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Both the Panamanian government and civil society face major challenges in sustaining the response to HIV and tuberculosis in the transition phase.
Source: Corresponsales Claves (Key Correspondents)
By: Bernabé Ruíz Águila
In the city of Panama, a training workshop is being held on April 1st and 2nd for promoters who will work on the transition proposal for a sustainable response to HIV and tuberculosis for the years 2019–2021.
After the review panel evaluated proposals submitted by civil society organizations to be sub-recipients, Asociación Panameña de Personas Trans (APPT, Panamanian Association of Transgender People), Asociación Viviendo Positivamente (AVP, Association Living Positively) and Asociación de Hombres y Mujeres Nuevos de Panamá (AHMNP, Panama’s New Men and Women Association) were selected to implement the proposal, which has a budget of 2.6 million dollars for the first and second years.
Peer promoters will be trained on April 1st and 2nd, and they will be part of the transition proposal’s interventions.
Corresponsales Claves had the opportunity to talk with Luis J. Guerra, who belongs to the AHMNP team. He stated that while goals reached this year regarding gay men and other men who have sex with men are high, they–as an organization–already have a strategy focused on peer work that will allow them to reach 62 men who have sex with men per promoter per month. They use a face-to-face strategy. For that purpose, they have previously mapped meeting and socialization places of men who have sex with men.
Guerra also said that the AHMNP proposal was submitted to carry out activities throughout the country and that they have the necessary capacities to reach the goals set, a team of 16 promoters who were part of the proposal that ended last year and new promoters who are being trained in this workshop. A challenge to be overcome in this stage of the transition process is how to pay professionals who will conduct the tests. This is a barrier imposed by the medical technologists’ union, as they refuse to allow civil society to conduct testing. According to this AHMNP member, they have planned to seek the support of the Ministry of Health. If they do not get it, they will use funds from their organization to cover this expense to fulfil the commitment they made, which is to reach 7,327 men who have sex with men this first year and test 8,137 men who have sex with men for HIV. The number of men tested is greater because it covers the universe of tests, either through the peer strategy or spontaneous demand.
AsociaciónViviendoPositivamente, an organization of and for people with HIV, which has carried out prevention actions with key populations including female sex workers, will be responsible for the strategy with this population. This association participated in the implementation of the previous proposal (2016–2018) funded by the Global Fund to fight AIDS, Tuberculosis and Malaria, in consortium with Asociación Nuevos Horizontes (ANH, New Horizons Association) and Asociación Cambiando Vidas (ACV, Changing Lives Association), with whom they reached the three key populations. This time, they must reach 2,057 female sex workers nationwide with information, inputs and testing, with a team of 14 women who will be responsible for the face-to-face intervention and the subsequent linkage to the health system, the so-called Clínicas Amigables (CLAM, Friendly Clinics).
A Social Contracting Proposal
The transition proposal suggests the appropriation of intervention strategies by the Ministry of Health. Thus, the cost of essential service packages, their provision and their administration has been determined, and those services shall be provided by civil society organizations, which will continue to do their work, but this time with financial support from the government. This is known as social contracting, a key strategy for the sustainability of the response.
For this social contracting, performance will be measured according to the objectives set, and both the State and contracted organizations must have the capacity to monitor, implement and determine the service’s scope and provision.
The Tuberculosis Component in the Response
The tuberculosis component, as in the previous proposal, will be implemented by health promoters of the Ministry of Health. This is because in Panama no organizations or groups of people with tuberculosis are openly known nor have applied to the process. One of the current challenges is to reactivate the Organización Panameña en contra de la Tuberculosis (Panamanian Organization against Tuberculosis), which was active until the 90s.
Cooperation between the State and civil society, which goes beyond social contracting and the allocation of the necessary public budget to take on all community strategies, is key to the transition proposal’s success, but it also needs a genuine commitment to reach people most vulnerable to HIV and tuberculosis, and to welcome successful experiences of civil society to integrate them into State systems.
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