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HIV/AIDSHealth Systems 20/20 is working at the country level to conduct comprehensive analysis of available and required human resources to scale up and sustain HIV/AIDS services and to facilitate solutions to address human resource shortages.

Responding to the HIV/AIDS Epidemic through Health Systems Strengthening Efforts

As countries work to scale up successful HIV/AIDS country programs, weaknesses in national health systems have grown increasingly apparent. Repeatedly, health system weaknesses, ranging from acute shortages of trained health workers to weak health management information systems to the inadequate integration of HIV services into basic health service provision, have threatened the successful scale up of urgently needed HIV and AIDS services.

International donors and national governments are increasingly recognizing the importance of strong health systems for achieving HIV/AIDS program targets and goals, and for providing long-term and sustainable support for prevention and management of one of the world’s deadliest infectious diseases. Health Systems 20/20 utilizes both proven and targeted approaches to strengthen health systems so they are prepared to meet the challenges of the HIV/AIDS epidemic.



What is the Health System?

A health system consists of all organizations, people, and actions whose primary intent is to promote, restore, or maintain health. Health Systems 20/20 incorporates the health systems strengthening framework of the World Health Organization in its approaches to health systems strengthening. The framework identifies the six building blocks of a health system as: service delivery, human resources for health, health information systems, pharmaceuticals, health financing, and governance. Each of Health Systems 20/20’s activities examines one or more of these building blocks in the context of HIV/AIDS programming at the country level.

Health Systems 20/20 Approach and Current Activity Highlights

Health Systems 20/20’s holistic approach to health systems strengthening allows it to link research to real-world applications, and address the spectrum of HIV-related prevention, treatment, care, and support needs. The project works closely with a diverse set of local partners including central ministries of health, district health managers, grassroots private groups, and others, to address those priorities.

For example, Health Systems 20/20 works with ministries of health, USAID country missions, and other local country partners, to apply our Health Systems Assessment Tool to rapidly assess health systems needs in the six WHO health systems strengthening areas and to prioritize responses.


Health Systems 20/20 also uses the HIV/AIDS Program Sustainability Analysis Tool (HAPSAT) to assess the current financing and scope of HIV/AIDS services in countries by estimating the cost of sustaining a prioritized set of HIV/AIDS services over a five-year period. The HAPSAT considers the total costs of sustaining programs including ARV drugs, infrastructural costs, equipment costs, M&E, and the cost of developing the human resources necessary to deliver HIV/AIDS services.

Health Systems 20/20 provides technical assistance in costing national HIV/AIDS strategies. As countries become increasingly interested in costing their three to five year HIV/AIDS strategies, this costing exercise provides strategic planning information by assessing the resource requirements for sustaining and scaling up HIV/AIDS programs. Leveraging the successful HIV/AIDS costing study done in Liberia and the ART costing studies done under the USAID-funded PHRplus project, Health Systems 20/20 is supporting development and costing of national HIV/AIDS strategies in five countries.

Health Systems 20/20 has several large activities focused on human resources for health using targeted approaches to improve the retention, performance, and motivation of health workers. These include a study in Ethiopia comparing financial and non-financial incentives to improve HIV/AIDS counseling and testing performance; an assessment in Uganda comparing performance, retention, human resource management practices and motivation at faith-based organizations and public sector facilities; an activity in Swaziland using non-financial incentives to improve retention and performance; and a study in Zambia testing productivity improvement among health workers.

The project has also been working on improving strategic information to inform program planning and decision making for service delivery by using GIS technology. GIS mapping and analysis is a key component of this process since it enables visualization of key program data within a geographic context. Health Systems 20/20 promotes the use of GIS mapping and analysis tools to graph health survey data, identify geographic trends, and promote optimal allocation and positioning of resources to address health needs.

Nigeria TB Supportive Supervision Pilot Evaluation

Elizabeth Ohadi, Leah Ekbladh, Anthony Okwuosah, Alison Comfort, and Alexandra Hulme
Sep 2012 | Health Systems 20/20  | Report 

Health Systems 20/20 Final Project Report

Health Systems 20/20
Sep 2012 | Health Systems 20/20  | Report 

Feasibility Study: Integration of Services into the Health System of Ukraine

Peter Cowley and Baktygul Akkazieva
Sep 2012 | Health Systems 20/20  | Report 

Cost and Efficiency of ART Regimens

Christina Juan, Itamar Katz, and James White
Sep 2012 | Health Systems 20/20  | Brief 

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Project Closes September 2012

Sep 21 2012

In launching the Health Systems 20/20 project in 2006, USAID recognized that “Only as we solve systemic challenges can USAID fulfill its mission of saving lives….” Through Health Systems 20/20, USAID has complemented its disease- and service-focused investments with technical assistance, capacity building, and global leadership in financing, governance, and operations. As a demand-driven project, Health Systems 20/20 responded to over 250 activity requests in 51 countries. More...

Mapping Health Services of Nigeria to Improve Accessibility and Quality

Sep 21 2012
The National AIDS/STI Control Program (NASCP) of the Federal Ministry of Health (FMOH) of Nigeria is in the process of surveying all health facilities in Nigeria with a technical assistance of Health Systems 20/20. More...

New Perspectives in Health Systems Strengthening: Lessons Learned for Building Stronger, Smarter Systems

Aug 2 2012
Health Systems 20/20 has conducted more than 250 health systems strengthening activities in 51 countries since 2006, helping to eliminate barriers to the delivery and use of priority health care, including HIV/AIDS services, tuberculosis treatment, and reproductive health services. More...

Who Will Pay - HAPSAT Results Widely Discussed at AIDS 2012

Jul 30 2012

Health Systems 20/20’s HIV/AIDS Program Sustainability Analysis Tool (HAPSAT) has been used in 14 countries to examine HIV/AIDS program sustainability issues related to efficiency, prioritization, and resource mobilization. Lessons learned from HAPSATs were discussed at several sessions at the recent AIDS Conference 2012.


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