Here is an anonymous comment received on the 14 November posting on payment for VCT in Myanmar. http://www.hivinfo4mm.org/blog/_archives/2006/11/14/2493566.html

**************************************

I would like to participate in discussing these issues though I had no connection with the two studies in question. However, I had a few years of work experience with MSI Myanmar and think that it would be helpful to discuss on this topic. Actually, the best person to respond to these queries is one of the authors listed in the abstract.

Firstly, it is hard to tell from the abstract that whether these data were representative of all the clients visiting MSI centers let alone representativeness of the people in the townships they are operating.

Secondly, "willingness to pay" is an economic measure to know how much people value a service =96 in this case a VCT service. "willingness to pay" measure is useful when we need to know the acceptable price , if it is not free, to be charged for a service. I guess the figure of $ 2.0 came from the follow up question: “If you are willing to pay for VCT service, how much would it be?”

"Willingness to pay" is different from "ready to pay" (in other words "ability to pay"). People may have enough money (ability) to pay for the VCT service; however, they might think that it is not worth giving money to get the service (unwilling to pay). Therefore, we cannot conclude that 25% of people who are not willing to pay =96 cannot afford the service. I am pretty sure that there are people who can't afford the service. The only thing I want to discuss here is  that it was not apparent from the abstract that what proportion of people has ability (enough money) to purchase the VCT service.

I did not notice any income level of sex workers in the abstracts. It only said that "Cambodia, sex workers felt strongly that HIV testing should be free for [them].”

I wouldn't argue with the fact that a good chunk of Burmese population has income of less than $ 1 per day.

VCT is provided free of charge in most of the countries, it is a fact. However, these programs are constantly facing with financial burden and continuity of service. Besides, donor fatigue is not uncommon. MSI philosophy, here, is to provide sustainable services using revolving fund and cross-subsidization. After all, private clinics are also charging for HIV testing services. Even some government hospitals charge for HIV testing of potential blood donors. (stored blood are tested for free, though).

It would be an ideal to provide all the health services free of charge. Is our country rich enough? Have we ever had enough resources in health sector? Can we be assured that we will have free flow of funding since 3D fund is granted? My point is we need to explore different modalities of health care financing and should not rely only on one particular source (ie. Donor funding).