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

BACKGROUND 30 years since HIV was discovered Response has yielded positive results: –An observed reduction in HIV incidence in many countries, including those in Sub- Saharan 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.

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

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

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

Health System Building Blocks

SERVICE DELIVERY

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

Quality Improvement

GOVERNANCE

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 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)

Global Health Agreements

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 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

Health Care Financing Innovative methods of raising funds in- country 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

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,

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

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

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

Thank you!