Sustainable Financing of the HIV Response in Vietnam: Integration of Donor Funded Treatment Facilities into Public Health System and the Social Health Insurance (SHI) Scheme Hien Nguyen T.1; Huong Nguyen T.1; Anh Nguyen T.C.2; Hieu Pham C.1; Ni Le A.1; Lam Dam D.1; Diu Nguyen T.1; Nazzarino Todini1; Nhan Do T.3; Huong Phan T.T.3; Long Duc Vu.3 Theodore M. Hammett1 1USAID/Health Finance and Governance Project, Abt Associates, Hanoi, Vietnam 2USAID, Hanoi, Vietnam 3Vietnam Administration of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam For more information, please contact Hien Nguyen at Hien_Nguyen@abtassoc.com July 2018

OPCs located at Provincial HIV/AIDS center (PAC) From donor-funded OPCs How They Are Integrated To health facilities reimbursed by Social Health Insurance fund OPCs located at Provincial HIV/AIDS center (PAC) Health facilities including hospitals, general clinics, HIV/AIDS specialized clinics PAC is not a curative health facility – not eligible for SHI contracting External integration: transfer patients to a curative health facilities with SHI reimbursement Internal integration: restructure themselves into a curative health facility with operational permit by DOH and process SHI contacting OPCs located at Preventive Medicine Center (PMC) PMC has not curative function – not eligible for SHI contracting HIV patient signs for his medication through SHI fund at a district hospital drug counter OPCs located at Provincial and district hospital Internal integration: fully integrate into the existing hospital OPCs operate independently from the hospital

OPC Integration Progress In PEPFAR TA supported provinces In USAID/HFG supported provinces   Treatment facilities with SHI contracts Treatment facilities with SHI reimbursement Baseline = 0 Dec- 2016 47/109 (43%) 24/109 (22%) Dec-2017 83/115 (72%) 70/115 (61%) Mar-2018 91/118 (77%) 83/118 (70%) Sep-2018 (Expected) 100/118 (85%) 95/118 (80%) – Hoa Binh – Hanoi – Hai Phong – Thai Binh – Phu Tho – Ninh Binh – Ho Chi Minh City – Dong Nai – Can Tho

Next Steps Complete the integration at the remaining health facilities (mainly PMCs and PACs) in PEPFAR focus provinces assigned by USAID along with support to increase SHI coverages for PLHIV. Prepare health facilities for the reimbursement of ARV through SHI (SHI coverage for ARV by beginning of 2019, but ARV are still partially funded by donors till 2020). Full integration will contribute to ensure financial protection for PLHIV through SHI coverage by 2020 and help Vietnam achieve the 90-90-90 goals. The 2nd 90% treated with ARV = PLHIV can access to treatment facilities with SHI reimbursement and afford ARV treatment through SHI coverage