Leveraging the lessons learned from financing HIV programs to advance the universal health coverage (UHC) agenda in the East African Community
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
Global health research and policy
Abstract
Although there is broad consensus around the need to accelerate progress towards universal health
coverage (UHC) in Sub-Saharan Africa, the financing strategies for achieving it are still unclear. We sought to
leverage the lessons learned in financing HIV programs over the past two decades to inform efforts to advance the
universal health coverage agenda in the East African Community.
Methods: We conducted a literature review of studies reporting financing mechanisms for HIV programs between
2004 and 2014. This review is further underpinned by evidence from a mixed-methods study entailing a survey of
195 health facilities across Uganda supplemented with 18 semi-structured interviews with HIV service managers.
Results: Our data shows that there are six broad HIV financing strategies with potential for application to the
universal health coverage agenda in the East African Community (EAC); i) Bi-lateral and multi-lateral funding vehicles:
The establishment of HIV-specific global financing vehicles such as PEPFAR and The Global Fund heralded an era of
unprecedented levels of international funding of up to $ 500 billion over the past two decades ii) Eliciting private
sector contribution to HIV funding: The private sector’s financial contribution to HIV services was leveraged through
innovative engagement and collaborative interventions iii) Private sector-led alternative HIV financing mechanisms:
The introduction of ‘VIP’ HIV clinics, special ‘HIV insurance’ schemes and the rise of private philanthropic aid were
important alternatives to the traditional sources of funding iv) Commodity social marketing: Commodity social
marketing campaigns led to an increase in condom use among low-income earners v) The use of vouchers: Issuing
of HIV-test vouchers to the poor was an important demand-side financing approach vi) Earmark HIV taxes: Several
countries in Africa have introduced ‘special HIV’ taxes to boost domestic HIV funding.
Conclusions: The lessons learned from financing HIV programs suggest that a hybrid of funding strategies are
advisable in the quest to achieve UHC in EAC partner states. The contribution of the private sector is indispensable
and can be enhanced through targeted interventions towards UHC goals.
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Keywords
Lessons, HIV programs, East African Community, Universal health coverage (UHC)
Citation
Zakumumpa, H., Bennett, S., & Ssengooba, F. (2019). Leveraging the lessons learned from financing HIV programs to advance the universal health coverage (UHC) agenda in the East African Community. Global health research and policy, 4, 1-10.