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Table 1 Future HIV financing options for PNFPs

From: The future of financing for HIV services in Uganda and the wider sub-Saharan Africa region: should we ask patients to contribute to the cost of their care?

Option Current status Government action required PNFP action required
Direct Government funding of services and/or centralized HIV/AIDS Fund [2, 6, 10] Inadequate resources and inadequate budget allocation • Streamlined, transparent public- private partnership (PPP) frameworks for health
• Long term budget commitment
• Engagement of donors for medium term budget support
• Innovative tax/revenue collection and allocation measures
• Stronger accountability and performance/quality measurement systems
• Systems to meet minimum public private partnership guidelines
• Less vertical /“silo” based programs
• Health system wide capacity building
• Quality Assurance and Performance measurement systems
National Health Insurance Scheme [6, 11, 13] In discussion • Stakeholder involvement; generating a consensus on nature and scope of coverage
• Fund management capacity
• Governance, accountability and confidence building
• Legislation and regulation
• Definition and implementation of systems to meet minimum NHIS requirements for PNFP providers
• Capacity building for NHIS compliance
• Quality Assurance and Performance measurement systems
Out-of-Pocket Service Currently funds 50 % of health care [32] • Stronger accountability and performance/quality measurement systems
• Direct cash transfers
• Quality Assurance and Performance measurement systems
Private Insurance [16, 17] Very low coverage, inadequate regulation • Stronger Regulation
• Stronger accountability and performance/quality measurement systems
• Creating an attractive business proposition for private insurance firms
• Creating systems to meet minimum private health insurance company requirements
Community Health Insurance Schemes [11] Very low coverage, inadequate regulation • Legislation and regulation • Community engagement and confidence building
• Community accountability mechanisms
• Differentiated care for scheme members
Co-Payment to subsidize overall costs of care Used mainly by faith based organizations and NGOs, but little documentation on coverage and best practices • No additional legislation and/or regulation • Creating capacity to manage and report separate (paying and non-paying client) income streams
• Mobilizing paying and non-paying client support
• Mobilizing external stakeholder (eg donor and government) support
• Maintenance of standard quality care for all clients