Closer to self-reliance as PEPFAR-funded NGOs contract with national insurance agency

In August 2019, three NGOs serving people living with HIV in the Dominican Republic joined the provider network of the national health insurance agency, SENASA. This major milestone marks the first time a PEPFAR-funded NGO has successfully contracted with SENASA under its subsidized scheme to cover this population group. This is a landmark achievement as the country moves toward self-reliance.

The Dominican Republic has an estimated 67,000 people living with HIV and approximately 34,000 people receiving antiretroviral treatment. Most people living with HIV belong to vulnerable populations which include men who have sex with men, female sex workers, transgender individuals, and Haitian migrants.  NGOs funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) have long provided HIV prevention and treatment services to these vulnerable populations in the country.  With SHOPS Plus’s support, three of these NGOs, serving more than 12,000 people living with or at-risk of HIV, took the first step towards reducing their reliance on foreign aid funding and securing their future as primary care providers within the Dominican health system.  

The Center for Comprehensive Research and Training, Clínica de Familia, and the Center for Human Advancement and Solidarity signed contracts to join the provider network of the subsidized scheme of SENASA, the national health insurance agency. With these contracts in place, SENASA will pay the NGOs to provide HIV and other primary care services to SENASA’s most vulnerable members so that they have continued access to treatment without financial burden. With the new revenue from the subsidized scheme, the NGOs will be able to expand their services, develop the systems needed to contract with other insurance schemes, and prepare for an eventual reduction in international donor funding. 

SHOPS Plus’s contributions to this achievement included advocating to SENASA to pursue contracts with NGOs and supporting the NGOs to meet pre-requisites and navigate the contracting process.  The project conducted an analysis to identify the obstacles to contracting, quantify the benefits, and identify the requirements for accrediting health facilities as a pre-requisite for contracting.  

Continuing its support, SHOPS Plus will work with the three NGOs to operationalize their contracts with SENASA by developing standard procedures for submitting claims, facilitating a knowledge exchange between NGOs that have previous experience billing other insurance schemes and those with no experience, and organizing contract review meetings with SENASA to address any issues that arise. 

The agreements reached between SENASA and the NGOs represent a promising achievement for building a sustainable, public-private HIV program and ensuring that vulnerable populations will continue to receive critical services without the need for foreign aid. 

Learn more about our work in the Dominican Republic, health financing,  and HIV.