The Global Fund to Fight AIDS, Tuberculosis and Malaria commissioned Euro Health Group to review the formal social security coverage of people living with HIV in Latin America and the Caribbean (LAC), including purchasing strategies and contractual relationships with civil society organisations. The methods employed included a comprehensive document search and literature review,country visits, interviews with key informants, and a survey. Findings,conclusions, and recommendations were generated, highlighting some essential recommendations for the Global Fund's future engagement in LAC.
The landscape review of social health insurance (SHI) coverage of HIV services in LAC was an exploratory study to help the Global Fund better understand the existing health financing systems in the region. Given the importance of social security in LAC, the Global Fund is increasingly considering SHIs as potential partners for intervention. Against this backdrop, the Global Fund was interested in opportunities and risks of collaborating with social security institutions. The Global Fund currently supports 17 countries in LAC, four of which were excluded due to either unstable political situation or the lack of importance of social security institutes. The review identified and documented population groups covered; the benefit packages covered by the different social security schemes, with special focus on HIV services; other basic characteristics of relevant SHI schemes, including regulation, enrolment and beneficiaries, financing, provider network and payment, and strategic purchasing mechanisms for contracting community and civil society organisations to provide HIV outreach services including pre-exposure prophylaxis for key populations. The review identified health protection bottlenecks in countries with SHI schemes in place and supported by the Global Fund. Four countries stand out for the relevance of SHI in social protection, and six countries for their momentum in health sector reform. The key findings were summarised in 13 country briefs that provide an overview and insight into basic data, figures, assessments,conclusions and recommendations. In three selected countries in different sub-regions and with different levels of SHI population coverage, the EHG team conducted a more in-depth analysis and provided more detailed recommendations. The findings of the review will inform the Global Fund LAC team on where and how to establish direct cooperation with SHI schemes in selected countries and further support SHI coverage of people living with and at risk of HIV.