Access to HIV/AIDS Support for Nurses Identifying Actions to Take A Strengthening Health Systems Approach Deloris Russell, Canadian Nurses Assoc. August 7, 2008

Context: Magnitude Country Population (million) HIV Prev. No. Persons Living with HIV Swaziland ,000 Botswana ,000 Lesotho ,000 Zimbabwe ,700,000 Namibia ,000 South Africa ,500,000 Zambia ,100,000 Mozambique ,800,000 Malawi ,000 Central African Republic ,000

Context: Financial Base Country Per Capita Health Exp GDP Per Capita Swaziland ,824 4,824 Botswana ,387 12,387 Lesotho ,335 3,335 Zimbabwe ,038 2,038 Namibia ,586 7,586 South Africa ,100 11,100 Zambia ,023 1,023 Mozambique ,242 1,242 Malawi Central African Republic ,224 1,224

Context: HIV Service Needs Country Contraceptive Prevalence Receiving ART PMTCT Swaziland48%31.0%11.9% Botswana48%85.0%- Lesotho37%14.0%5.1% Zimbabwe54%8.0%4.4% Namibia44%35.0%25.0% South Africa 60%21.0%14.6% Zambia34%27.0%4.0% Mozambique17%3.4%3.4% Malawi33%20.0%2.3% Central African Republic 28%16.4%16.4%

Context: Health MDG Country Under 5 Mortality Rate Maternal Mortality Rate % Population Under- nourished % Children under weight for age South Africa 68400<2.512 Botswana Namibia Lesotho Swaziland Zimbabwe Malawi Zambia Central African Republic Mozambique

Gov. Spending (% of GDP) CountryHealthEducationMilitary Debt Services South Africa Botswana Namibia n/a Lesotho Swaziland Zimbabwe Malawi Zambia Central African Republic 1.5** Mozambique

2006 DAC Contributions US $ Billion Country Contribution United States 15-19Nil UK, Japan, France, Germany 5 – 9 Netherlands 0 – 4 Sweden, Spain, Canada, Italy, Norway, Denmark, Australia, Belgium, Switzerland, Austria, Ireland, Finland, Greece, Portugal, Luxembourg, New Zealand M. Total DAC Contributions

Top 10 ODA Recipient Countries United State Eur. UnionUnited King.CanadaJapan IraqTurkeyNigeriaIraq Afghan.Morocco IraqCameroonChina Sudan IndiaAfghan.Indonesia ColumbiaEgyptAfghan.Haiti Nigeria Egypt Serbia TanzaniaIndonesia Philippines Ethiopia Afghan Sudan EthiopiaViet Nam Congo DRPalestinian Bangladesh India Nigeria Congo DR PakistanGhanaThailand Pakistan IndiaGhana Mozambique Zambia Jordan Ethiopia Malawi SudanSri Lanka

Percentage Expenditures on Education, Health & Population Japan Norway United Kingdom Canada European Union United States

Context Summary 1. Top HIV prevalence countries o Low income countries = low tax base. Tax base low to meet pandemic needs.Tax base low to meet pandemic needs. Individual income frequently low Individual income frequently low High range of needed services High range of needed services High HIV prevalence = high prevention and health care costs High HIV prevalence = high prevention and health care costs 2. ODA Funding High HIV prevalence countries not top ODA recipients. High HIV prevalence countries not top ODA recipients. Health, Education & Population varied Health, Education & Population varied 3. HIC/MIC = higher tax base > more resources. Strengthening LIC health systems = Transfer of resources (human and financial) from HIC.

Nursing Response of Support Population health requires strong health system. Population health requires strong health system. Long-term sustainability of health system (public or private) requires quality input. Long-term sustainability of health system (public or private) requires quality input. Nurses are majority health care providers. Nurses are majority health care providers. Gender issue ? “Vacuum of silence” on global health issues. Gender issue ? “Vacuum of silence” on global health issues.

Nurses Addressing Global Health Organizational Development Organizational Development Building strong nursing associations.Building strong nursing associations. Building strong nurses unionsBuilding strong nurses unions Education Education Strengthening Faculties of Nursing Providing scholarships and education Research Implementing best practices Leadership & Dialogue Leadership & Dialogue International Council of Nurses World Health Organization World Health Assembly United Nations International Labour Organization

Case Study: Canadian Nurses Association Federation of 11 provincial and territorial nursing associations and colleges Represents 133,700 registered nurses and nurse practitioners. History: Policy Leadership, Educating members Advocacy w/ Government Program Leadership, Volunteerism, Achieved results Goal: Advance international health policy and development in Canada and abroad to support global health and equity CNA Position - Global Health & Equity

Social Justice Approach “ Canadian health professionals, including registered nurses, have the right and responsibility to raise awareness of the root cases of inequity in global health and to participate in finding solutions. Collaboration, cooperation and communication among all health professional are key to advancing an agenda to improve global health and equity.” Position Statement, Global Health and Equity Canadian Nurses Association

CNA International Development Program 30 year history 30 year history Partnership approach Partnership approach CIDA Funding: CIDA Funding: On-going program funding to strengthen nursing associations (US$ 1million). Funds 8 NNA / 1 regional HIV network.On-going program funding to strengthen nursing associations (US$ 1million). Funds 8 NNA / 1 regional HIV network. Bilateral HIV & Nursing Support project.Bilateral HIV & Nursing Support project. Research grant reduce needle stick injury.Research grant reduce needle stick injury. Bilateral project strengthening regulations.Bilateral project strengthening regulations. Federation of Unions contribution to strengthen union. Federation of Unions contribution to strengthen union. On-going Membership Education On-going Membership Education

Nursing Organizations Can: Educate membership Educate membership Global health issuesGlobal health issues Promote involvement at local, national and international levelPromote involvement at local, national and international level Organizations can: Organizations can: Implement partnership programs/projectsImplement partnership programs/projects Partnership in research for best practicesPartnership in research for best practices Advise government to meet global health needs.Advise government to meet global health needs. Provide support and mentorshipProvide support and mentorship Undertake projects in partnershipUndertake projects in partnership Mobilize financial supportMobilize financial support

Multi-Sector Approach to HIV & Health Systems Strengthening Physicians Persons Living with HIV Faith Based Organizations Musicians Community Organizations Labour Economists Historians Social Workers Sports Persons Government: Local, National, International Business Universities Community Caregivers

Ending the Vacuum of Silence Physicians Persons Living with HIV Faith Based Organizations Musicians Community Organizations Labour Economists Historians Social Workers Sports Persons Government: Local, National, International Business Universities Nurses Community Caregivers

Thank You Data Sources: Organization for Economic Cooperation and Development: 2006 Expenditures Report UNAIDS Report 2008 CNA Backgrounder: Social Determinants of Health and Nursing.