The HFG Project’s program in the Caribbean has included activities in 11 countries: Antigua and Barbuda, Barbados, Dominica, Grenada, Guyana, Haiti , St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Suriname, and Trinidad and Tobago. In light of decreasing donor funding and increasing costs associated with non-communicable diseases, many countries in the Caribbean face more strain on their domestic health budgets, making effective financial planning and management a priority. All of the countries in the region have committed to adopt WHO’s recommended Test and Start approach to HIV care, which will result in short-term increases in cost of care. In the Eastern and Southern Caribbean countries HFG provides capacity-building support and technical assistance to plan, finance, and monitor a financially sustainable, effective, and efficient HIV response. Activities are designed to support domestic resource mobilization and targeted financing through the analysis and use of financial data for decision-making.

HFG’s current Eastern and Southern Caribbean portfolio includes five countries and one regional activity:

• Barbados: HFG is facilitating a PEPFAR Sustainability Index and Dashboard (SID) exercise and providing guidance on health financing technical support options. In order to generate data for decision-making in the face of the country’s adoption of Test and Start and the associated potential increased need for community-based support, HFG is conducting a study to examine the cost-effectiveness of scaling up community-level HIV/AIDS interventions. HFG is also conducting an assessment of the supply chain management (SCM) systems for HIV-related pharmaceuticals and laboratory commodities in Barbados to identify opportunities for efficiency gains and cost savings.
• Guyana: HFG is supporting the updating of the existing SID and sustainability plan for the HIV response to ensure that the new costs and program needs are reflected. In addition, HFG is supporting the Ministry of Health to conduct a Health Accounts exercise to assess public, private and donor funding for health and HIV and its allocation. This process will also identify how HIV information systems can be aligned with fiscal data tracking and analysis in order to better monitor and analyze resource allocation and efficiencies.
• Suriname: HFG is conducting an assessment of SCM systems for HIV-related pharmaceuticals and laboratory commodities to identify opportunities for efficiency gains and cost savings.
• Trinidad and Tobago: HFG is supporting a SID exercise and prioritization process, including developing an additional component of the SID to assess the psycho-social support provided to key populations. HFG is also conducting a Health Accounts exercise with a focus on funding the HIV response in collaboration with the University of West Indies Health Economics Unit (UWI-HEU).
• Support for a Sustainable Regional Response: HFG collaborates with regional donors and implementing partners, and brings health financing and governance technical expertise and inputs to regional meetings and events. Targeted technical assistance and capacity development is provided to the Pan-Caribbean Partnership against HIV/AIDS (PANCAP) Resource Mobilization Advisory Group, including facilitating the updating of its Resource Mobilization Strategy and developing an implementation plan for the strategy. Lessons learned from HFG work in the region will be disseminated among Eastern and Southern Caribbean countries.

HFG achievements in the Caribbean include:
HFG worked with the governments of Barbados and St. Vincent and the Grenadines and UWI-HEU to complete Health Accounts estimations in 2014, marking the first time they had been completed in either country. By producing health and HIV expenditure data, these results helped fill data gaps and generate essential information to support national HIV strategic planning and advocacy for resources. Both countries are using the health accounts results to inform the design of health financing reforms, and to plan for more effective HIV and AIDS financing.

In Antigua and Barbuda, Dominica, Grenada, St. Kitts and Nevis, St. Lucia, and St. Vincent and the Grenadines, HFG worked with national governments, UNAIDS, the Pan American Health Organization (PAHO), civil society, and the Regional Coordinating Mechanism of the Organization of Eastern Caribbean States (OECS) to develop HIV investment cases that were used to inform country planning, resource allocation, and funding applications for HIV responses, including a successful application for a $5.3 million multi-country Global Fund grant. The investment cases identify strategic investments to maximize available resources and achieve the greatest impact. To develop the investment cases, HFG engaged multiple stakeholders for country-based dialogue and prioritization exercises, and updated the OECS Regional HIV Strategic Framework. In Dominica, this process also informed the country’s HIV/AIDS Strategic Plan (2015-2019).

HFG also worked to strengthen the technical and leadership capacity of UWI-HEU and PANCAP as regional resources supporting the HIV response. HFG trained UWI-HEU staff in the System of Health Accounts (SHA) 2011 methodology for estimations, and worked with specialists from the organization to complete them. UWI-HEU used its enhanced capacity to help lead data collection and analysis for the Health Accounts in Barbados and St. Vincent and the Grenadines, and will support the conduct of Health Accounts in Trinidad and Tobago, including providing training in the SHA methodology. HFG supported PANCAP members in defining the long-term role of the organization and the relevant capacity needed. The project provided organizational development assistance to PANCAP in a number of priority areas, including the development of an orientation package for board members and the development of its Resource Mobilization Strategy.

Announcements and Successes

• Domestic Resource Mobilization for HIV in the Caribbean: Technical Workshop for Ministries of Health and Finance
• Organization of Eastern Caribbean States Successful in Global Fund Bid
• Advancing Maternal, Child Health in Latin America and the Caribbean
• Applying Lessons Learned to PEPFAR Transitions in the Caribbean

Publications

• Aedes Vector Control Capacity in Latin America and the Caribbean – Five Country Assessments
• System of Health Accounts (2011) and Health Satellite Accounts (2005): Comparison of Approaches
• Sustaining the HIV and AIDS Response in the Countries of the OECS: Regional Investment Case Analysis
• PEPFAR Transitions: Lessons Learned through the Experience of past Donor Transitions and Applications for the Eastern Caribbean