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

2. Context: Magnitude Country Population (million) HIV Prev. No. Persons Living with HIV Swaziland1.033.4 220,000 Botswana1.824.1 270,000 Lesotho1.823.2 270,000 Zimbabwe13.020.1 1,700,000 Namibia2.019.6 230,000 South Africa47.418.8 5,500,000 Zambia11.717.0 1,100,000 Mozambique19.816.1 1,800,000 Malawi12.914.1 940,000 Central African Republic4.010.7 250,000

3. Context: Financial Base Country Per Capita Health Exp GDP Per Capita Swaziland 367 367 4,824 4,824 Botswana 504 504 12,387 12,387 Lesotho 139 139 3,335 3,335 Zimbabwe 98 98 2,038 2,038 Namibia 407 407 7,586 7,586 South Africa 748 748 11,100 11,100 Zambia 63 63 1,023 1,023 Mozambique 42 42 1,242 1,242 Malawi 58 58 667 667 Central African Republic 54 54 1,224 1,224

4. 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%

5. Context: Health MDG Country Under 5 Mortality Rate Maternal Mortality Rate % Population Under- nourished % Children under weight for age South Africa 68400<2.512 Botswana1203803213 Namibia622102424 Lesotho1329601320 Swaziland1603902210 Zimbabwe1328804717 Malawi12511003522 Zambia1828304620 Central African Republic 1939804424 Mozambique1455204424

6. Gov. Spending (% of GDP) CountryHealthEducationMilitary Debt Services South Africa 3.55.41.52.0 Botswana4.010.73.00.5 Namibia4.76.93.2n/a Lesotho5.513.42.33.7 Swaziland4.06.21.81.6 Zimbabwe3.54.62.36.7 Malawi9.65.80.74.6 Zambia3.42.02.33.3 Central African Republic 1.5**2.21.10.4 Mozambique2.74.32.31.7

7. 2006 DAC Contributions US $ Billion Country Contribution 2006 20-24 United States 15-19Nil 10-14 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 107.42 M. Total DAC Contributions

8. 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

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

10. 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.

11. 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.

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. Thank You Data Sources: Organization for Economic Cooperation and Development: 2006 Expenditures Report. 2007 UNAIDS Report 2008 CNA Backgrounder: Social Determinants of Health and Nursing.