[Global Health] ② Paraguay is about to graduate from the original… Healthcare self-reliance test bed

“The time of relying on aid is over. The purchase of treatment and diagnostic reagents for HIV patients is already 100% covered by the national budget. We are pouring in about 15 million dollars (about 21 billion won) from our own health budget over the past two years.”

At a session of the Paraguay Global Fund National Coordinating Mechanism (CCM) meeting held in Asuncion, the capital of Paraguay, on the 10th (local time), Elena Candia, director of the National HIV/AIDS Program (PRONASIDA), expressed her will to become self-reliant in public health in a firm voice.

Director Candia explained, “Unlike in the past when there was nothing, now you can get a rapid test in any of Paraguay’s 18 health districts and start treatment right away at a primary medical institution.” He added, “The Global Fund’s support is now focused on priming areas such as prevention activities for key vulnerable groups, civil society solidarity, and building a digital health system.”

◇ Entering the end phase of external support… HIV Final Distribution Cycle Countdown

Paraguay's health field is facing a major transition. This is because the support system of the Global Fund, the world's leading global health financing public-private partnership (PPP), which was established in 2002 and raises and invests more than $4 billion annually to lead the eradication of AIDS, tuberculosis, and malaria and the strengthening of the health system, has entered the so-called transition phase.

Thanks to its economic growth, Paraguay was classified as an upper middle-income country (UMIC) by the World Bank. Accordingly, malaria, which was certified eradication by the World Health Organization (WHO) in 2018, and tuberculosis, which received transition support funds in the past, have already been excluded from the Global Fund's new country distribution target.

In the HIV field, where the disease burden is still high, the 8th subsidy cycle (GC8) from 2027 to 2029 was confirmed as the final national allocation. According to regulations, the Global Fund's financial support will end on December 31, 2030. Paraguay, which has been building up its infectious disease response infrastructure by executing a cumulative subsidy of more than $82 million since 2004, faces a test of having to fully absorb prevention and patient management projects that used to depend on external support with its own finances within the next four years.

Health authorities and civil society, led by Paraguay's National Coordination Body (CCM/MCP), are hastening a soft landing by shifting treatment costs and the purchase of diagnostic reagents to the public budget and introducing a performance-based payment model.

At the 7th Global Fund Replenishment Meeting in 2022, it pledged $50,000 as a donor country, becoming the first Latin American and Caribbean country to demonstrate its will to transition from a beneficiary country to a donor country.

In fact, the changes in the field were clear. At Cacoupe Regional Hospital, 54km east of Asunción, visited by Korean reporters, the expansion of the regional base for infectious disease treatment was in full swing. This hospital, which recently received on-site diagnostic equipment (Abbott PIMA) from the National AIDS Program (PRONASIDA), was able to determine the immune status of about 200 HIV-infected patients at a local site, directly supply antiretroviral treatment, and perform regular follow-up management without sending patients to large hospitals in the capital.

◇ Beyond treatment, prevention and human rights protection… Task for civic groups to stand alone

However, there are formidable challenges on the road to complete independence. Above all, there is great concern that grassroots civil society organizations that have been supporting the vulnerable may take a direct hit when financial support is cut off.

'OPUMI', which we met in downtown Asuncion on the 11th (local time), is Paraguay's first self-help and advocacy non-governmental organization (NGO) for women living with HIV/AIDS. The Spanish name (Organizadas por un Mismo Ideal), literally meaning 'women united by one ideal', was established in 2009 and is based in the capital Asuncion and the nearby Fernando de la Mora region, supporting approximately 900 infected women annually. They play a wide range of roles, from peer counseling and hospital accompaniment to help newly diagnosed women overcome isolation and continue treatment, to human rights advocacy to eliminate stigma and discrimination, education on prevention of mother-to-child transmission, and policy participation in the National AIDS Program (PRONASIDA) and the Global Fund's National Coordinating Organization (MCP).

Opumi CEO Maria Lourdes Herreira, who founded the organization 16 years ago after becoming infected through her husband 27 years ago, vividly conveyed the desperation in the field seeking self-reliance over the walls of discrimination and stigma.

CEO Erreira said, "In the past, if the infection was known, even hospital births were denied and people were kicked out of their jobs. Patients fought directly and won anti-discrimination laws, and now we are helping infected women give birth to healthy children through peer mentoring and family education."

Opumi, which has received funding for its activities through the Center for Development Information Resources (CIRD), a receiving organization (PR) hosted by the Global Fund, is also preparing to stand on its own after 2030. Currently, about 100 members are leading the way and are expanding their activities beyond Asunción to surrounding states, and are promoting an economic self-reliance model that reinvests profits by operating a social enterprise brand (Creativa by OPUMI) that produces and sells clothing and household goods directly.

Representative Herreira appealed, “If it were not for the support of the Global Fund and the global solidarity of the international community, our activities today would not have been possible,” and added, “I hope that the government will continue to provide institutional and financial support to civil society’s prevention and human rights protection activities so that the seeds sown so far do not wither even if support from international organizations ends.”

Paraguay's domestic general government health expenditure is 4.47% of gross domestic product (GDP), which falls short of the Pan American Health Organization (PAHO) recommended standard (6%), and the proportion of direct household medical expenses is still high at 35.94%. Paraguay's challenge to break away from external aid and promote self-reliance in public health and civil society shows a milestone of self-reliance that true global solidarity should aim for amidst the international health crisis.