Health systems versus AIDS programs: A new discussion on a familiar topic
Aug 8 2008 in Health Systems, HIV/AIDS
Submitted by
Thirty years ago a similar discussion happened in relation to Family Planning programs. At that time there was an important concern about the apparently opposite approaches to the so called “vertical health programs” versus “comprehensive health programs,” the latter related today to the modern expression “health systems.” Probably everybody remembers the end of this story: vertical programs were a good idea in the short term but in the long term they necessarily had to be integrated into the national health systems for many reasons. Probably the most important reason was to guarantee they were sustainable. The other lesson learned was that vertical and comprehensive health programs were not really opposite approaches. The programs were inseparable parts of the system.
Today the issue is similar. The AIDS problem probably has the same importance and at least as much urgency as high fertility and family planning were seen to have in the 1970s and into the 1990s. One difference, however, is the huge amount of money that the international community has committed to HIV and AIDS. The objective is clear: to control the epidemic quickly. But behind this objective should be the most important goal: to foster governments through their national health system to assume their responsibilities for the long term. If this is not done, the AIDS vertical programs will erode the country’s capacity to develop and sustain these programs. Also, it will create a circle of dependency where every time it will be more difficult for the international donors to leave each country without severe concerns about how these programs will be sustained in the future by each individual country.
In any case, AIDS resources should be used to promote the development of the national health systems and not to promote isolated kingdoms as is the case in some countries. It is better to teach people how to fish than to give them fish.
