Strategy two: Implementing Innovative Health Financing Mechanisms


In order to make HIV prevention and treatment services available to mobile and migrant populations, the countries need to explore new sources of funding to support their health budgets.

  • The English speaking Caribbean countries and territories follow a central government financing mechanism. This system grants free access to healthcare services for all registered residents within the respective country.
  • The remainder of the Caribbean region’s health systems is based on a social security system. This system requires citizens to possess a social security card to access public health services except emergency services.
  • Both systems are tax funded. The difference lies in the mode of access. All countries and territories rely on a mix of public and private instruments. While the majority of hospital and public health services are paid for by tax funds, ambulatory care (visits to private doctors and specialists) and pharmaceutical services often depend on out of the pocket payments and limited private health insurance (Barrett and Lalta, 2004).


Different challenges faced:

  • Patients seek treatment in other countries. Either because of insufficient supplies of ARV drugs, or to avoid disclosing their HIV status in their domestic environment.
  • The lack of a regional health insurance mechanism and a functioning patient monitoring and M&E system impedes accurate data on patient mobility.
  • The majority of the Caribbean countries have very small populations. Therefore implementing and expanding healthcare services confronts the problem of high unit and per capita costs, specifically with regards to procurement practices.
  • The large differences that exist in the composition and the level of health spending in the different countries.


  • Promoting economies of scale. Collaborators are donors like the Global Fund.
  • Implementing a functional patient monitoring and M&E system at national and regional level to document migrant flows and their demand for healthcare services on a continuous basis.
  • Conducting a feasibility study to assess the cost of setting up the respective systems. So that funding can be allocated in an efficient and equitable manner.
  • More accurate information on health care expenditure by sector will not only lead to identify gaps in funding, but specifically to target the development of health financing mechanisms according to the respective sector involved.