Domestic lessons from Ryan White: Can they be applied internationally? Kristen A. Stafford, MPH

1. Domestic lessons from Ryan White: Can they be applied internationally? Kristen A. Stafford, MPH University of Maryland School of Medicine – Institute of Human Virology

2. Overview • Ryan White CARE Act • Administrative Agent • Planning Council

3. Ryan White Care Act • First authorized in 1990 • PL 101 – 381 “To provide emergency assistance to localities that are disproportionately affected by the Human Immunodeficiency Virus epidemic and to make direct financial assistance available to states to provide for the development, organization, coordination and operation of more effective and cost efficient systems for the delivery of essential services to individuals and families with HIV disease in urban and rural areas.” • Reauthorized for 3rd time in 2006 • PL 109 – 415 “…to revise and extend the program for providing life-saving care for those with HIV/AIDS” The purpose of the CARE Act is to: “address the unmet care and treatment needs of persons living with HIV/AIDS by funding primary health care and support services that enhance access to and retention in care.”

4. Parts • Part A (Former Title I) • Eligible Metropolitan Areas • Part B (Former Title II) • States, ADAP, Emerging Communities • Part C (Former Title III) • CBO’s (early intervention services primarily) • Part D (Former Title IV) • Women, infants, children and youth • Part E – Emergency Response Employees • Part F (Still Part F) • AETC, Dental, SPNS

5. Administrative Agent HRSA Formula/Demonstrated Need Funding Based on Epidemic Administrative Agent (State HD) (Mayor – usually detailed to Local HD) Competitive Funding Based on Cyclical Application Process Service Providers (Primary Care, Case Management, Housing, Supportive Services)

6. Role of the Administrative Agent • Manages competitive grant process • Distributes RFP’s, reviews proposals, contracts with service providers • Fiscal Management of Funds • Monitoring of Funding Recipients • Site Visits to assess performance • Reports to Planning Council on utilization of services, people served, fiscal expenditures • Budget Changes • Must allocate funds based on priorities and funding percentages established by the Planning Council

7. Planning Council Administrative Agent (State HD) (Mayor – usually detailed to Local HD) Planning Council (Volunteer Board made up of service providers, service recipients and community representatives) Service Providers (Primary Care, Case Management, Housing, Supportive Services, etc.)

8. Role of the Planning Council • Set priorities for funding based on input from Administrative Agent reports, service providers and the community • Conducts Needs Assessments • Reviews the performance of the Administrative Agent • Addresses community grievances • Sets service standards and guidelines

9. One Possible Model • Establishing indigenous organizations as Administrative Agents • Build capacity of local organization to directly receive funds from the US government • This group would not be a service provider • Capacity build to manage RFP process, contracting and site management • Planning Council • Comprised of funding recipients, implementing partners, USG and the community to set priorities and funding levels

10. Administrative Agent (NGO – Indigenous Org.) Administrative Agent (NGO – Indigenous Org.) Administrative Agent (NGO – Indigenous Org.) PC (Community, Service Providers, MOH, IPs, USG) PC (Community, Service Providers, MOH, IPs, USG) PC (Community, Service Providers, MOH, IPs, USG) Service Provider Service Provider Service Provider Service Provider Service Provider Service Provider Service Provider Service Provider Service Provider Service Provider Service Provider Service Provider Possible Model OGAC HRSA/CDC

11. Lessons Learned • Community Involvement is written into the legislation • Check and balance system with PC defining funding priorities and AA distributing and monitoring funds • Funds are supplemental not supplanting • Up to 5% for QI programming • Funding must be used for continuity services, either provided by one group or documented linkages between services, no silo programs