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How Can USAID Help Eastern Caribbean Countries Prepare to Lead Their Own HIV Programs?

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has helped introduce lifesaving treatment to 7.7 million people living with HIV (PLHIV) worldwide since it was launched in 2003.

PEPFAR has shifted from an emergency response to a program with a more sustainable, country-owned response. PEPFAR 3.0, running 2013–2019, seeks to maximize the impact of investments by targeting evidence-based interventions for key geographic areas and populations with the highest incidence rates.

The process of transition to country ownership is already underway in the Eastern Caribbean, which includes Antigua and Barbuda, Bahamas, Barbados, Belize, Dominica, Grenada, Jamaica, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Suriname, and Trinidad and Tobago.

The adult HIV prevalence in the Eastern Caribbean is approximately 1 percent, with a concentration in commercial sex workers, men who have sex with men, and prisoners.

How can USAID Help Eastern Caribbean countries best prepare to lead their own HIV programs?

Abt Global’s staff conducted a literature review for USAID, examining 48 resources on donor transitions to country ownership in family planning, HIV, and other areas that addressed key steps in the transition process and determinants of readiness for transition. The review was published in the journal Global Health: Science and Practice.

“We found six best practices these countries can embrace to make this transition,” said Kylie Graff, co-author of the review and an associate for Abt. They are:

Develop a roadmap: The literature revealed a lack of clarity among stakeholders about what transition to country ownership meant in practical terms.

Involve stakeholders: This increases the likelihood that counterparts at all levels buy into the plan, understand its intentions, and accept responsibilities. These participants should include high-level diplomats, officials from the Ministry of Health and Ministry of Finance, civil society organizations, other donors, and private sector representatives.

Communicate the plan through high-level diplomacy: Leaders from donor and recipient countries should be viewed as active partners with shared, consistent core messaging around why and how transition will happen. Messaging should also acknowledge challenges to successful transition.

Support midterm evaluations: Midterm assessments provide an opportunity to validate initial assumptions underlying transition plans and to respond to emerging challenges.

Provide technical support to implement the plan: Gauging financial and technical capacity can inform the roadmap for donor withdrawal and reveal which areas require additional support.

Support ongoing monitoring and evaluation: Ongoing funding for research and health outcomes measurement should be incorporated into the transition roadmap to assist the country in monitoring progress, to help measure the USG’s own success in transitioning, and to contribute to global health research agendas.

The Eastern Caribbean also needs to identify HIV champions, strengthen leadership and management, improve policies to protect key populations, engage the private sector and civil society more, integrate HIV programs into primary care, improve supply chain capacity, and address health worker shortages, according to the review.

Read the full Abt literature review.

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