Approaching HIV funding differently: A prescription for a healthier financing system

By Nicole Spieker

HIV activists are known for their willingness to break down barriers, and for their historic, persistent and vocal demand for change. A decline in HIV specific funding, and a new epidemic emerging in Eastern Europe and Central Asia, means that this spirit is needed as much today as it ever was. With the AIDS 2018 conference in Amsterdam having recently come to a close, we must ask, is the community able to innovate and embrace new concepts to meet these demands?

PharmAccess believes that technology holds the key to progress on healthcare financing and delivery and more needs to be done to embrace the digital revolution. It is technology that will help us to reach every patient, and it is technology that will help us to finance care in a smart way that not only makes the most of declining resources but helps to crowd in and stimulate more investments.

For years now, vertical funding streams (focused on single diseases, or specific interventions) have dominated the health sector with well-known examples like the Global Fund and GAVI making impressive strides. But there has also been a growing consensus around the need for Universal Health Coverage and a recognition that one disease does not define a person’s health. A one treatment approach can be costly, can divert money from general healthcare, have high administrative costs and spur distinct healthcare infrastructures and workforces.

There needs to be a funding solution that reflects the reality of life with HIV today. That is, a solution that treats an HIV person like any other member of a community, someone who could have a wide range of health needs and care preferences that go beyond HIV. A solution that brings together vertical financing (i.e. funding ear marked for a specific disease) and horizontal funding (e.g. financing for general primary, secondary, preventive care). A combined approach that pools resources at the point of care would be more efficient and we believe, deliver more holistic, and improved quality care for everyone. This is where technology like M-TIBA comes in.

M-TIBA is a mobile health wallet that has the potential to fundamentally change healthcare. For the individual user, M-TIBA, like all good innovations, is a simple, easy to use, yet life-changing development. With a basic mobile phone in hand, individuals, however poor or excluded, can access the M-TIBA health wallet at the touch of a button. Without needing a bank account, users can directly and at no costs, save into the wallet, ask their families to instantly transfer contributions into it in times of need, or access vouchers or health insurance cover. This reduces the risk of catastrophic out of pocket expenditures that push 100 million people per year into poverty when faced with health issues.

At the back-end, the platform really comes to life. M-TIBA collects vital data that is useful for everyone; It enables doctors to improve healthcare delivery and empowers patients to make informed decisions about care. Crucially, M-TIBA also has the capacity to bring together different financing solutions from donors, investors and governments, uniting the current fragmentation in the sector.

The idea for M-TIBA was first conceived in 2014 through a collaboration between PharmAccess and Safaricom, Africa’s largest telecommunications company and the platform is now being developed by CarePay, a Kenyan IT company. M-TIBA has been well received, with over a million registered users and 600 connected providers since the launch of the technology in 2016 in Kenya. We know that patients, funders and healthcare providers like the technology and there is now demand to take the technology to scale in Kenya and other African countries.

The ‘proof of concept’ as far as combining HIV funding with other sources is concerned, can be found in the slums of Nairobi. In 2016, 60,000 people were given access to an integrated care package including HIV care and general primary care services, through the M-TIBA mobile health wallet. The pilot was able to reach a much larger group than the existing outreach program that it replaced (that had previously reached 2480 patients through HIV vertical funding programs).

This new approach was led by Gertrude’s Children’s hospital and its outreach clinics. Those who participated did not experience any discernible distinctions between the specific and the general benefits that they could access for healthcare (whereas previously they may have experienced a difference in access and quality based on disease). Clients eligible for specific treatments (e.g. HIV) were covered for related and unrelated diseases and care needs. Likewise, the staff could not make a distinction between patients. Only in the M-TIBA back office were funds allocated based on diagnoses.

The advantages of this approach are manifold:

• Clients with specific diseases are ensured of care for related and unrelated morbidities. In practice this means that an HIV patient suffering from a respiratory infection for example, would receive treatment for both despite each disease being funded separately.
• By combining the different funding streams and access to data via one platform, it’s possible to gain near real time insights into the actual costs of all care for HIV and other patients.
• By pooling health risks across a general population of the informal settlements the average cost of care per participant (including the original HIV clients from the Sunshine program) was less than US$ 15 per annum. The cost of administration per participant was less than US$ 1.50 per annum.

The pilot offers some hopeful findings for governments who face the weighty challenge of providing Universal Health Coverage. In the case of Gertrude’s, the pilot showed that through the use of efficient technology and combined financing solutions, the cost of providing care for individuals (including but not limited to HIV treatment and care) can be brought to within the range of the Kenyan governments own National Hospital Insurance fund which currently has a cap of USD$ 15 per person.

PharmAccess has shown that technology like M-TIBA can deliver the solutions that are urgently needed. We now call on the international donor community, on governments and investors to adopt this approach at scale and do healthcare differently. Use technology like M-TIBA to integrate financing, share risks and lower costs, while at the same time improving the quality of care delivery.