Accessibility of National Health Security Office (NHSO) HIV Prevention Funding for Civil Society Organizations

Civil society organizations (CSOs) have played a critical role in Thailand’s HIV response. As the national HIV epidemic has become concentrated in specific key populations (KPs), including men who have sex with men (MSM), transgender people (TG), male sex workers (MSW), female sex workers (FSW), and people who inject drugs (PWID), CSOs have worked to bridge the gap between these vulnerable communities and the healthcare system, ensuring that life-saving HIV health services can reach the communities most in need. The Global Fund to Fight AIDS, Tuberculosis, and Malaria and the President’s Emergency Plan for AIDS Relief (PEPFAR) have historically provided funding to CSOs to engage KP communities in HIV prevention programs and promote early diagnosis and treatment. However, PEPFAR is scheduled to withdraw its funding from Thailand by 2019. Similarly, the Global Fund appears to be initiating its own transition out of Thailand, with strong pressures from national government to move towards complete national independence in financing Thailand’s AIDS program. Amidst these transitions, the role of CSOs in the national HIV response is threatened: without a sustainable replacement to international donor funding, CSOs will be unable to continue their vital work in ensuring access to HIV services for high-risk KP communities, thereby jeopardizing Thailand’s goal of ending its AIDS epidemic.

In September 2015, the National Health Security Office (NHSO) initiated a 200-million-baht HIV Prevention Fund to ensure that key populations, including men who have sex with men (MSM), transgender people (TG), male sex workers (MSW), female sex workers (FSW), and people who inject drugs (PWID), receive a cascade of HIV interventions as per the Reach-Recruit-Test-Treat-Retain (RRTTR) package detailed in the ‘Thailand National Operational Plan: Accelerating Ending AIDS 2015-2019’. In the first year of implementation, CSOs experienced difficulties in accessing these funds due to a complex contracting process requiring hospital intermediaries, which in turn limited the performance of the fund nationally (38% of total targeted KP clients ‘reached’ in Year 1).

In 2017, through an Article 44 directive issued by the National Council for Peace and Order (NCPO), CSOs were granted the ability to directly contract with NHSO to access these funds. Thus, the NHSO zonal offices were tasked to distribute these funds to CSOs, provincial health offices (PHOs), and hospitals with strong records of performance with this fund in the previous year. The government’s decision to prolong the fund in future years will depend on its performance over this year.

In 2017, this fund aims to serve approximately 85,000 KP clients. A civil society working group, composed of Raks Thai Foundation, Rainbow Sky Association of Thailand (RSAT), Thai National AIDS Foundation (TNAF), and Pink Monkey, was awarded funding from the NHSO to create awareness among CSOs about these funds and mobilize participation, with the ultimate aim of improving the fund’s national performance, as measured by the number of KP clients receiving the full RRTTR set of interventions.

This study aims to monitor the implementation of the NHSO HIV Prevention Fund, using information collected from field visits and stakeholder consultations, to identify challenges and best practices for CSOs in accessing NHSO funding. This study will present information that can guide CSOs in efforts to access NHSO funding, and also serves as a case study in monitoring the implementation of large-scale policies. Lastly, the Article 44 directive that allows CSOs to directly contract with NHSO is a temporary measure: when the National Health Security Act will be revised, the Article 44 directive will no longer be in effect. Therefore, to ensure the longterm access of CSOs to this fund, the National Health Security Act must be revised in a fashion to allow CSOs to continue to participate in these types of health promotion projects.