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BACKGROUND: MPLUS Foundation is a community-based organization delivering comprehensive HIV, STI, and primary healthcare services through a key-population-led health service (KPLHS) approach. Over two decades, MPLUS evolved from conducting only HIV outreach to now serving as a government-certified clinic, extending its services to include HIV-adjacent areas like mental health, stigma and discrimination, and anti-bullying. This expansion is supported by diverse funding sources, including USAID, the Global Fund, domestic health financing, grants, and social enterprise incubation.
DESCRIPTION: Based on clients’ needs, strategic planning, and its evolving mission, MPLUS expanded its services over time to offer increasingly comprehensive HIV/STI services and primary healthcare. This now includes HIV testing, PrEP, and referral to ART services, all recognized over time by the Thai government as reimbursable services by the Thailand National Health Security Office (NHSO). In 2019, MPLUS became the first KP-led organization certified as an HIV testing facility and gained ART provider certification in 2023. This certification led to increased domestic financing, reducing MPLUS’ dependence on international donors. These sources supported 18% of total operational costs in 2019, increasing to 56% in 2023. Furthermore, a fee-based social enterprise service was added in 2023, accounting for 2% of total revenue in 2023.
LESSONS LEARNED: Challenges remain to full sustainability. In January 2023, the Thai government restricted HIV prevention services for non-universal coverage (UC) clients, challenging MPLUS's financial viability. As a certified health facility, MPLUS was more resilient than others in continuing core HIV services through a fee-based model for certain HIV services, utilizing this revenue as a revolving fund to sustain essential HIV services for key populations whose health benefits are not registered under the UC scheme and those with economic challenges. MPLUS accessed the domestic health fund to explore government reimbursement for adjacent diseases like mental health and telemedicine for noncommunicable diseases to promote well-being of older key populations and other groups in need.
CONCLUSIONS: With careful strategic planning and in environments with universal health coverage, KP-led organizations can transform into primary care facilities to sustainably serve their targeted populations through a one-stop shop model supported by diversified funding, including domestic health financing, grants, and social enterprises.