The Political Economy of HIV/AIDS in Developing Countries
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The Political Economy of HIV/AIDS in Developing Countries

TRIPS, Public Health Systems and Free Access

Edited by Benjamin Coriat

The book is based on original data and field studies from Brazil, Thailand, India and Sub-Saharan Africa. Focusing on the issue of universal and free access to treatment (a goal now taken to heart by the international community), it assesses the progress made and presents a rigorous diagnosis of the obstacles that remain, especially the constraints imposed by TRIPS and the poor state of most public health systems in Southern countries. In so doing, the book renews our understanding of the political economy of HIV/AIDS in these vast regions, where it continues to spread with devastating social and economic consequences.
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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

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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...

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