Universal Health Coverage and Access to HIV Treatment and Care in the Eastern Caribbean

Abstract

This dissertation includes four papers— two conceptual and two empirical— on universal health coverage introduced in global health as a policy concept to improve access to health care. The conceptual papers review the selection process for the Sustainable Development Goal indicator on universal health coverage and propose parameters to guide an evaluation framework for universal health coverage. The first two papers show that including participants from as many sections of the health sector and policy community is recommended in policy formulation and evaluation, and recognize that decision-making might be slower as a result. While the first two papers focus on the third Sustainable Development Goal to achieve universal health coverage, the following two empirical papers focus on the sixth Millennium Development Goal which committed to provide universal access to treatment and care for people living with HIV. The first empirical paper shows how physicians in six Eastern Caribbean countries (Antigua and Barbuda, Dominica, Grenada, St. Kitts and Nevis, St. Lucia and St. Vincent and the Grenadines) cope with the lack of resources for treatment and care. Access was implemented broadly emphasizing the availability of HIV treatment and care while ensuring that everyone who needed antiretrovirals did not incur out-of-pocket costs. In most cases, this meant receiving care in the public system which was mostly centralized and where people living with HIV had concerns about their privacy being compromised in societies where HIV stigma was prevalent. The second empirical paper shows that in St. Lucia, third-line antiretrovirals could be unaffordable to as much as 98 % of the population, depending on how affordability is measured. The papers collectively demonstrate how the Millennium Development Goals provided an opportunity for policy learning by comparing the implementation of universal access for HIV treatment and care with universal health coverage in the Sustainable Development Goals.