Beyond Vertical Health Programs: Experts Explore Ways to Integrate HIV into Health Insurance
Globally, as of 2017, 37 million people were living with HIV, and at least US$21 billion has been allocated toward the response—the largest disease-specific mobilization of resources in world history. More than half of this amount has been drawn from countries’ own resources. Additional resources must be mobilized to turn the global HIV epidemic around and meet the ambitious targets that UNAIDS and others have set. Yet HIV is mostly absent from discussions on health sector reform and universal health coverage, which focus on mobilizing financing and expanding the coverage of affordable, high-quality essential health services.
As global experts, policy-makers, and civil society representatives met in Liverpool at the Fifth Global Symposium on Health Systems Research (#HSR2018) this month, a key collection of partners organized a critical discussion on integrating HIV services, especially diagnosis and antiretroviral therapy, into the global agenda as essential life-saving interventions. These interventions include legal, policy formulation, technical design, and implementation actions that are increasingly necessary as global funding from development partners for HIV plateaus and more sustainable models for financing HIV programs with domestic resources are needed. While in the past, country programs managed HIV successfully as a vertical program with stand-alone funding streams and systems, the key issue emerging now is not whether HIV should be integrated into universal health coverage-focused schemes and programs, but how.
The discussion took place at a satellite session co-hosted by USAID’s Sustainable Financing Initiative team, HP+, and SHOPS Plus, held during #HSR2018. Susanna Baker of USAID and Arin Dutta of HP+ moderated the session, “Beyond Vertical: Sustaining HIV Service Delivery through Health Insurance.” The session featured a presentation and remarks from Nertila Tavanxi, Technical Lead for Transition and Health System Strengthening at UNAIDS, on the political will needed for integrating HIV into health sector reform and the universal coverage agenda that includes integration into health insurance schemes. Arin Dutta, Senior Technical Director for Health Financing at HP+, then provided a deeper dive into the how and when of HIV service integration into health insurance schemes, offering examples from the project’s work in Indonesia. Caroline Quijada, Deputy Director at SHOPS Plus, spoke about her experience in working with the private sector to deliver HIV services under national programs, including examples from the project’s work in the Dominican Republic. Later, a panel featuring Suneeta Sharma, HP+ Project Director, and Bob Fryatt, Abt’s lead on the recently concluded Health Finance and Governance project, rounded out an engaged discussion with session attendees. The lively debate touched on issues beyond the aforementioned presentations, including whether integration into schemes allows HIV services to be purchased more efficiently, enhancing quality, and whether incentives could be included to reduce thorny issues such as provider-induced stigma and discrimination.
The session was well-received and participants are exploring hosting a follow-on session in Washington, DC.
In addition, two HP+ posters were presented at the HSR2018 main conference: one on total market approach and another on women’s leadership and accountability. The latter poster, presented by RTI’s Christin Stewart, was awarded a “high scorer” prize and will be featured on the conference website soon.