Health AIDS WAD

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Health Systems and AIDS: 

Health Systems and AIDS Keith Hansen LCSHH November 30, 2005

Sector support for AIDS: 

Sector support for AIDS Advocacy and awareness-raising Surveillance Basic RH and HIV-specific counseling Testing Diagnosis Treatment: AOIs, HIV, PMTCT Protecting health workers

System constraints: 

System constraints Multiple HR shortages: 31 African countries have andlt;1 MD/10,000 22 African countries have andlt;1 RN/2,000 Poor incentives/high brain drain Ghost workers sometimes andgt;25% of payroll Weak surveillance and M andamp; E Low coverage of core services (e.g. RH) Poor supply chain management

Sector constraints: 

Sector constraints Limited access to clients (esp. men) Very limited access to high-risk groups Limited impact on social norms Adverse political economy: Programs disfavor stigmatized diseases Funding favors wrong skill mix Guild approach and focus on credentials

AIDS-aggravated constraints: 

AIDS-aggravated constraints Growing pressure on health andamp; demand AIDS-opportunistic infections 5% prevalence = 26% jump in demand

Slide6: 

Regional TB incidences

Slide7: 

DOTS impact in Africa

AIDS-aggravated constraints: 

AIDS-aggravated constraints Growing pressure on health andamp; demand AIDS-opportunistic infections 5% prevalence = 26% jump in demand HR issues Occupational risk of exposure Effect on morale and nature of work Poaching by donor-funded NGOs, etc.

AIDS-aggravated constraints: 

AIDS-aggravated constraints Growing pressure on health andamp; demand AIDS-opportunistic infections 5% prevalence = 26% jump in demand HR issues Occupational risk of exposure Effect on morale and nature of work Poaching by donor-funded NGOs, etc. Dominance of external aid Volatile, uncoordinated, uncontrolled

Slide10: 


Opportunities to strengthen: 

Opportunities to strengthen Capitalize on the 'opportunity' of AIDS Primum non nocere Respect country systems and stewardship Create 'fiscal space' Take long-term system view Improve surveillance and Mandamp;E Address HR issues at all levels, incl. global Incentives, accountability, demand

Expand HIV treatment: 

Expand HIV treatment Savings in averted AOI care Reduce pressure on health system Good for health staff: Boost life expectancy Reduce absenteeism Boost morale and sense of effectiveness Reduce stigma Avert larger second-line costs

Slide13: 

SÃO PAULO mortality, 1985 - 2003 0,0 5,0 10,0 15,0 20,0 25,0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Year of ocurrence MR (p/ 100,000 inhab) Source: Seade

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