Operating a Checkpoint

Financial viability and sustainability

In general, CBVCT services in Europe operate on the basis of a combination of funding sources. Some are parts of larger organisations with long-term public funding, others rely on short-term grants and/or private sector sponsorship. At the same time, trust in a service provider is built on continuity. Reliable, uninterrupted service is important for building a reputation with the key population and therefore increasing reach.

Financial viability and sustainability are constant topics for most NGOs, including CBVCTs. It helps motivation and morale if management and board foster a positive and optimistic attitude towards funding sustainability by showing confidence that funding sources will be found.

Question twelve of the Euro HIV EDAT Self-evaluation Grids focuses specifically on integrating CBVCT within health and community services to make it more sustainable.

Get some insights from different Checkpoints in Europe in our video from the Workshop in Ljubljana:

Russian subtitles included /Включая российские субтитры

Item Does your CBCVT have this in place? Is there a documented standard, guideline, plan, policy, procedure, contract or agreement? Is it adapted to local needs and conditions? Is it working as intended? Action
Public/private/research funding sources
Description

Description

Public funding means financial support from governments and private funding comes from commercial companies. Research funding may come from public, private or NGO sources (e.g. foundations), but is tied to research projects.

 

Guidance

Guidance

It is rare for health systems to fully fund CBVCT services if other HIV testing options are already available, even if these fail to reach key populations. Public funding may reach CBVCTs via allocations to HIV prevention NGOs or as special pilot projects or complementary programmes.

Some private companies, e.g. those selling HIV treatments, HIV tests or related products have a commercial interest (not necessarily to the exclusion of humanitarian motives) in the early diagnosis of as many HIV infections as possible. They are therefore an important source of funding for CBVCTs, or may supply HIV testing kits free of charge or at reduced prices. They are often a good source of funding to get CBVCT services started.

Membership fees and donations received from the key population as well as ‘friends and supporters’ of the organisation, e.g. at fundraising events, can provide additional income. Some organisations have a separate fundraising position (volunteer, paid or contracted personnel) to focus on this source.

Research projects based on HIV testing and other demographic and epidemiological data collected about key populations may incorporate new CBVCT services (e.g. outreach) in the research design or support existing services.

With the rare exception of unspecified grants, donations or endowments, all external funding generally comes with criteria, conditions, expectations, accountability and reporting requirements.

In your decision regarding which funding options to pursue or which funding conditions to accept, consider the following:

  • Compatibility with principles and values: will the funding conditions support the primary purpose of the CBVCT (e.g. community involvement)?
  • Acceptability: will the funding conditions be acceptable to the key population (e.g. data collection required by research funding)?
  • Accountability and reporting: does the CBVCT have the capacity to fulfil accountability and reporting requirements?
  • Co-contributions: does the CBVCT have the financial capacity to contribute co-funding where it is part of the conditions for a grant?
  • Cross-compatibility of funding sources: do any of the CBVCT’s funding sources exclude others (e.g. some grant funding conditions exclude company sponsorship or only allow it up to a certain proportion of overall project funding)?

The following table lists funding sources and compares them according to their amounts, funding period and the bureaucratic effort they require. Please note that the assigned values are relative to each other and based on the collective experience of CBVCT operators across Europe.

Funding sources comparison table

 

Adaptation

Adaptation

Local needs and conditions influence how individual CBVCT initiatives develop financial resources. Governance structures (e.g. boards, management committees) need to weigh up the benefits and possible disadvantages:

  • To demonstrate that a CBVCT service is viable and beneficial, short-term or restrictive funding conditions may be acceptable in the short term.
  • Lack of policy-level support or restrictive regulations may make a research-based pilot project a viable option.
  • If the local policy environment is hostile, international funding sources may assist.

The disadvantages of restrictive funding arrangements can be managed by:

  • Using initial project periods to build the evidence needed to apply for more sustainable funding (documentation and data analysis)
  • Including the key population in the decision-making process
  • Developing a range of complementary funding sources to decrease dependence.

Options for low-cost operations:

  • Determine the minimum funding level and work out a basic plan for maintaining core services during periods of financial stress (e.g. with volunteers, in-kind laboratory services, outreach instead of a permanent site, sharing premises etc.).
  • Use a collaborative approach where the team works together to raise funds.
  • Team members who have other sources of income may be able to volunteer while there is no funding.
  • The balance of paid and volunteer work depends on the local environment (sense of urgency, need, passion, level of professionalization).

 

Quality Improvement

Quality Improvement

Many structured quality improvement tools include sections on financial resources (e.g. QIP or Succeed, available at  www.qualityaction.eu). Step-by-step guides to participatory methods that include key populations in decision-making processes can be found in the PQD tool (Participatory Quality Development, also available at  www.qualityaction.eu).

 

Action plan

Action plan

This Action Plan helps you to work directly on the items identified as priorities (yellow and/or red fields in the Checklist). Please list actions that are as specific as possible. You can download your finished Action Plans for each section as an xlsx.-document and print it afterwards. The Action Plans form the basis for your further planning, implementation and evaluation.

The Action Plan shows a sequence of steps to be taken, or activities to be performed for a strategy to succeed. The Action Plan has four major elements: (1) what will be done (specific tasks), (2) by whom (responsibility), (3) by when (timeframe), and (4) how the implementation of the task will be monitored.

 


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Viability fees
Description

Description

Fees the CBVCT charges clients for the test in order to remain financially viable.

 

Guidance

Guidance

In general, testing guidelines and policy recommendations state that free HIV tests have the best chance of increasing uptake, especially by vulnerable populations at higher risk. However, in many countries, free HIV testing is not widely available and even if CBVCTs charge a nominal fee to remain viable, they can still be a relatively low-cost testing option for MSM.

Informing clients how the fees are set and why the CBVCT charges them can contribute to acceptance and uptake. Some CBVCTs inform clients that payment is optional, but will ensure access for others who would otherwise be unable to afford the test.

 

Adaptation

Adaptation

Setting viability fees means balancing the financial requirements to operate the service with maximising access for those at greatest risk. Many factors play a role in adapting fees to local circumstances:

  • Running costs of the CBVCT
  • Income distribution and affordability for the key population and subgroups
  • Local significance of cost as a barrier to testing

The aim is to set the fee so it does not act as a barrier to testing, but still contributes to the viability of the service. Setting a higher fee may defeat the purpose of providing a low-threshold testing option. It may be necessary to find other funding sources in order to keep fees sufficiently low.

Some of the options used by CBVCTs are:

  • ELISA test (if reimbursed by health insurance) available for free and rapid test available for a fee
  • Fees can be cost-recovery fees or include a surcharge to make free tests available for those who cannot afford it. This is communicated as an appeal to those who can pay more.
  • Donations boxes on open display. Ensure there is always money, e.g. in a transparent box, that encourages good size donations (e.g. if there are 5 euro notes visible, people will tend to donate the same amount, if there are 20 euro notes, people will tend to donate that amount if they can).

 

Quality Improvement

Quality Improvement

Many structured quality improvement tools include sections on financial viability and funding security (e.g. QIP or Succeed, available at www.qualityaction.eu). If the CBVCT charges viability fees, it is important to invite clients to provide feedback on the role the price played in their decision to get tested. Step-by-step guides to participatory methods for collecting feedback can be found in the PQD tool (Participatory Quality Development, also available at www.qualityaction.eu).

 


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Action Plan

Operating a Checkpoint
Financial viability and sustainability
ItemWhat will be done?Who will do it?When?How will we monitor it?
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