Building on three years of implementation through Health Systems 20/20, the Health Finance and Governance project will continue to support partner countries efforts to increase domestic resources available for HIV and health care, manage those resources more effectively, and improve the efficiency of purchasing decisions. In concert with these activities, partner countries will also improve strategic transition planning and create more efficient, accountable operations, thus enhancing the responsiveness of health systems to their populations needs.

The Health Finance and Governance project will achieve three overarching results:

Improved financing for priority HIV and health services;

Strengthened health and HIV governance capacity of partner country systems; and

Improved country-owned systems in HIV and public health management and operations.

The project team will continue to collaborate with partner countries to develop integrated strategies for strengthening health financing, including: increasing domestic resources (resource mobilization); reducing financial barriers and expanding access (risk pooling and users fees); and improving efficiency (allocation, production and purchasing). Enhancing governance will improve health outcomes by increasing accountability and transparency, enhancing public policy debate, opening public-private partnering opportunities, and moving countries toward universal health coverage.

Implementing and sustaining effective HIV and health programs relies heavily on availability and efficient use of financial resources. Understanding the financial situation for continued HIV services is of vital importance in the Caribbean. The economic downturn has resulted in less revenue and the increasing burden on the health system (HS) by chronic non communicable diseases means funds must stretch further than before. Governments are striving to raise and appropriately allocate adequate resources to purchase the mix of health services needed to address the regions diverse health conditions: HIV/AIDS, persistent infectious diseases, and expensive complications of chronic non-communicable diseases. Emergence of HIV as a chronic disease also mandates a sustained, integrated response requiring sustainable financing.

Although PEPFAR was initiated as an emergency response to rapidly scale up treatment and other activities to prevent the spread of the HIV epidemic, the reauthorization of PEPFAR has shifted its focus toward a more targeted, sustainable response with greater country ownership. With this focus in mind, the need for developing individual transition, or graduation, plans in the Caribbean are a vital next step to ensure that government can lead their responses as PEPFAR funding decreases.

Funding in this IM will address the following health financing barriers: shortage of domestic resources as external funding declines; heavy reliance on out-of-pocket payments to finance health services; lack of private insurance coverage for PLHIV; and lack of health financing evidence to promote rational health and HIV planning. Funding will also support transition planning in two countries, likely Jamaica and St. Lucia, that will serve as pilot countries for an expanded transition planning effort in FY2014. If the May, 2013 Interagency pipeline review identifies additional pipeline resources to program this calendar year, the PEPFAR team will increase the number of countries supported in this effort prior to the FY2014 ROP.

After a careful literature review, the Caribbean PEPFAR team has identified: (1) key questions for USG agencies to consider prior to transition planning, (2) Steps to include in the process, (3) Areas to evaluate in assessing readiness for successful transitions, and (4) Potential Indicators to monitor for successful transitions. An interagency Transition Planning committee will guide this effort and lessons from Jamaica and St. Lucia will be documented and shared across the region.