IN THE ERA OF DECLINING DONOR FINANCING, CAN DOMESTIC RESOURCES SUSTAIN CIVIL SOCIETY ORGANIZATIONS' EFFORTS TO END NEW-BORN HIV INFECTIONS

Efforts to increase uptake of prevention of mother-to-child transmission of HIV (PMTCT) services has produced a historic reduction in transmission rates to infants, but a significantly larger investment will be needed to end the HIV/AIDS epidemic by 2030. Civil society organizations (CSOs), which have traditionally been funded by international donors, have made important contributions to reducing new infections in children, largely due to their close links to local communities, understanding of the barriers to accessing HIV services, and ability to reach vulnerable populations. CSOs are effective at delivering and supporting PMTCT services, but there is little evidence demonstrating that they are cost-effective—that they avert more child infections and connect more women to treatment per dollar invested than other modalities. As international donors reduce their support to low and middle income countries (LMIC), it is imperative for governments to incorporate CSOs into their health systems—lest CSOs risk not having funding to provide crucial services. LMIC governments should study the cost-effectiveness of CSOs for delivery and support to PMTCT services to determine how partnering with them can provide the most value for money. For models that are effective, LMIC governments should consider initiating performance-based contracts with CSOs and giving grants to domestic community-based organizations to supplement the impact of public health services. International donors should facilitate these activities by building the capacity of LMIC governments and CSOs to enter into formal partnerships. Delaying investment in CSOs will deprive LMICs of their most effective, and potentially cost-effective, resources for ending the HIV/AIDS epidemic.