Health Systems 20/20 Caribbean – Summary of accomplishments for PEPFAR Semi-Annual report (October 1, 2012 – March 31, 2013)

The project aims to ensure long-term financial sustainability for health and HIV programs in the region. Abt Associates leads the project in partnership with the Centre for Health Economics, University of the West Indies (UWI-HEU). National Health Accounts (NHA) exercises are being implemented in Dominica and St. Kitts and Nevis. NHA is a health expenditure tracking methodology that provides comprehensive information on the amount, sources, and uses of public and private expenditures on health and on HIV. Data were collected on health expenditures among governments, donors, non-governmental organizations (NGOs), insurance companies, and employers during the initial phase in 2012. The current phase involves a household health expenditure survey and a survey of health expenditures made by people living with HIV (PLHIV) in each country. Local Ministries of Health are collaborating with Abt and UWI-HEU to draft survey questionnaires, obtain Institutional Review Board approval, and begin recruiting data collectors. In Antigua, the project is strengthening the Ministry of Health's (MOH) capacity for evidence-based financial management of the HIV program by costing services at the primary health care (PHC) level, costing outpatient HIV/AIDS services, and costing services at Mt. St. John's Medical Centre (MSJMC). The HS 20/20 Caribbean team has taken a collaborative approach to implementing these costing exercises to build capacity among country counterparts. Training was provided to counterparts on using costing data for planning and resource allocation, and two local multi-institutional working groups were established to gather cost data. In Grenada, the project developed a scope of work for costing inpatient services for 5 priority health conditions at the island's General Hospital, in addition to costing inpatient and outpatient HIV services. The study will inform the design of a benefits package for a planned National Health Insurance Scheme, which will include coverage for HIV prevention and treatment. This will help ensure greater sustainability for HIV services into the future. In Saint Lucia, a Universal Health Care (UHC) program is being developed, and the project team is working with the Ministry of Health to prepare a "roadmap" for collecting cost data on services that might be covered by the program, including HIV services. A local technical working group has been organized to conduct the cost analyses, and a concept note has been drafted outlining priority costing questions.