Thailand’s HIV/AIDS program after weaning-off the global fund’s support

BMC Public Health

Viroj Tangcharoensathien²  Nakorn Premsri¹  Rapeepong Suphanchaimat²  Chompoonut Thaichinda²  Thitikorn Topothai²  Suwat Kittidilokkul³  Noppakun Thammatacharee⁴  Walaiporn Patcharanarumol² 

[1] Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand;International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi, Thailand;Bureau of Policy and Strategies, Ministry of Public Health, Nonthaburi, Thailand;Health Insurance System Research Office, Health System Research Institute, Nonthaburi, Thailand

关键词: Migrants;    Key Affected Populations;    Global fund;    Thailand;    Principal-Agent relationship;   

Others  :  1161614
DOI  :  10.1186/1471-2458-13-1008

 received in 2013-04-03, accepted in 2013-10-07,  发布年份 2013

【 摘 要 】

Background

Though 85% of financing HIV/AIDS program was domestic resources, Global Fund (GF) programs played a significant role in prevention interventions and treatment for non-Thai Key Affected Populations (KAP) and migrants. As upper-middle income country, Thailand is not eligible for GF support. This study identified the remaining challenges and funding for prevention interventions for Thai and non-Thai KAP and migrants if GF supports were to curtail.

Methods

Qualitative method was applied including document review and in-depth interviews of 21 key informants who were Principal Recipients, Sub-recipients, provincial level program implementers and policy makers in health financing agencies. A multi-stakeholder consultation workshop was convened to discuss recommendations.

Results

The “public financed public services model” where Principal and Agents were the same entities resulted in less accountability than the “contractual agreement” in GF programs where the Principal Recipients, as the Agents were more accountable to the GF as Principal through results based financing. If GF supports were to curtail, impacts on the current programs would be varied from low to high degree of negative consequences. Scale down the scope and targets, while keeping the most critical components were common coping mechanisms. All three, except one, Principal Recipients had difficulties in fund mobilization. Prevention among non-Thai KAP and migrants were identified as the remaining challenge.

Conclusions

A pooled funding mechanism from multiple domestic sources was proposed. Replacing the conventional public-financed-public-service by a contractual model was preferable. The GF should continue funding the non-Thai KAP and migrant as transition mechanism. Multi-countries or regional programs especially at the border areas were priorities.

【 授权许可】

   
2013 Patcharanarumol et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]The Global Fund: Strategic Investments for Impact. Geneva: Global Fund Results Summary; 2012.
• [2]The Global Fund: Our history. 2013. Online at http://www.theglobalfund.org/en/about/whoweare/history/ webcite - accessed on 22 March 2013
• [3]The Global Fund: Download Grant Data. 2013. Online at http://portfolio.theglobalfund.org/en/Home/Index webcite - accessed on 26 October 2013
• [4]The Global Fund: Our Principles. 2013. Online at http://www.theglobalfund.org/en/about/principles/ webcite - accessed on 26 March 2013
• [5]Bundhamcharoen K, Odton P, Phulkerd S, Tangcharoensathien V: Burden of disease in Thailand: changes in health gap between 1999 and 2004. BMC Public Health 2011, 11:53. BioMed Central Full Text
• [6]Punpanich W, Ungchusak K, Detels R: Thailand’s response to the HIV epidemic: yesterday, today, and tomorrow. AIDS Educ Prev 2004, 16(3 Suppl A):119-136.
• [7]Aungkulanon S, Kusreesakul K, Kunnathum J, Bundhamcharoen K: Decreasing the burden of infectious disease in Thailand. Lancet 2013, 381:s11. doi:10.1016/S0140-6736(13)61265-9
• [8]Thai Working Group on National AIDS Spending Assessment: National AIDS Spending Assessment Report 2010-2011.
• [9]Thai Working Group on National AIDS Spending Assessment: National AIDS Spending Assessment Report 2008-2009.
• [10]The Global Fund: Policy on Eligibility Criteria, Counterpart Financing Requirements, and Prioritization of Proposals for Funding from the Global Fund. In Twenty-third Board Meeting: 2011. Geneva; 2011. http://www.theglobalfund.org/documents/board/23/BM23_14PICPSCJEligibilityAttachment1_Policy_en/ webcite
• [11]Grossman S, Hart O: An analysis of the principal–agent problem. Econometrica 1983, 51:7-45.
• [12]Nguyen H: The principal-agent problems in health care: evidence from prescribing patterns of private providers in Vietnam. Health Policy Plan 2011, 26:i53-i62.
• [13]Brinkerhoff D: Accountability and Health Systems: Overview, Framework, and Strategies. Bethesda, MD: The Partners for Health Reformplus Project, Abt Associates Inc.; 2003.
• [14]Buchanan A: Principal/agent theory and decision making in health care. Bioethics 1988, 2(4):317-333.
• [15]Teerawattananon Y, Tantivess S, Yothasamut J, Kingkaew P, Chaisiri K: Historical development of health technology assessment in Thailand. Int J Technol Assess Health Care 2009, 25(Suppl 1):241-252.
• [16]Revenga A, Over M, Masaki E, Peerapatanpokin W, Gold J, Tangcharoensathien V, Thanprasertsuk S: The economics of effective AIDS treatment, evaluating policy options for Thailand. Washington, USA: The World Bank; 2006.
• [17]National AIDS Prevention and Alleviation Committee: UNGASS Country Progress Report, Thailand, Reporting period. In Office of Technical Development to Support HIV/AIDS Responses. 1st edition. Edited by Sirinirund P, Khemngern P, Danthamrongkul V, Tangsaowapak W, Sangkote S, Kuaikiatkul P. Thailand: Department of Disease Control, Ministry of Public Health; 2006.
• [18]Thailand AIDS Response Progress Report 2012 Reporting period. 2013. 011. Online at http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_TH_Narrative_Report webcite[1].pdf
• [19]Tantivess S, Walt G: The role of state and non-state actors in the policy process: the contribution of policy networks to the scale-up of antiretroviral therapy in Thailand. Health Policy Plan 2008, 23(5):328-338.
• [20]National AIDS Prevention and Alleviation Committee: Agenda 5.1: Integration and task assignment on AIDS prevention and alleviation programmes , the 1st Meeting of National AIDS Prevention and Alleviation Committee. Royal Thai Government.
• [21]Martin P: The economic contribution of migrant workers to Thailand: towards policy development. Bangkok: International Labour Office; 2007.
• [22]Chamchan C, Apipornchaisakul K: A Situation Analysis on Health System Strengthening for Migrants in Thailand. Nakorn Prathom: Institute for Population and Social Research; 2012.
• [23]Srithamrongsawat S, Wisessang R, Ratjaroenkhajorn S: Financing Healthcare for Migrants: a case study from Thailand. Thailand: International Organization for Migration and World Health Organization; 2010.