Caribbean Regional Strategic Framework

Sustainability

Key to sustainable HIV programming is the capacity of countries to invest to meet nationally-determined priorities and to provide uninterrupted high-quality services. On average, 45 percent of HIV expenditure is currently used for ARVs, resulting in significantly reduced AIDS-related mortality and contributing to declining incidence rates. Reductions in funding would place the lives of an estimated 167,500 people living with HIV and currently on treatment at risk, and could see the Caribbean revert to mortality levels not experienced since the early 1990s.

While a few countries have made good progress in reducing their dependency on external funding of ARVs, 11 countries must still address the challenges of maintaining treatment programmes in the face of looming reductions in donor support, while all must contend with expanding access in line with the 2013 WHO Treatment Guidelines. In the long term, strategic expansion of treatment programmes is an important tool for promoting sustainability, as reducing incidence and controlling the epidemic will ultimately result in cost-savings. In the short term, the cost implications will be that significant and increased funding will be needed. A continued focus on securing reductions in the prices of ARVs by employing a range of mechanisms, including maximising the use of Trade-Related Aspects of Intellectual Property Rights (TRIPS) flexibilities and cost-pooling facilities is critical. This must take place alongside country efforts to develop and implement innovative financing methods, which can support Universal Health Coverage, including dedicated tax levies, visitor health fees, regional health insurance and new private-public partnerships.

Financing mechanisms must be matched with policies and strategies which leverage investments for maximum value for money. Programmes must be targeted at key populations and efficiency measures instituted to increase coverage and impact. An important first step is for countries to develop sustainability plans grounded in the principles of equitable access to quality health services for all people without the risk of financial hardship. In some countries, sustainability planning is well underway and steps have already been taken to increase domestic funding and integrate HIV with other health services.

Strategic objective 6.1: Sustainable financing of national responses.

Expected results:

1. National investment frameworks are developed to achieve universal health coverage with no financial risk to citizens.
2. Sustainable HIV financing plans that increase the share of national funding of programmes in keeping with country capacity are developed.
3. Reductions in the price of ARVs and other medical products and technologies (medication for comorbidities, kits for rapid testing, CD4 and viral load, etc.) are pursued through regional negotiating mechanisms, including pooled procurement and the PAHO Strategic Fund.

Strategic objective 6.2: Policy, planning and evaluation for sustainable high-impact programmes

Expected results:

1. Policies for the sustainability of national programmes are developed.
2. Multiyear sustainability plans, including for human resources, to develop capacity for and transition to full national management and financing of high-quality programming are implemented.
3. Evaluations, including expenditure and costing analysis, of programmes for evidence-informed planning and priority setting are conduct