How are HIV/AIDS donors interacting with national health systems?

HIV/AIDS Monitor

Goal

Improve performance of HIV/AIDS aid

Objectives• Create new knowledge on HIV/AIDS aid design,

delivery and management• Inspire and influence change in donor programs

for HIV/AIDS• Stimulate informed conversation

HIV/AIDS Donors’ Interactions with the Health System

• investigates and compares the donors’ interactions with three components of health systems:– the health information system, – the supply chain system for essential

medicines, – And human resources for health.

• in Mozambique, Uganda, Zambia

HIV/AIDS Donors’ Interactions with the Health System

Why do we care?

• $10B for AIDS in 2007• Is this money strengthening or weakening health

systems or both?• Lack of strong evidence base to answer this

question• BUT:

– Future of the global AIDS response cannot be considered independently of the health system

• AND donors should be concerned because – Health systems already face challenges

Why Health Information Systems?

• In many African countries the information that all stakeholders including donors use comes from the national health information system and other country systems

• Donors have a strong interest in strengthening the systems that yield the data on which they base their assessments

Giacamo Pirozzi / Panos Pictures

Why Supply Chains for Drugs?

• Because functioning supply chain systems are required to ensure that drugs reach people at the right place, right time and in right quantities

• Because supply chains for ARVs and the supply chain for essential drugs rely on many of the same resources

Sven Torfinn / Panos Pictures

Why health workers?

• Health worker shortage is perhaps the greatest obstacle to improving health in Africa.

• AIDS programs rely health workers so the human resource crisis is becoming a major barrier to scale up HIV/AIDS programs Aubrey Wade / Panos Pictures

Seizing the opportunity to strengthen health systems while expanding AIDS programs

• AIDS-specific processes that donors have helped set up for human resources, health information, and supply chains use many of the same resources as the broader health system

• As donors continue to increase AIDS funding and expand their programs, they will require greater shares of the resources in each country’s health system, but by doing so without strengthening already weak systems, they are likely to strain them

Seizing the opportunity to strengthen health systems while expanding AIDS programs

• Because stronger health systems are essential to ensure a long-term, expanded AIDS response, the three donors should take decisive action to benefit both AIDS programs and larger country health systems

• Specific actions include…

RecommendationsHealth information systems:• Coordinate information needs and flows• Design and invest in information technology solutions • Systematic learning about capacity development • Create incentives through information feedback systems

Supply chain systems:• Shared distribution and logistics management of

essential medicines and ARVs

Human resources for health:• Train new health workers• Finance new health worker hires• Help governments improve public-sector human resource

policies

Health information systems

To improve health information systems, the donors should coordinate government and donor information flows through the national health management system and other systems…

…to reduce information system fragmentation...

...to minimize duplicative and burdensome reporting

...and to improve data quality

Giacomo Pirozzi / Panos Pictures

Supply chain systems

To improve supply chain systems, the donors should pursue strategies to let antiretroviral drugs and essential medicines be distributed jointly and managed using the same logistics management information system…

• In all three countries studied, once procurement is completed, essential medicines and antiretroviral drugs follow paths with clear similarities.

• Despite these similarities, the three global AIDS donors have decided for several reasons—including weaknesses in existing health drug distribution systems and the critical importance of avoiding stockouts of ARVs—to largely support procedures for ARVs that are separate from those for essential medicines.

Some movement toward integration has already occurred…

• Partial integration in Mozambique

• Distribution on same trucks in Zambia

• Development of LMIS for all health goods in Uganda

Give priority to financing for new health worker hires—as opposed to top-ups for current health workers

Since hiring new workers requires an adequate supply of qualified health workers, that underscores the need for donors to finance the training of new health workers through pre-service training.

If top-ups are to be used, donors should consider supplementing workers for all the hours they work—not just for the hours they spend on AIDS tasks.

Anders Gunnartz / Panos Pictures

Bottom line…

“As PEPFAR, the Global Fund, and the MAP increase funding for HIV/AIDS, the donors will continue to fin that country health system weaknesses create barriers to program expansion. To surmount those barriers they should finance programs in a ways that create the most positive spillovers to broader country health systems while doing the least harm to those systems. Since earmarked funding for HIV/AIDS is evidently here to stay, such an approach will ensure that donor funds bring the greatest possible benefits to country health systems while achieving desired AIDS-specific outcomes.”