Monitoring UA 2010 in health sector 1 |1 | Monitoring progress towards Universal Access 2010 in the health sector Kevin M De Cock Ties Boerma

Monitoring UA 2010 in health sector 2 |2 | Monitoring progress towards Universal Access by 2010 UN General Assembly 60 th session, June 2006 –Reiterates "commitment to pursuing all necessary efforts to scale-up … towards the goal of universal access to comprehensive prevention, treatment, care and support by 2010" –Calls for setting up and maintaining rigorous monitoring & evaluation frameworks Lessons learned: solid commitment to monitoring progress essential –International initiatives: Health for All by the Year 2000; Millennium Development Goals; "3 by 5" –Too much focus on indicators and reporting requirements –Too little focus on investment in measurement and country health information systems

Monitoring UA 2010 in health sector 3 |3 | WHO framework for monitoring the health sector: components of access Availability reachable and affordable services that meet a minimum standard Coverage people using the intervention among those who need it Impact reduction in new infection rates and improved survival of those infected Health Interventions

Monitoring UA 2010 in health sector 4 |4 | WHO framework for monitoring the health sector: priority interventions Availability Coverage Impact ART Treatment programs for people with advanced infection PMTCT Preventive therapy for pregnant women Counseling & testing TB patients, risk populations Nosocomial infections Blood safety, universal precautions Most-at-Risk Populations Targeted interventions Strategic Information: Comprehensive HIV/AIDS surveillance systems

Monitoring UA 2010 in health sector 5 |5 | Indicators and Targets Indicators: minimize the number of indicators to monitor progress –Impact: UNGASS and other goals (e.g. prevention HIV in infants) –Coverage: UNGASS and other goals (e.g. people on ART among those in need) –Availability: focus on basic indicators to measure progress and direct link with service provision (e.g. districts providing ART services) Measurement: invest systematically in better measurement to obtain quality data –Facility census, service recording and reporting, coverage surveys, vital registration What about setting targets?

Monitoring UA 2010 in health sector 6 |6 | Global scale-up experience Trends in the number of people on ART All low and middle income countries Sub-Saharan Africa 3 by 5 target

Monitoring UA 2010 in health sector 7 |7 | Global scale-up experience Trends in the number of people on ART * All low and middle income countries Sub-Saharan Africa 3 by 5 target ART need 2006

Monitoring UA 2010 in health sector 8 |8 | Country experiences (1) Rapid increase in number of ART sites, selected countries in Africa

Monitoring UA 2010 in health sector 9 |9 | Country experiences (2) Expanding sites and site volumes, Malawi

Monitoring UA 2010 in health sector 10 | Country experiences ART availability and coverage trend, Thailand, Number of ART sites Number of people on ART

Monitoring UA 2010 in health sector 11 | ART coverage (%) trends in six African countries, Namibia Rwanda South Africa Malawi Tanzania Nigeria

Monitoring UA 2010 in health sector 12 | Targets and global standards Universal – aim for 100%, with global standards as benchmarks –TB: 70% case detection / 85% treatment success rate –Immunization: Reach Every District (RED) = at least 80% DPT3 coverage in every district; includes equity Targets: Country-specific targets are important, supported by global standards for universal access –Example: 80% of districts have at least 2 ART facilities by 2008 Variable time line adapted to country-specific constraints –What are the constraints?

Monitoring UA 2010 in health sector 13 | Targets and Timelines Overcoming country constraints to reach minimum standards *Constraints: adapted from Hanson K et al. J Int Dev 15, 2003: 1-14 Epidemiologic situation ability to reach the people in need Community and household demand for services, barriers to use Health sector policy and strategic management level Public policies Government bureaucracy, infrastructure Health service delivery infrastructure, staff, drugs and supplies Contextual factors governance, physical environment * Country rates of scale-up Minimum standard for UA Constraints

Monitoring UA 2010 in health sector 14 | WHO's commitment Take responsibility for monitoring progress in the health sector at the international level and set international standards for key interventions, in close collaboration with UNAIDS and other partners Provide guidance and assistance to countries to develop national targets and monitor progress Launch a first Update on progress in the health sector by World AIDS 2006 focusing on –Availability, Coverage and Impact of the priority interventions –Development of global standards for universal access –Progress in the highest burden countries Provide annual Updates on progress in the health sector