Transcript AIDS 2008 PowerPoint Template

NATIONAL HIV PROGRAMMES
– SYNERGIES WITH HEALTH
SYSTEMS AND HEALTH CARE
FINANCING
PRESENTED BY
DR. VELEPHI OKELLO (BSC, MBCHB)
NATIONAL CO-ORDINATOR
HIV CARE AND TREATMENT PROGRAMME
MINISTRY OF HEALTH
SWAZILAND
JULY 2011
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BACKGROUND
• 30 years since HIV was discovered
• Response has yielded positive results:
– An observed reduction in HIV incidence in
many countries, including those in SubSaharan Africa
– An increase in the availability of life-saving
ARV medicines in LMIC
– Significant increase in investment in the HIV
response, through the GHIs such as
PEPFAR, GFATM, GAVI, etc.
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The Impact of HIV on the Health
System
• Two arguments have emerged on the
effects of HIV programmes on health
systems:
– Negative impact on health systems - created
vertical systems - expensive to maintain and
may not be sustainable in resource-limited
countries
– Positive impact - Opportunities and platforms
for improving general health care delivery have
emerged
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Common Goals
• HIV Programmes and Health systems share
common goals:
• Improving health outcomes by addressing
issues of equity
• Ensuring that in accessing health services,
the population is protected from
catastrophic expenditure
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Synergies with the Health
Systems
• Experience in LMIC – areas of synergy
between HIV Programmes and health
systems are found in all the 6 building
blocks of the health systems:
– Governance
– Health Care Financing
– Health workforce
– Medical products & technologies
– Health information
– Delivery of services
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Health System Building
Blocks
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SERVICE DELIVERY
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SERVICE DELIVERY
• Approaches that have worked for HIV
Programmes and can be applied to health care
delivery for other chronic conditions within the
health system:
– Decentralization of services
– Chronic care model
– Integration of services
– Community involvement
– Patient-centred health care
– Quality improvement
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Quality Improvement
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GOVERNANCE
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STEWARDSHIP AND
GOVERNANCE
• Management of HIV Programmes - target setting,
accountability to the population
• Improved awareness and accountability of
governments on their performance on specific HIV
targets
• Now increased awareness of health-related MDGs
- renewed commitment - 2010 NY High Level
Summit on MDGs
• September 2011 – focus on NCDs - Governments
to agree (hopefully) on setting new targets for
NCDs
• Call for renewal of PHC (WHO Alma Atta
Declaration, 1978)
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Global Health Agreements
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HEALTH CARE FINANCING
HIV programmes have benefitted from increased
funding since their establishment
• GHIs - GFATM, GAVI, PEPFAR - doubled their funding
over the past 5 years
• There is great pressure for Governments, esp in Africa
to increase their funding for health in line with the Abuja
Declaration of 2001- Rwanda, Botswana met the targets
(March 2011)
• Since 2008, most of the donors opened up their funding
to cover other aspects of the health systems - IHP+
(2007), 30% GFATM and PEPFAR funds support HSS,
World Bank, ADB
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Health Care Financing
• Innovative methods of raising funds incountry include:
– AIDS levy (3%) on salaries - Zimbabwe
– Levy on mobile phone usage - Gabon
– National health insurance for all employed
– Tax on tobacco and alcohol, sugary drinks
and foods high in salt or trans-saturated
fats
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Other health system
synergies
• Management of health
workforce – in-service
trainings and CMEs,
HIV programmes
working to improve
pre-service training
curriculum, motivation
strategies, health
worker wellness
programmes,
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Other health system
synergies
• Management of patient
data – paper &
electronic PMS for
quality care, for
research to inform
future interventions
• Simplification of
diagnostic
technologies e.g. POC
CD4 machines now in
clinics, same possible
for glucometers
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Making it happen
• Countries to identify areas of synergy between HIV
programmes and health systems that are relevant to local
setting
• Country strategic frameworks should include strategies for
improving HSS – leadership and guidance to donors
• Countries to strive towards achieving the target of
spending at least15% of national budgets on health –
advocacy, prioritization!
• Donors and Development Partners to adhere to the Paris
Declaration principles of aligning aid to national priorities
and systems
• Governments and donors to enhance their accountability
to their populations
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Conclusion
• “We will not be successful in our efforts to
end deaths from AIDS, malaria, and
tuberculosis unless we do more to improve
health systems around the world, focus our
efforts on child and maternal health, and
ensure that best practices drive the funding
for these programs.”—President Obama,
during the launch of the GHI
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Thank you!
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