The Impact of HIV Spending on Health Outcomes in Thailand

Background: The Sustainable Development Goals commitment to Ending HIV/AIDS by 2030 requires sustained adequate investment. This study sought to examine the association between HIV/AIDS spending and outcomes in Thailand between 2008 and 2019. Methods: A quantitative secondary data analysis with time-series was conducted using a retrospective dataset of HIV spending and some selected outcomes including the number of people living with HIV (PLHIV), incidence and prevalence of HIV/AIDS, the prevention of mother-to-child transmission (PMTCT) and AIDS-related deaths. Data were obtained from a diverse set of sources. Descriptive statistics and univariate regression model were used to analyze HIV expenditure and outcomes. Results: HIV spending per PLHIV rose by two folds from $347 in 2008 to more than $600 in 2019, mostly financed by domestic sources. This increase of domestic resources per PLHIV was significantly associated with better HIV-related outcomes especially in the reduction of PLHIV and AIDS-related deaths through increased number of people receiving antiretroviral therapy (ART). However, the spending per PLHIV varied across the three public health insurance schemes. Comparison of HIV expenditure and health outcomes across upper-middle-income countries shows Thailand is not highly ranked in terms of spending efficiency despite having made good progress. Conclusion: Domestic financing for HIV programs is indispensable for achieving the goal of ending AIDS. Despite significant improvement in HIV-related outcomes, challenges remain in achieving the 90-90-90 goal. The redesigning of payment methods should be considered to increase the efficiency of HIV financing. Other factors related to strengthening the health system should not be overlooked.

Strengthening the migrant-friendliness of Thai health services through interpretation and cultural mediation:a system analysis

Background:In addition to healthcare entitlements,‘migrant-friendly health services’in Thailand include interpretation and cultural mediation services which aim to reduce language and cultural barriers between health personnel and migrants.Although the Thai Government started implementing these services in 2003,challenges in providing them still remain.This study aims to analyse the health system functions which support the interpretation and cultural mediation services of migrant health worker(MHW)and migrant health volunteer(MHV)programmes in Thailand.Methods:In-depth interviews were conducted in two migrant-populated provinces using purposive and snowball sampling.A total of fifty key informants were recruited,including MHWs,MHVs,health professionals,non-governmental organisation(NGO)staff and policy stakeholders.Data were triangulated using information from policy documents.The deductive thematic analysis was classified into three main themes of evolving structure of MHW and MHV programmes,roles and responsibilities of MHWs and MHVs,and supporting systems.Results:The introduction of the MHW and MHV programmes was one of the most prominent steps taken to improve the migrant-friendliness of Thai health services.MHWs mainly served as interpreters in public facilities,while MHVs served as cultural mediators in migrant communities.Operational challenges in providing services included insufficient budgets for employment and training,diverse training curricula,and lack of legal provisions to sustain the MHW and MHV programmes.Conclusion:Interpretation and cultural mediation services are hugely beneficial in addressing the health needs of migrants.To ensure the sustainability of current service provision,clear policy regulation and standardised training courses should be in place,alongside adequate and sustainable financial support from central government,NGOs,employers and migrant workers themselves.Moreover,regular monitoring and evaluation of the quality of services are recommended.Finally,a lead agency should be mandated to collaborate with stakeholders in planning the overall structure and resource allocation for the programmes.