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Improving Access to HIV Services for Mobile and Migrant ...

Improving Access to HIV Services for Mobile and Migrant ...

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espect to APUA the state owned operator, there is no requirement to publically report financial results of the organisation and no data has been obtained in respect the revenue raised by the Telecommunications Division 3. Debt Conversion. Antigua facilitated by the IMF the government has had discussions with the domestic banks, in respect to re-structuring public debt, implementation of fiscal measures that would begin to eliminate the arrears on the public debt and to seek debt relief from public and private creditors. The debt restructuring included the lengthening of loan maturity rates with domestic and international lenders and reduced interest rates. In addition, the payment arrears which had generated with multi-lateral financial institutions have either been cleared or agreements have been reached on their clearance. As the country has recently undertaken a series of debt restructuring measures it is unlikely that further measures can be considered at this stage. For the discussion an evaluation methodology that identified the gaps and challenges was developed based on the following questions: 1. Can the mechanism be easily implemented? What are the obstacles to implementation? a. Legislation – Under Corporation Tax Law domestic companies pay tax at 40% however, under the Fiscal Incentive Act Tax holidays apply for foreign based companies which invest in Antigua & Barbuda. Some of the tax privileges include: i. Freedom from the payment of Corporate Tax on the profits arising out of the profitable operations of the company for a period of 15 years. The company can then apply for a renewal for a period of a further 15 years; ii. waiver of all import duties on consumption tax on the importation of materials and equipment used in the operations of the company; iii. grant of an export allowance in the form of an extended tax holiday on the exportation of goods produced in Antigua and Barbuda; iv. The right to repatriate all capital royalties, dividends and profits free of all taxes or any other charges on foreign exchange transactions. v. All office equipment and vehicles to be used in the company's operations can be imported free of duty and consumption taxes. The government grants all work permits and the necessary residential status to all expatriates who are key to a company's operations. 10

. In order to collect taxes under an innovative financing mechanism it is likely that the current corporation tax rules could need to be amended and industry specific levy charged. i. Political willingness of countries to adopt it. This may well depend on a number of factors, which would include a realization of the extent of the problem in terms of, the extent of HIV, together with the extent of HIV in the migrant population, and the influence of business interests who would be against additional taxation. For Antigua & Barbuda the willingness would need to be demonstrated in amending the tax holidays associated with foreign investment and the Fiscal Incentive Act. 2. What problem is it addressing? a. Does the target population have problems accessing the services. Whilst at the policy level references are made to citizens of Antigua & Barbuda at the actual service delivery level services are provided free of charge and access to based on need. Equity is a key feature with every resident of Antigua and Barbuda is covered under the primary health care system and HIV medication is provided without cost. 3. What impact will it have on the problem? a. Is there a current methodology for the identification of the target population as they access the health services? The challenge for the feasibility study here is that there is no process of identification of the target population as they access services. In addition, there is no funding mechanism in existence which links services performed to contracts and payments. 4. Who will benefit or be adversely affected (e.g. health-care consumers, developing country governments, taxpayers, industry)? 5. Is it likely to generate additional (incremental) funding or simply replace current support? a. Whilst there are some incremental revenues generated they are generally small and the collection costs may exceed the revenue collected. Challenges and Recommendations Challenges Recommendations The IMF Stand By Agreement with Antigua & It is not recommended to invest further resources 11

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