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HIV and Social protection

Bold move in Sri Lanka lets people with HIV get health coverage

For the first time, leading insurance firms in Sri Lanka will cover HIV-related medical costs. The move – spearheaded by the ILO – means increased access to treatment and a better quality of life for HIV-positive patients and their families.

Feature | 07 July 2014
GENEVA (ILO News) -- Palitha Bandara runs a business in Colombo buying and selling ready-made garments, which brings him a small income. Eight years ago, he was diagnosed with HIV.

Until recently, his HIV-positive diagnosis left him excluded from health insurance and he received no reimbursement for HIV-related medical costs. For people in Bandara’s situation, this often means severe financial consequences for them and their families.

However, in a bold move spearheaded by the International Labour Organization (ILO), four insurance companies in Sri Lanka have now removed HIV-related exclusion clauses. The firms - Janashakthi Insurance PLC, People’s Insurance Ltd, Alliance Insurance Pvt Ltd and Co-operative Insurance Company Ltd - will now pay medical expenses for those living with the virus.

This policy shift has turned life around for many in the country who are HIV-positive. It means out-of-pocket expenses -- such as the cost of taking public transport to health services - are now covered.

“This will really be helpful for positive people in cases of medical emergency. It can also help to enhance the quality of life for us and our families and reduce stigma and discrimination towards us,” says Bandara, who is also a member of Sri Lanka’s Positive Hopes Alliance, a network for people living with HIV.

Out-of-pocket impact

Chandra Schaffter
Chandra Schaffter, Founder and Deputy Chairman of Janashakthi Insurance PLC, reflects the evolving attitude among insurers when it comes to health coverage policy.

“In my own view, HIV is not much different to diabetes, cancer or kidney failure…and there is no real reason for treating it differently. Insurance is meant to cover unexpected events and not certainties,” he says.

Over the past few years, the ILO has been advocating for a national dialogue with insurers in Sri Lanka.

In August 2013, Indira Hettiarachchi, National Project Coordinator/ILO, Sri Lanka, was invited to address the country’s quarterly CEO forum on the social and economic case for including those living with HIV in policies.

Stressing that HIV coverage would not burden companies with major costs, the ILO presented an evidence-based, humane and economic argument, and emphasized that better policies would help people avoid falling into poverty. The logic worked. As a result, several CEOs decided to overhaul their firms’ policies.

The insurers’ move is seen as the first step in the challenge to get all 20 of Sri Lanka’s insurance companies to drop HIV-related exclusion clauses.

This is a very important milestone in improving social protection for people infected and affected by HIV"
“This is a very important milestone in improving social protection for people infected and affected by HIV. We are confident that more insurance companies will also join this initiative, which is a significant step towards eliminating discrimination,” says ILO Country Director Donglin Li.

ILO recommendations

Such insurance industry progress is in line with the recommendations of a recent ILO study, Access to and effects of social protection on workers living with HIV and their households. The study, launched by the ILO in June 2014 in Geneva, was undertaken in four countries, including Guatemala, Indonesia, Rwanda and Ukraine.

According to the study, the public sector plays a dominant role in social protection. But the majority of those living with HIV, particularly women and transgender persons, are not reached, as they are more likely to work in the informal economy, and often without contracts.

The report highlights the issue of high out-of-pocket expenses, including transport costs, in accessing free government-provided antiretroviral medication and treatment for opportunistic infections.

Beyond Sri Lankan borders

“It is extremely important for the private sector to complement the effort of governments and extend health insurance to people living with HIV. I hope the initiative of Sri Lankan insurance companies will be replicated in other countries as well,” says Alice Ouedraogo, Chief HIV/AIDS and the World of Work (ILOAIDS), Geneva.

Even more could be done to boost the impact of social protection for people like Bandara. Beyond enhanced health insurance, this includes a combination of income, livelihood and employment support. However, in Sri Lanka, better health insurance coverage marks an ambitious step forward.

“The intervention lifts the financial barriers in accessing treatment and related services in the private sector, broadening the scope of HIV treatment, care and support,” says UNAIDS Country Officer Dayanath Ranatunga. “This is a giant achievement in the Sri Lankan HIV response.”