Learning from the past: HIV, TB and the Science of Service Delivery PATRICK OSEWE WORLD BANK JULY 24, 2014

Why is HIV so important?

HIV is unprecedented among epidemics  A persistent pandemic that has global reach  Garnered sustained global attention for more than a decade  More money mobilised than any other disease  Generated many useful lessons for service delivery and access

What we have learnt from HIV? Strategic planning Drug procurement M&E Civil society involvement Universal access Life-long treatment Targeting high risk groups Gender Advocacy Results Donor/government involvement Costing Modes of transmission Behaviour change Efficiency

What did we learn from reproductive health? Health systems M&E Civil society involvement Equal access High risk groups Gender Advocacy Results Donor/government involvement Behaviour change

How to learn lessons? The example of the Science of Service Delivery  Problem-driven approach  Context sensitive  Feedback loops, evidence and knowledge  Multi-sectoral and multidisciplinary approach  Adaptive leadership and change management  Partnerships

Application to HIV and TB in the mining sector  TB in the mines an emergency for 100 years  Driven by poor living conditions, occupational risks, circular migration, and, most recently, HIV  Multi-sectoral, cross-border problem  Public and private sector cooperation essential

Science of Service Delivery: solutions  Targeting of high-risk groups  Migrant outreach, multiple countries  Testing and extension of occupational health services  Contract tracing and family/community involvement  Community mobilisation  Stakeholder coordination  Multi-sectoral, multi-partner approach  All have common features with aspects of the HIV response

The South Africa Knowledge Hub  Established between the World Bank and the Government of South Africa in 2012  To extract best practices from South Africa to share with other countries  To bring international best practices to this region  Establish a platform for consistent and productive south-south knowledge exchange  Eg, Knowledge Hub events in Pretoria (Sept 2013), Melbourne (July), Cape Town (Oct)

The South Africa Knowledge Hub (2) The way forward Encourage active participation by practitioners, implementers, and policymakers: ◦Identify and document lessons learnt – failures and successes ◦Assisted documentation through support services ◦Share experiential knowledge and disseminate best practices ◦Writing and publication workshops

THANK YOU CONTACTS: ◦Patrick Osewe, World Bank ◦Hannah Kikaya, Strengthening Health Systems