TRIPS, Public Health Systems and Free Access
Edited by Benjamin Coriat
Chapter 14: Implementing Funding Modalities for Free Access: The Case for a ‘Purchasing Fund System’ to Cover Medical Care for PLWHA
Philippe Vinard, Karim Diop and Bernard Taverne INTRODUCTION Since 2006, abolition of user fees at the point of service delivery for care and drugs has been one of the pillars of the public health approach proposed by the WHO for scaling-up access to medical treatment and care for PLWHA in low-income countries (Gilks et al., 2006). However, provisions to deﬁne the modalities for implementing this recommendation have not been made. This absence of directives has led to numerous concerns, and even reluctance, among public health programme directors in low-income countries, raising questions about the economic feasibility of such a decision and how to implement a policy that supports free access to HIV/ AIDS-speciﬁc care and services. Moving from the provision of free drugs to the provision of complete free care requires the implementation of eﬀective and sustainable funding management. There is a danger that free access without secure and properly functioning funding will quickly work against the desired objectives. The negative side eﬀects of a poorly-run free access policy – breaks in supply, lower service quality, under-the-counter payments – have frequently been described in the economic and public health literature. In Senegal, several studies have analysed the funding of the national AIDS treatment programme (Ciss et al., 2004; Vinard et al., 2003), the programme’s ﬁnancial accessibility (Lanièce et al., 2003) and the evaluation of extra-ARV costs for patients (Canestri et al., 2004). They have demonstrated the ineﬃciency and drawbacks of payment systems, as well as the...
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