PEPFAR Technical Assistance Support for Health Financing in the Caribbean
Elaine Baruwa, PhD Health Systems 20/20 Caribbean Project Abt Associates Inc. May 2013
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HIV, health systems strengthening, and financial sustainability Financial sustainability of HIV programs linked with
overall health system financial sustainability Need for health system financial planning: Cost escalation? Rising out-of-pocket spending? Increasing prevalence of NCDs? Global recession? Decreased tax revenues? Need HIV program sustainability planning, given decline
in external funding:
What public and private domestic resources can be leveraged?
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Leveraging USG resources for health systems strengthening PEPFAR II has emphasized health systems
strengthening to improve financial sustainability U.S.-Caribbean PEPFAR Partnership Framework aims
to increase HIV program sustainability by:
Supporting health system and health financing reforms
Strengthening and expanding partnerships among public and
private entities
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U.S.-Caribbean PEPFAR Partnership Framework
6 U.S.G. Agencies: CDC, Dept. of Defense, Peace Corps, HRSA, State Department, USAID
12 countries: Antigua & Barbuda Dominica Grenada St. Kitts & Nevis Saint Lucia St. Vincent & the Grenadines
Bahamas Barbados Belize Jamaica Suriname Trinidad & Tobago
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USAID-funded projects working on sustainability in the Caribbean Health Systems 20/20 Caribbean
Strengthening Health Outcomes
through the Private Sector (SHOPS) Health Policy Project Health Policy Initiative MEASURE Evaluation
Caribbean HIV/AIDS Alliance (CHAA) PANCAP 5
Information needs for financial sustainability planning Question
Approach
Example
How much have public and private entities spent on health overall? Is spe di g allocated to the right thi gs?
National Health Accounts (NHA)
St. Kitts & Nevis, Dominica
How much have public and private entities spent on HIV and AIDS?
NHA subaccounts for HIV and AIDS
St. Kitts & Nevis, Dominica
What do HIV prevention and treatment services currently cost?
Costing studies (unit cost estimation)
Antigua, Grenada
Are services being provided more efficiently in some facilities or programs than others?
Efficiency analysis
Haiti
What resources will be needed to support HIV programs adequately in the future?
Financial projections and gap analysis (such as HAPSAT)
Guyana
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Information needs for financial sustainability planning Question
Approach
Example
How much have public and private entities spent on health overall? Is spe di g allocated to the right thi gs?
National Health Accounts (NHA)
St. Kitts & Nevis, Dominica
How much have public and private entities spent on HIV and AIDS?
NHA subaccounts for HIV and AIDS
St. Kitts & Nevis, Dominica
What do HIV prevention and treatment services currently cost?
Costing studies (unit cost estimation)
Antigua, Grenada
Are services being provided more efficiently in some facilities or programs than others?
Efficiency analysis
Haiti
What resources will be needed to support HIV programs adequately in the future?
Financial projections and gap analysis (such as HAPSAT)
Guyana
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Focus example: NHA & HIV Subaccounts Financing Source
Funds Managers
Providers
Functions
NHA quantifies health spending and tracks every health dollar from the original source through the funds manager, to the provider, and finally to the type of health service where it is spent
Focus example: NHA in the OECS NHA health spending
information is urgently needed to:
Understand current health
care use and spending patterns for evidence-based planning Design national health insurance schemes Plan for reduced donor HIV funding
St. Kitts & Nevis and
Dominica are the first in the OECS to collect NHA data and HIV Subaccounts 9
Focus example: NHA in the OECS Household and HIV expenditure surveys
in the field now dissemination in September 2013
What are PLHIV spending out-of-pocket
on HIV care?? What are governments spending on HIV programs??
HS20/20 collaboration with UWI-HEU:
Building regional capacity to conduct future rounds of NHA
Information needs for financial sustainability planning Question
Approach
Example
How much are public and private entities National Health spending on health overall? Is spending Accounts (NHA) allocated to the right thi gs?
St. Kitts & Nevis, Dominica
How much are public and private entities NHA subaccounts for spending on HIV/AIDS? HIV/AIDS
St. Kitts & Nevis, Dominica
What do HIV prevention and treatment services currently cost?
Costing studies (unit cost estimation)
Antigua, Grenada
Are services being provided more efficiently in some facilities or programs than others?
Efficiency analysis
Haiti
What resources will be needed to support HIV programs adequately in the future?
Financial projections and gap analysis (such as HAPSAT)
Guyana
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Focus example: Costing for Improved Policy and Planning in Antigua & Barbuda MOH and HS20/20 estimated
unit costs of:
Primary health care services
HIV and AIDS outpatient clinical
services, including for Opportunistic Infections (OIs) Inpatient care including inpatient HIV and AIDS services
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Antigua & Barbuda costing: Process and findings Process: Collaboration has built capacity of MOH, National
AID“ Progra , a d Mou t “t. Joh ’s Medical Ce tre staff
Selected findings:
Data gaps inhibit understanding of costs
Incremental cost for decentralizing VCT services to Health
Centers estimated at US$30 per person counseled & tested/yr Per person average annual cost for PLHIV on ART estimated at US$1,658 73% is cost of ARV drugs
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Information needs for financial sustainability planning Question
Approach
Example
How much are public and private entities National Health spending on health overall? Is spending Accounts (NHA) allocated to the right thi gs?
St. Kitts & Nevis, Dominica
How much are public and private entities NHA subaccounts for spending on HIV/AIDS? HIV/AIDS
St. Kitts & Nevis, Dominica
What do HIV prevention and treatment services currently cost?
Costing studies (unit cost estimation)
Antigua, Grenada
Are services being provided more efficiently in some facilities or programs than others?
Efficiency analysis
Haiti
What resources will be needed to support HIV programs adequately in the future?
Financial projections and gap analysis (such as HAPSAT)
Guyana
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Focus example: Haiti OVC program cost analysis Analysis of OVC program sustainability Questions What are we spending on what?
What exactly is being provided to how many OVC?
Is there variation? – efficient, inefficient or just variable? What will it cost to meet Haitian OVC needs?
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Unit cost per service per OVC, Haiti $300
Nutrition
Education
Psychosocial
Health
Other
$250 $200 $150
$100 $50 $Under 5 High Under 5 Low 5-14 High 5-14 Low 15-18 High Age categories of OVCs
15-18 Low 16
Implications of findings What exactly is being provided to how many
OVC?
Few
