Resource Type: Report
Authors: Dr. Sophie Faye, Chisa Cumberbatch, and Altea Cico
Published: September 2017

Barbados is currently experiencing tight fiscal constraints due to the slowdown of economic growth coupled with the fact that as a high-income country, it now no longer qualifies for concessional loan arrangements and grants from development partners. The President’s Emergency Plan for AIDS Relief (PEPFAR) has indicated a plan to reduce, and eventually cease, funding for HIV programs in Barbados, within the next two years. Given the current funding environment, the Ministry of Health and Wellness is looking for ways to continue financing the program through improved efficiency and by making evidence-based investments into cost-effective interventions. They are also seeking ways to identify new approaches to financing, which will allow continued health coverage and maintain the gains seen in the sector.

Civil society organizations (CSOs) began offering community-level HIV interventions in 2017, including testing, treatment, and social support to key populations. Some of these populations are highly stigmatized, so community outreach is perceived as necessary. Community-based services are expected to result in improved outcomes for these populations (e.g., reduced loss to follow-up and higher retention in care, improved adherence to treatment). This outreach could be particularly valuable in supporting the government’s adoption of the WHO-recommended Treat All strategy by helping to link persons living with HIV (PLHIV) to treatment and promote adherence.

This study assesses the cost of HIV-related services provision at the CSO level. It aims to  benefit both the CSOs themselves and the government of Barbados.  The government will be able to consider the results in deciding whether or how to allocate funds to CSOs to enable the CSOs to provide some key services when PEPFAR funding ceases. This study is one of several HFG activities implemented in four countries in the Caribbean to prepare the countries for donor transition.