BACKGROUND: Key population-led health services (KPLHS) organizations have substantially contributed to Thailand’s HIV response. Data from Oct. 2021-Sept. 2022 show that 47% of case finding among KPs under the national HIV prevention fund was through KPLHS organizations under the USAID/PEPFAR EpiC project. Additionally, four out of five PrEP clients nationwide are receiving services from these organizations. As donor funding decreases, these services need to be sustained by financing from the national health system or social enterprises by the organizations themselves that generate income.
DESCRIPTION: EpiC KPLHS partners developed a pathway to sustainability in 4 steps: i) consensus building among national stakeholders to increase domestic financing and agreed steps for implementation; ii) demonstration of a social contracting mechanism for financing certified and accredited KPLHS organizations through reimbursement from the National Health Security Office (NHSO); iii) increasing available domestic financing to scale up and sustain KPLHS organizations based on rigorous costing data to ensure adequate reimbursement to cover operational costs for these organizations; and iv) diversifying sources of financing to cover declining donor funding of KPLHS operations. These options included future strategic and business planning on resource mobilization, social enterprise incubation, and expanding KPLHS sites to polyclinic status, which allows them to access a broader menu of government reimbursements.
LESSONS LEARNED: Since 2016, public sector expenditures for KP-led HIV services have increased significantly in the past five years. By 2023, between 40-60% of several KPLHS organizational budgets were supported by the Thai National Health Security Office (NHSO). However, this funding is fragile and has met with some resistance among government stakeholders who question the role of KP-led organizations in providing some HIV clinical services. Simultaneously, several KPLHS organizations have initiated social enterprises and polyclinics that show early promise in diversifying funding sources by generating income that can be channelled back into HIV services.
CONCLUSIONS: The sustainability and domestic financing of HIV services requires long term planning, advocacy, implementation science, cost analyses, and business acumen. While domestic government investments in KPLHS can be successful, it remains necessary to continue to provide data and advocacy on the value of KPLHS investments so that skeptical stakeholders can be convinced.

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