Because of their rising national incomes and relatively low HIV and TB burdens, the six countries of the Organisation of Eastern Caribbean States (OECS) – Antigua & Barbuda, 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.

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.


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 Sustainability Strategy 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 Strategy 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 has been 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 validated though conversations with the Global Fund, the RCM, and other informants.

Phase 2 (March 2020 – June 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 Strategy report and presented it to the Global Fund and HTEP.

Phase 3 (July 2020 – November 2020): In the final phase of the project, the Pharos team sought 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 built consensus on a feasible workplan to implement the main recommended actions.

Extension (January 2021 – March 2021): With the regional HIV and TB Sustainability Strategy in hand, each of the six countries looked for specific and concrete actions tailored to their own national needs. As such, the Global Fund engaged Pharos for an extension to help develop specific Country Action Plans (CAPs) in each island. Pharos held workshops with national stakeholders including government officials, finance representatives, CSO leaders, and members of the key populations. The Pharos team built out a total of six tailored CAPs for each country and collaborated with the RCM to ensure any potential Global Fund regional funding for these initiatives.


It is vital for the six OECS countries to commit to implementing the Sustainability Strategy framework 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 Strategy 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: Completed

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

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

LEARN MORE about Pharos Global Health Advisors response to the COVID-19 pandemic.