Bridging the divide between HIV programmes and other health needs

There is a growing realisation that in order to strengthen health systems, the gap between HIV research and programme implementation and other health needs must be closed and programmes have to be integrated with other sectors.

HIV programmes and their interaction with, and impact on overall health systems has been debated at length this year at the International AIDS Conference in Vienna. HIV programmes have, in many cases, been successful, large-scale chronic disease programmes in resource-poor countries. But it’s also evident from discussions and study findings that we need to learn lessons from scaling up such programmes in order to gear these investments to also improve health system performance and achieve the Millennium Development Goals relating to child and maternal health.

Many health systems are in crisis and facing problems with infrastructure, human resources, laboratory conditions, pharmaceutical systems and drug supply and barriers to accessing health services (such as health care fees charged in medical clinics) etc,.

The funding for HIV has and hasn’t strengthened the overall health systems; there have been positive and negative effects.

So what are the positives? HIV programmes have:

• led to an increased awareness of public health
• contributed to creating new financing mechanisms
• increased community participation
• scaled up primary health care facilities
• increased awareness of human resources for providing health care services
• led to the development of monitoring and evaluation tools for programming
  
• some programmes have combined treatment with treatment for other diseases.

HIV programmes have also often been an entry point for capacity building within larger health systems. Training for health workers on HIV programmes also include aspects of maternal and child health, such as preventing mother-to-child transmission and family planning.

The community systems, which provide support and other services, must also be included in this discussion as they go beyond the health sector and contribute to the health system. These systems are comprised of teachers, carers and community workers, among many others, who may have experienced some positive impacts from HIV programming. The number of community based organisations (CBOs) has risen and they have been able to address vulnerable groups and provide services to those otherwise not in reach by the health sector.

But there are negatives as well. Many health workers have left the health service to work on HIV exclusively. This brain drain effect has also been seen by heath staff leaving the health sector to work for CBOs, non-governmental organisations or international non-governmental organisations. Funding for HIV programmes often provides a higher wage and thus an incentive to focus purely on HIV.  Anti-retroviral medication has improved, however has this been a detriment to the development of other medication? Has HIV funding taken away money from other services, such as childhood illnesses and access to clean water and sanitation? Training opportunities provided through HIV programmes have encouraged health workers to stay in training as this is a stable source of income. Have these effects resulted in jealousy and resentment from other workers within the health sector not working in HIV?

So what are the options for the future? How can we learn from the negative impacts and how can we put concrete plans in place so that HIV programmes improve health systems and the positives mentioned are not just spin-off effects? How can HIV programming maintain stable, increased and innovative funding to help optimise the World Health Organisation building blocks and achieve an effective health care system?

Governments need to develop health system strengthening plans and donors need to be encouraged to fund them. Funding platforms should be embraced, longer-term approaches need to include health system capacity building, ownership must be adopted at country level for integrated health care implementation and strengthening community systems has to be seen as a key factor to strengthening overall health systems.

During one session, UNAIDS claimed it was integrating its programmes to achieve the three zeros; zero infection, zero discrimination and zero deaths. All of which should not be isolated to the AIDS response. It  stated the need to increase the positive effects and decrease the negative ones – MDGs 4, 5 and 6 cannot be achieved in isolation.

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