YR 3 supports TA in HSS, PFIP Goal 4. TA attempts to strengthen PPP and address public sector constraints that hinder sustainability. Building on YR 2 activities, gains will be made in building country capacity to increase management efficiencies; improve continuity of care; expand the health workforce and service delivery infrastructure; and provide more complete data on private sector services. TA activities cover six OECS countries, Barbados and regional activities inclusive of all PF countries and reach public and private leaders at many levels. TA addresses cost efficiency by: using state-of-the-art private sector models, approaches, and tools; advancing knowledge about the private sector; and strengthening PPPs that diversify resources, maximize skills and expertise, and strengthen advocacy.

Countries will need to integrate HIV/AIDS services into their health system in the future. Information emerging from OECS private sector assessments indicates the private sector is interested in playing a larger role in HIV service delivery. SHOPS will work to integrate HIV/AIDS-related services into private sector health clinics in two countries with a multi-pronged approach. This will include policy reform, training for private providers, creating a reporting system for private sector providers to share health data and implementing an awareness campaign to promote private sector services. A process evaluation will document challenges and opportunities in implementing this approach. Transitioning to regional/country structures will be achieved by: Promoting maximum participation and use of existing structures; Facilitating linkages between levels and areas of the system; and Ensuring transition plans for funding covering new coordinating structures or human resources.

Recent work in the region shows a nascent understanding or inclusion of the private sector across all health system building blocks. MOH face many challenges, often with limited resources such as time, staff, money, and expertise. The private sector, on the other hand, has many resources that can be mobilized to help the public sector. The SHOPS project addresses multiple barriers across the health system by increasing private sector engagement for a sustained country and regional HIV response. There are many opportunities where strengthened patient referral systems and the sharing of patient records between public and private health providers could vastly improve service delivery. Systems for collecting service data from private providers are either nonexistent or weak.

For governments to engage the private sector as partners rather than competitors in health care, they need to play an enabling role while maintaining stewardship. Based on YR 1 and YR2 activities, SHOPS will continue to provide TA, with the intentional spillover of activities into broader health issues, including support for: Normalizing coordination and establishing mechanisms to formalize coordination, information sharing and partnerships; Strengthening key government functions, such as regulation, information collection, and oversight of the private health care sector in order to improve the quality of services; Identifying strategies to systematically include the private sector in public health planning and policy processes, including building the capacity of the public sector to work with the private sector; Employing new ways to engage private industry in the HIV response; and Strengthening the business skills of civil society organizations working in HIV/AIDS by formalizing linkages to the private sector. SHOPS coordinates closely with other donors and regional partners that implement programs in the region. Special attention has been paid to joint activities where feasible, and every effort is made to avoid duplication of efforts. Additionally, focused coordination in support of NGO advocacy efforts continues to play a critical role in holding public and private providers and decision makers accountable for improving health.