A Partnership to scaleup ART, Better caresupport and Strengthen Patient Involvement

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A Partnership to scale-up ART, Better
care/support and Strengthen Patient Involvement

• By Steven Lanjouw, Dr Tazeem Bhatia Theuss and Dr
  Nwe Ni Myint

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Situation in Myanmar

• One of Asia's most serious HIV/AIDS epidemics
• Government expenditure on public health is 0.3
  of GDP, priorities lie elsewhere
• Active, but inexperienced (in HIV care) private
  health sector
• According to National Health Accounts 89.8 of
  household expenditure on health is in the private
  sector
• People living with HIV face stigma and
  discrimination, can not afford treatments and
  lack opportunities for self help initiatives

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An Innovative Approach

• Created a partnership between civil society and
  the private sector in order to meet the public
  health needs of the people.
• The partnership consists of numerous, existing,
  local stake holders People living with HIV,
  Community based organisations, Private sector
  GPs, Laboratories, Public hospitals
• It provides subsidized care to targeted
  vulnerable PLWHA populations

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Alliance
SC Steering Committee MU Management Unit MPG
Myanmar Positive Group
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Why is PPPH innovative?

• It gives CBOs, self help groups and the private
  sector a space in which they can develop
• Partnerships between Private GPs, CBOs, Public
  Hospitals and the MU are constructed and
  standardised through a set of performance
  agreements based on specific outputs
• A democratic organisational framework equal
  representation and ownership is by the local
  partners
• A referral network that enables the continuum of
  care

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Achievements

• Referral system is functioning
• 112 beneficiaries selected and offered subsidised
  care. Total of 150 expected by the end of 2009.
• 106 are receiving prophylaxis and OI treatment
• 39 have started ART
• Increased capacity and diversified skills of CBO
  and private providers
• Increased dialogue, accountability and trust
  between partners

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Achievements

• 4 Step selection process increases participation
  and reduces bias
• Output based performance agreements along with a
  costing of services allows for a standardised
  approach
• Model attempts to strengthen purchasing power of
  beneficiaries
• Independent feedback mechanism through the
  Myanmar positive group

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Challenges/ Lessons learnt

• The model is novel and innovative, but challenges
  a traditional environment.
• Encouraging good communication between partners
• Setting up an inclusive and effective selection
  process that reaches the most vulnerable PLHA is
  difficult and time intensive
• The programme lacks sufficient experience to
  negotiate the performance agreements effectively
• The model is intricate and currently resource
  intensive
• 1yr Pilot Project funded by the Alliance.
• Redressing inequalities faced by PLWHA requires a
  sustained approach and a larger commitment