Success story: Tracking HIV spending to build financial sustainability in St. Kitts and Nevis

Kitts and Nevis was a groundbreaking exercise that marked the country's first-ever successful completion of an internationally-standardized health expenditure tracking exercise. The initiative was launched in September 2013, with the Permanent Secretary for Health, Andrew Skerritt, highlighting the importance of NHA data in improving the financial sustainability of the health sector and HIV programming. The Ministry of Health had recognized the value of NHA over a decade ago, and the successful completion of this exercise was a significant milestone in the country's efforts to strengthen its health sector initiatives. The Health Systems 20/20 Caribbean project, led by Abt Associates in partnership with the Centre for Health Economics of the University of the West Indies, provided technical assistance for this first round of NHA and HIV Subaccounts. The project received funding from USAID and involved the systematic compilation of health and HIV spending data from public and private institutions, including the Ministry of Health, international donors, NGOs, private insurance companies, and employers. A representative national health expenditure and utilization survey, as well as a survey of people living with HIV, were also conducted to provide a comprehensive understanding of the country's health financing system. The analysis of the data highlighted both strengths and weaknesses in St. Kitts and Nevis's health financing system. The country funds most of its own HIV treatment efforts, but a future funding gap for prevention services may be created by the expected decrease in donor funding. Prevention programs run by NGOs constitute the bulk of donor spending, and the Government of St. Kitts and Nevis will need to identify resource mobilization strategies to ensure that these programs continue. The NHA also showed that the country relies heavily on out-of-pocket spending to fund health care, which is not sustainable or equitable, but people living with HIV are largely protected from burdensome health care costs. The successful completion of this exercise has significant implications for the country's efforts to achieve Universal Health Coverage. The analysis will support evidence-based planning and budgeting, and officials in the Ministry of Health and National AIDS Programme intend to make resource tracking with NHA a routine part of government operations. The Centre for Health Economics is now poised to take a lead role in providing future NHA technical assistance in St. Kitts and Nevis and other Caribbean countries, building on the training and experience gained through this project. The findings of the NHA and HIV Subaccounts Estimation were presented by Roxanne Brizan-St. Martin of the Centre for Health Economics, University of the West Indies, in September 2013. The exercise has set a precedent for future health expenditure tracking exercises in the country, and its findings will inform policy decisions and resource allocation in the health sector. The successful completion of this exercise demonstrates the country's commitment to improving the financial sustainability of its health sector and achieving Universal Health Coverage.