HIV/AIDS and health systems

A report released in mid-August by the Center for Global Development (CGD) “suggests that AIDS donors may actually have weakened the health systems necessary for an effective AIDS response,” according to this IRIN/PlusNews article.

The report, titled “Seizing the Opportunity on AIDS and Health Systems,” looked at the interaction between the world’s three largest HIV/AIDS donors — the Global Fund to Fight AIDS, Tuberculosis and Malaria, the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the World Bank’s Multi-Country AIDS Programme (MAP) — and the national health systems of Mozambique, Uganda and Zambia. 

According to the article, “Focusing on three components of those health systems – health information systems, supply chains for essential drugs, and human resources – the researchers found that donors had developed AIDS-specific processes, often creating a drain on resources essential to the country’s broader health system.”

AIDS donors often require separate procedures and record-keeping aimed at increasing efficiency and accountability.  Ironically, the CGD report indicates that these requirements place added burdens on already “overstretched” health care workers and create unneeded complexity at clinics that distribute donor-funded antiretrovirals.

Another problem is that donor-driven AIDS programs can actually reduce the number of health workers available to developing countries.  According to the PlusNews article:

All three countries covered in the report are experiencing severe shortages of qualified health workers, but instead of training additional workers, the three donors have funded specific training in HIV/AIDS for existing staff. In some cases, they have rewarded staff for the extra work administering their programmes with salary top-ups.

“Such top-ups … focus the attention of clinical staff on HIV/AIDS – in some cases reducing the time they give to other health services,” the report’s authors argued.

PEPFAR has also funded the hiring of large numbers of non-governmental organisation (NGO) health workers, who often earn significantly more than their counterparts working for the state. […] Not surprisingly, donor funding for better paying jobs with NGOs has sometimes pulled desperately needed staff away from the state sector.

According to the CGD summary, the report “argues that donors need to pay more attention to their overall effect on health systems.”  This means HIV/AIDS donors need to take a wider view of the landscape they hope to impact.  “Because stronger and robust health systems are essential to ensure a long-term, expanded AIDS response, the authors urge the donors to take advantage of specific opportunities to strengthen both AIDS programs and larger country health systems.”

The report makes the following recommendations:

Improve health information systems:

  • Coordinate government and donor information needs and flows through national health management information systems and other systems—to reduce information fragmentation, to minimize duplicative and burdensome reporting, and to improve data quality;
  • With governments and other stakeholders, jointly design and invest in information technology solutions for data capture, management and analysis in health ministries, districts, and facilities;
  • Capture investments and their results in building information systems management capacity more systematically; and,
  • Create data collection and reporting incentives through information feedback systems.

Improve supply chain systems:

  • Pursue strategies that will let antiretroviral drugs and essential medicines be distributed jointly and managed using the same logistics management information system.
    • Strengthen human resources for health:

    • Provide more support to train new health workers;
    • Give priority to financing for new health worker hires—as opposed to top-ups for current health workers; and,
    • Work with governments to improve public-sector human resource policies.
      •  
        For more on the issue of HIV/AIDS and health systems, see this August 6 article from Medical News Today.  According to the article, “Leaders and experts in the fields of HIV and human resources for health have stressed that reaching universal access to HIV prevention, treatment, care and support will not be possible unless both communities work much closer together, reject notions of ‘competition’ between the two responses and unless stigma within the health professions is seriously addressed.”

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        ~ by h.e.g. on September 9, 2008.

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