THE PROBLEM

Jamaica is an upper-middle-income-country in the Latin American and Caribbean region with a high HIV burden of 1.5% adult prevalence – over 32,000 Jamaicans are currently infected. Among those people living with HIV who know their status in 2018, just 53% were accessing antiretroviral therapy, and only 65% of those on treatment were successfully suppressing their viral load. Key populations in Jamaica bear the largest HIV burden with an HIV prevalence of 2.8% among sex workers, 25% among transgender people, and 32.8% among men who have sex with men (the highest prevalence rate in the Caribbean).

Despite these challenges, because of Jamaica’s middle-income status, the country is expecting external financing for its HIV program from the Global Fund and PEPFAR to decline in the coming years. These external agencies currently cover 55% of Jamaica’s HIV spending. In some key areas such as HIV prevention and strategic information systems, Jamaica’s dependence on outside donor support is even larger. At the same time, the government’s ambitious plans to expand prevention and treatment efforts will raise the cost of fighting AIDS in Jamaica well beyond the $28 million currently being invested. It is therefore urgent to prepare now for future reductions in external funding and for increases in domestic resources for HIV.

In 2016, an HIV Transition Readiness Assessment was conducted that identified several risks to Jamaica’s transition from major donor support. However, these risks were never prioritized and solutions were not developed and implemented by the government, leaving the country ill-prepared to handle declines in outside funding, as occurred in 2018-19 when PEPFAR cut its direct support to the Ministry of Health and Wellness (MoHW).

THE PHAROS SOLUTION

At the request of the MoHW and with support of UNAIDS, a Pharos team comprising international and local health systems, civil society organizations, and financing experts is working to develop a Sustainability and Transition Plan endorsed by the government and other key stakeholders and to design a detailed roadmap for implementation. The team is also expecting to work with the MoHW, the Global Fund, and PEPFAR to ensure that the main recommended actions in the Sustainability & Transition Plan are included in the government’s HIV National Strategic Plan for 2021-24 and in upcoming grants and budgets. Pharos’s work in Jamaica builds on its previous assignments in nearly a dozen countries of LAC, Asia, and Africa.

Preparation/Diagnostic Phase (Dec 2019 – Jan 2020) Pharos initiated the project with kick-off meetings with the Jamaica HIV Sustainability and Transition Technical Working Group and conducted an extensive desktop review of documents and interviews with key local and international stakeholders involved in Jamaica’s HIV/TB responses. Sustainability and transition risks were grouped into four areas – financing, health systems, governance, and community responses including contracting with Civil Society Organizations.

Transition Risk Assessment Phase (Feb-April 2020) The Pharos team visited Jamaica in February 2020 and gathered additional information from interviews with officials of the MoHW, ministries of Labor and Finance, the Planning Institute of Jamaica, the National Health Fund and representatives of academic, private sector, and civil society organizations. A debriefing workshop was held at the conclusion of the mission attended by the Permanent Secretary of Health and many others. Preliminary analysis of S&T risks and corresponding recommended actions were presented and approved by the workshop participants. Pharos used the results of the workshop and follow-up interviews to draft its initial Sustainability & Transition Plan.

Validation Phase (May-September 2020) Pharos held a large virtual stakeholder validation meeting at which the Sustainability & Transition Plan was reviewed, revised, and finalized. Sections of the plan have accordingly been incorporated into the new HIV National Strategic Plan. There are also strong signals that the MoHW intends to implement some of the main recommendations in the plan, especially by launching a government-financed scheme to contract with civil society organizations to deliver prevention and treatment services to key populations.

Status: Completed, September 2020

Team Members Involved: Robert Hecht, Diana Gonzalez, Sandra McLeish, Gabriella Desir, Walter Gabriel, Moises Escobar

For more information, contact Robert Hecht at [email protected].