Honduras and Guatemala are both lower-middle income countries with high HIV burdens. With some of the highest HIV infection rates in the LAC region, the HIV epidemic has largely been concentrated among key populations including men who have sex with men, transgender women, female sex workers, and the ethnic minority Garífuna population in Honduras. Similarly, the burden of TB in Honduras is concentrated among specific populations including people with diabetes, prisoners, and people living with HIV. Challenges facing the health sectors, including high rotation of human resources and an increasingly decentralized health system, have weakened national responses to HIV and TB and limited its ability to combat drug-resistant forms of both diseases.
Additionally, Honduras lacks a formal mechanism to contract CSOs with public funds to deliver prevention interventions to key populations. Currently, Honduras finances 72% of its HIV response and 36% of its TB response with domestic funds, and the remaining financing stems from external donors like the Global Fund. Given Honduras’ lower income status and higher burden of HIV and TB than many other countries in the region, the Global Fund has stressed that Honduras should improve the sustainability of its national responses such that it can be better prepared for transition from external funding in the future.
While neither country is expected to see GF exit in the next few years (with the exception of the TB program in Guatemala), it is crucial that they start planning to transition efficiently and sustain the gains they have achieved. The Pharos team engaged in this mission to support Guatemala and Honduras in facilitating the Sustainability Strategies (SS) and its corresponding Workplan Roadmaps (SWR).
Pharos partnered with Bitran y Asociados and APMG Health to adapt our previous approach to HIV Transition Readiness Assessments to that of a Sustainability Strategy for HIV and TB in Honduras. Conducted in parallel with our work focusing on the sustainability of the HIV response in Guatemala, the Pharos, Bitran y Asociados, and APMG team created Sustainability Strategies and Sustainability Roadmaps for these two countries. Building on our experience conducting CSO and intersectoral workshops to inform country-specific Roadmaps in Colombia and Ecuador, we adapted these workshop methodologies to identify risks, assess the severity and probability of these risks, and develop mitigating actions to ensure program sustainability in Honduras. Pharos approached this work through three core project phases:
Preparation Phase (October 2018 – November 2018):
Pharos prepared a team consisting of its core staff along with international and local consultants with expertise in HIV and TB in the Latin American region. The team initiated the project by conducting a desk review of key national documents and interviews with the Country Coordinating Mechanism (CCM) and the Global Fund to gain a thorough understanding of the HIV and TB epidemiological context, Honduras’ governance, institutional, and human rights characteristics, as well as its health system’s responses to the two diseases. Areas investigated during this phase also included the country’s HIV and TB supply chains, information systems, prevention services, and health financing.
Transition Risk Assessment Phase (November 2018 – January 2019):
The team conducted its first country visit to Tegucigalpa at the end of November 2018. During the visit, the team interviewed key stakeholders including members of the CCM, civil society organizations (CSOs), as well as government officials of the Ministry of Finance and Health, and the Secretary of Government Coordination. The team also attended a conference on human rights and access to HIV services in Honduras.
Information gathered during this visit, in conjunction with knowledge gained from the preparation phase of the project, was used to inform the creation of preliminary risks to the sustainability of the national HIV and TB responses. These risks were presented to the CCM and prioritized by its members at the end of the first country visit. The prioritized risks and knowledge gained were synthesized to develop the HIV and TB Sustainability Strategy.
The civil society specialist on our team coordinated three workshops with CSO representatives in San Pedro Sula, La Ceiba, and Tegucigalpa in January to validate our preliminary findings and help inform action steps to strengthen CSOs’ role in the HIV and TB responses in Honduras.
The team conducted a second country visit and hosted an intersectoral workshop on January 10, 2019, to refine and validate the identified sustainability risks. The intersectoral workshop was attended by diverse country stakeholders who outlined specific action steps, responsible bodies, and timelines to be detailed in the Sustainability Roadmap.
Roadmap Phase (January 2019 – May 2019):
Following the second country visit, the Pharos team refined the Sustainability Strategy, which provides a detailed overview of the epidemiological context of HIV and TB in the country, Honduras’ responses to the two diseases – specifying aspects of the response including financing, governance and institutions, civil society, and human rights.
Information gathered from the CSO and intersectoral workshops was applied to creating the Sustainability Roadmap, which includes prioritized risks to sustainability as well as key actions to strengthen the sustainability of the HIV and TB responses. Feedback from the CCM was incorporated into the Sustainability Strategy and Roadmap to ensure country ownership of the final products and approval of recommended future actions.
Pharos’ work on the sustainability of the HIV and TB programs in Honduras and Guatemala builds upon our knowledge gained from conducting transition and sustainability assessments in other countries in the region. This work will provide Honduras and Guatemala with the guiding tools to strengthen their national HIV and TB responses and improve their preparedness for eventual transition from GF support. With sufficient political support, leadership, and financing, these programs can be improved to reach the most vulnerable populations in the country. Our findings from this project, as well as past and future work in this area, can be used to inform syntheses of best sustainability and transition practices in the region.
Team Members Involved: Diana Gonzalez, Hannah Rees, Claudia Valdez, Karla Zepeda, Hernan Fuenzalida, and Robert Hecht
For more information, contact Diana Gonzalez at [email protected].