1. HIV & MNCH: Can we do one without the other? Key Issues & Emerging Evidence Presentation for the XVIII International AIDS Conference-AIDS 2010 Rights Here, Right Now July 18, 2010 Ann Starrs, President Family Care International

2. Presentation Outline Brief background on MDGs 4, 5 & 6 Program linkages: target populations, common needs, comprehensive services Policy harmonization: focus on health systems nationally and globally Funding integration: moving toward a common platform?

3. The health MDGs are integrally linked Inadequate progress on MDGs 4, 5 & 6 (5 furthest off track) HIV, TB, malaria are significant factors for maternal and child mortality Weak health systems limit potential for progress Funding is inadequate to meet health system and program needs Background/Context

4. Maternal and child mortality worldwide Source: Countdown to 2015, from WHO, UNICEF, UNFPA, World Bank MDG4: Trends in child mortality, 1990-2015 On track Insufficient progress No progress /reversal No data Low maternal death ratio Medium maternal death ratio High maternal death ratio Very high maternal death ratio No data MDG5: 2005 MMR estimates Background/Context

5. Global HIV prevalence, 2007 Source: UNAIDS, 2008 Report on the global AIDS epidemic Background/Context MDG6: Sub-Saharan Africa hardest hit, also central Europe

6. SRH/MCH-HIV program linkages Major overlap in core target populations Diseases/health problems often concurrent or linked Basic services provided through same/ similar channels Common health system needs Similar underlying gender/cultural/social factors Program Linkages

7. Target populations –the overlap Women of Reproductive Age 1.8 billion Children <5 642 million Pregnant Women 210m/yr HIV+ 39 million Newborns 136 million High Risk Groups (MSM, IDU, CSW) Program Linkages Sources: UN Population Division, USAID and UNFPA

8. Interconnected problems & interventions SRH/MCH Sexuality education Family planning/ safe abortion Antenatal care Skilled care at childbirth Postnatal care, incl. immunization and Family planning HIV Risk reduction, esp. among young people Prevention of HIV, STIs Voluntary counseling & testing PMTCT (ARV prophylaxis) Ongoing PMTCT, b’feeding counseling, ART for mother Program Linkages

9. Health systems strengthening needs SRH/MCHHIV/AIDS Health workforce Infrastructure Commodities Management/supervision Health education/ community engagement Health information system Program/Policy Integration

10. Benefits of program/policy integration: principles Improved access and increased utilization of services Reduction of stigma and discrimination Better protection of individuals’ rights Improved quality of care Greater program effectiveness/efficiency Better utilization of health workforce Program/Policy Linkages Source: IPPF et al, “SRH and HIV Linkages: Evidence Reviews and Recommendations”

11. Focus on ‘health’ MDGs as a whole Within global mechanisms: High Level Task Force for Innovative International Financing for Health Systems Secretary General’s Joint Action Plan for Women’s & Children’s Health Among major funding sources: Health systems Platform (GAVI, GFATM, WB) Global Fund Decision Point on MCH USG’s Global Health Initiative, MASSIVEGOOD, G8/Muskoka Initiative Policy/Funding Integration

12. Annual funding shortfalls for the health MDGs, 2011-2015 Source: UN Secretary General’s Joint Plan of Action for Women’s and Children’s Health Policy/Funding Integration

13. Effective funding mechanisms for SRH/MCH-HIV Be responsive to country needs/plans, fill gaps Reward performance/results Minimize administrative burdens Allow for multi-sectoral participation Take a rights-based approach Promote/facilitate integrated approaches Strengthen health system capacity to provide high impact, high quality care Policy/Funding Integration

14. Possible discussion questions Do we have enough evidence on programmatic benefits of integrated approaches? Where/when does integration not work? What is the role of funding mechanisms? Is integrated funding necessary for integrated programming? Can the SRH/MCH and HIV communities come together effectively?

15. Come talk about the UNSG’s Joint Action Plan Breakfast panel When: Wednesday, July 21, 2010 7:30am – 9:00am Where: Restaurant Waggon 31, near the Wheel Panelists from: UNAIDS, UNFPA, Civil Society