THE KEY IS SUSTAINABIITY: But do we know how it really looks like?
In the past decade, Asia Region has witnessed remarkable advances on and effectiveness of HIV programs, particularly HIV testing and HIV treatment. HIV programs which successfully contributed to the increase of testing and decline of new infection rates are focused on improving and sustaining good practices in service delivery while at the same time continuing to adapt innovations on HIV science.
COP/ROP 2021 introduces an optional focus on models and approaches to support the sustainability of key population-led civil society organizations, expanding the options available to strengthen and support the long-term viability and strength of these organizations as an opportunity to promote innovative models and a longer-term strategic approach to supporting key population-led service delivery.
The FACT SHEET: Virtual Country Operational Plan (COP) 2021 highlights the challenges that KP-led civil society organizations face related to sustainability, which is one of key focus of the COP/ROP 2021:
- Challenges in diversifying the HIV services offered to fully meet the needs of key populations.
- Inadequate capacity to develop business plans for sustainability.
- Lack of access to capital on preferential terms.
- Difficulty to fully integrate into national health systems and insurance schemes, thereby limiting their ability to sustain themselves and provide diverse and quality services.
- Difficulty accessing quality assurance and accreditation processes and tools due to the nature of funding and targeted service delivery
- National policies and practices that do not support key population programming and/or legal, functioning, and transparent social contracting mechanism.
THE 6-PIECE PUZZLE OF SUSTAINABILITY
For communities’ better understanding of ‘SUSTAINABILITY’ here are 6 points that can provide a clearer picture on what it means in the HIV and AIDS Response:
Financial Sustainability. Are there stable and diverse funding in place to finance the AIDS response? To address this, 2 focus areas are:
- Innovative financing mechanisms for HIV;
- Increased efficiency in HIV spending from available resources;
This is critical for sustainability especially for high burden countries.
IMPORTANT: Sustainability in the HIV Response DOES NOT only focus on financial perspective.
Programmatic Sustainability. Does the specific program or intervention make sense in an integrated primary care system? Sustainability requires a transition of HIV services from an emergency response to a long-term main-stream approach.
Political Sustainability. Will HIV and AIDS remain in the policy agenda? Is the legal and policy environment conducive for an effective response?
Structural Sustainability. Is the social and environmental context enabling for a long-term effective response? A sustainable HIV response requires focus not only on securing financial resources but also on addressing structural barriers to access.
Epidemiological Sustainability. Is there a trend of declining new HIV infections and AIDS-related deaths? One measure of epidemiological sustainability is when the number of people on treatment is greater than the number of new infections.
Human rights. How will the right to health be protected for key populations who might be excluded from the decision-making based on the five points listed above? Funding partners have difficulty promoting human rights while also encouraging country ownership in places where some key populations are criminalized.
The human rights are critical to ensure that key populations who are criminalized are included in sustainable HIV responses.
“PEPFAR and the Global Fund are two of our major funders for HIV programs in Papua New Guinea. We plea to both funders to work closely with key affected communities, including people living with HIV, so that there is sharing of resources, skills, knowledge, experiences and learnings. We feel there is a need at the community level for both donors to work together, communicate well and have one national plan.”Papua New Guinea