery, program financing and CSO engagement.

Transition Risk Assessment Phase (May – October 2018): In May 2018 the team traveled to Quito to facilitate focus groups with the CCM, CSOs, government officials (Ministries of Health, Planning, Justice and Labor) and international agencies. The team conducted workshops with CSOs in Quito and Guayaquil.

Roadmap Phase (October 2018 – July 2019): The last phase of the project consisted of summarizing the governance, epidemiological, financial and programmatic challenges for the HIV response and drafting a detailed Roadmap to guide the implementation and monitoring of recommendations. During a second visit to Quito in October 2019, priority recommendations were selected and integrated into the recent Global Fund funding request.


Political instability and high turnover of personnel in the Ministry of Health’s HIV Program has hindered implementation of the Sustainability and Transition Roadmap. The signing and launch of the new Global Fund grant has faced many delays as of 2020. Pharos has been requested to provide technical assistance to the MoH to brief the new MoH team and develop terms of reference for several core activities in the Roadmap in 2020.

Status: Completed, April 2018 – December 2020

Team Members Involved: Ricardo Bitran, Xavier Solorzano, Rodrigo Tobar, Paula Arpon, and Diana Gonzalez.

For more information, contact us at [email protected].

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