Health Systems and AIDS

1
Health Systems and AIDS

• Keith Hansen
• LCSHH
• November 30, 2005

2
Sector support for AIDS

• Advocacy and awareness-raising
• Surveillance
• Basic RH and HIV-specific counseling
• Testing
• Diagnosis
• Treatment AOIs, HIV, PMTCT
• Protecting health workers

3
System constraints

• Multiple HR shortages
• 31 African countries have lt1 MD/10,000
• 22 African countries have lt1 RN/2,000
• Poor incentives/high brain drain
• Ghost workers sometimes gt25 of payroll
• Weak surveillance and M E
• Low coverage of core services (e.g. RH)
• Poor supply chain management

4
Sector constraints

• Limited access to clients (esp. men)
• Very limited access to high-risk groups
• Limited impact on social norms
• Adverse political economy
• Programs disfavor stigmatized diseases
• Funding favors wrong skill mix
• Guild approach and focus on credentials

5
AIDS-aggravated constraints

• Growing pressure on health demand
• AIDS-opportunistic infections
• 5 prevalence 26 jump in demand

6
Regional TB incidences
7
DOTS impact in Africa
8
AIDS-aggravated constraints

• Growing pressure on health demand
• AIDS-opportunistic infections
• 5 prevalence 26 jump in demand
• HR issues
• Occupational risk of exposure
• Effect on morale and nature of work
• Poaching by donor-funded NGOs, etc.

9
AIDS-aggravated constraints

• Growing pressure on health demand
• AIDS-opportunistic infections
• 5 prevalence 26 jump in demand
• HR issues
• Occupational risk of exposure
• Effect on morale and nature of work
• Poaching by donor-funded NGOs, etc.
• Dominance of external aid
• Volatile, uncoordinated, uncontrolled

10
(No Transcript)
11
Opportunities to strengthen

• Capitalize on the opportunity of AIDS
• Primum non nocere
• Respect country systems and stewardship
• Create fiscal space
• Take long-term system view
• Improve surveillance and ME
• Address HR issues at all levels, incl. global
• Incentives, accountability, demand

12
Expand HIV treatment

• Savings in averted AOI care
• Reduce pressure on health system
• Good for health staff
• Boost life expectancy
• Reduce absenteeism
• Boost morale and sense of effectiveness
• Reduce stigma
• Avert larger second-line costs

13
SÃO PAULO mortality, 1985 - 2003
25,0
20,0
15,0
MR (p/ 100,000 inhab)
10,0
5,0
0,0
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Source Seade
Year of ocurrence