Thailand’s HIV/AIDS program after weaning-off the global fund’s support

Abstract

Background: Though 85% of financing HIV/AIDS program was domestic resources, Global Fund (GF) programs played a significant role in prevention interventions and treatment for non-Thai Key Affected Populations (KAP) and migrants. As upper-middle income country, Thailand is not eligible for GF support. This study identified the remaining challenges and funding for prevention interventions for Thai and non-Thai KAP and migrants if GF supports were to curtail. Methods:Qualitative method was applied including document review and in-depth interviews of 21 key informants who were Principal Recipients, Sub-recipients, provincial level program implementers and policy makers in health financing agencies. A multi-stakeholder consultation workshop was convened to discuss recommendations. Results:The "public financed public services model" where Principal and Agents were the same entities resulted in less accountability than the "contractual agreement" in GF programs where the Principal Recipients, as the Agents were more accountable to the GF as Principal through results based financing. If GF supports were to curtail, impacts on the current programs would be varied from low to high degree of negative consequences. Scale down the scope and targets, while keeping the most critical components were common coping mechanisms. All three, except one, Principal Recipients had difficulties in fund mobilization. Prevention among non-Thai KAP and migrants were identified as the remaining challenge. Conclusions: A pooled funding mechanism from multiple domestic sources was proposed. Replacing the conventional public-financed-public-service by a contractual model was preferable. The GF should continue funding the non-Thai KAP and migrant as transition mechanism. Multi-countries or regional programs especially at the border areas were priorities.

HIV/AIDS health care challenges for cross- country migrants in low- and middle-income countries: a scoping review

“…A recent study by Martin in 2007 suggested over 1.3 million migrants in Thailand were unregistered, about triple the number of registered migrants in that year 83. As a result, the responsibility of taking care of this hard-to-reach popula tion who were often engaged with other populations at risk, eg, men who have sex with men and people who inject drugs, were mostly shouldered by nongovernmental organizations (NGOs) in the country 84. Those NGOs thereby mobilized resources from Global Fund (GF) to support their activities for non-Thai key affected populations and migrants.…”

After Weaning-off the Global Fund's Support-Can Thailand’s HIV/AIDS Program Survive?

“…A majority share of total AIDS spending, 50% in 2015, was used for ART [7] as a result of rapid expansion of ART coverage. The international funding was largely for HIV prevention [1], accounted for 29-42% of total international funding during 2008-2013. However, international partners spending had shifted to Systems Strengthening & Programme Coordination which increased from 32% in 2014 to 41% in 2015.…”

“…Such good governance and accountability should be applied and replaced the current integrated model where MOPH plays two roles: funding and implementation agency where there is limited accountability [1]. The Thai UC Scheme where National Health Security Office is the financing agent which purchases services from the public and private health care providers had demonstrated better accountability to the citizens [10].…”

“…It introduces several policies including increased counterpart financing, differentiation of support [1]. Thailand, an upper middle income country with the GDP per capita of 5,816 US$ in 2015, [2] is not eligible for the Global Fund's support.…”

Elimination of mother-to-child transmission of HIV: lessons learned from success in Thailand

“…The Thai 2014 national PMTCT guidelines are in accordance with WHO recommendations for Prongs 3 and 4, and these overlap in interventions aimed at them. Prong 3 includes testing pregnant women for HIV, providing HIV-infected pregnant women with ART as soon funding from multiple domestic sources has been proposed [56]. More interventions are required to encourage mothers who are HIV-positive to access post-partum care services because 40% do not.…”