Is the HIV/AIDS Response Strengthening Health Systems?
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There were no less than four sessions* looking at the question of how the AIDS response is affecting country health systems – here are some highlights.
In “Positive Synergies” the leaders of UNAIDS, the Global Fund, PEPFAR, and the World Bank Multi-country AIDS Program (MAP) found many examples of the AIDS response strengthening the health systems of developing countries:
- Raised the visibility of pre-existing health systems weaknesses to attract resources and solutions
- Saving the lives of health workers
- Reducing the financial resource gap in countries with a historic and absolute shortfall of health funding
- Reducing the burden of disease to free clinics and hospitals to treat other conditions
- Improved equity due to its emphasis on human rights
- Expansion and empowerment of civil society organizations
- Leaving behind improved infrastructure, laboratories, procurement systems, and trained health workers
Data to back up these claims? Dybul shared data from Pepfar. Based on a literature search on the effectiveness of horizontal versus vertical programs, WHO Euro concluded that despite a 50 year debate and 8000 articles, the evidence for claims on either side is very limited (only 12 that met the Cochrane criteria for inclusion in their study). The Ministers of Health from Ethiopia and Thailand told their success stories that had strong national leadership in common, which is a nice transition to...
“Global Financial Architecture” where several of the same players (WB, GF, USG/Pepfar, UNAIDS, WHO, MOH/Ethiopia) made many of the same points, this time adding the dimension of donor coordination and the need to adhere to the Paris Principles.
Mission accomplished? Not quite. All seemed to agree that we must and can do better. How? The Center for Global Development released the results of the HIV/AIDS Monitor studies from Mozambique, Uganda, and Zambia that identified eight opportunities for global AIDS initiatives to benefit both AIDS programs and the larger health system, including: eliminate donor-specific AIDS information systems, explore how to merge the supply chain systems for ARV and essential medicines, train new health workers (as opposed to retraining the existing workers), and finance the hiring of new health workers (as opposed to paying salary top offs to existing workers).
To varying degrees, the Global Fund, MAP, and Pepfar-funded programs reflect country priorities and decisions. So why aren’t more countries opting to use AIDS funds in ways that strengthen their whole health system? The leaders of these programs offered several explanations: countries not clear what they can ask for, limited technical assistance to help countries figure out what to ask for, countries reluctant to propose a health system component for fear that it might sink their whole proposal, lack of coordination within the country between HIV/AIDS and the general health system, and there aren’t enough funds to do both.
Botswana, Ethiopia, and Rwanda offered some success and lessons on this question. The Minister of Health of Ethiopia described how strong national leadership can achieve some degree of harmonization and alignment of external assistance to reduce the transaction costs of planning, procurement, and reporting; and integrate HIV/AIDS with the broader health system.
* Sessions that looked at HIV/AIDS and health system strengthening:
From Dr. Kazadi JC Mwayabo on 9 September 2008, 11:34
This is a very important topic which actually touches all developing countries and let it not end there, but advocate donors to change their limitatation in the usage of the donated fund towards health system which automatically include human ressources, which is a key component as we embark in improving the health system.
From ch.s.naidu, apaidscon, hyderabad on 23 October 2008, 01:06
There is very essential to strengthen the health information system. Because every health care center least bothered about data collection, dissemination analysis and use of the data to take good decisions to improve the quality of health services.