Increasing enrollment of people living with HIV in family health insurance
Contracting with Seguro Nacional de Salud (SENASA), the public health insurance company, to receive payments for services rendered to people living with HIV is a critical element of strengthening the financial sustainability of non-governmental organizations (NGOs). However, these people must be enrolled as SENASA members before the insurance company will pay the NGOs for their care. Many barriers prevent people living with HIV from enrolling in social health insurance, ranging from bureaucratic and legal barriers to stigma and social exclusion.
SHOPS Plus has fostered collaboration among NGOs, public providers, and the government to enroll people living with HIV in the health insurance scheme. Through discussions with four key government bodies, including SENASA, SHOPS Plus developed standard operating procedures and quality control requirements to be used in the enrollment process. The project drafted an agreement to institutionalize the procedures as the official process for enrolling people living with HIV in the health insurance scheme. The agreement was signed in October 2019, increasing access to health insurance for people living with HIV and sustainable financing for NGO providers. SHOPS Plus is continuing to support these institutions to integrate the procedures into daily operations and monitor their success in increasing enrollment of people living with HIV.