ARVs friends or foes McCoy

Friends or foes? ARVs, Global Health Initiatives and African Health Systems: 

Friends or foes? ARVs, Global Health Initiatives and African Health Systems Dr. David McCoy Equinet, Global Health Watch

Tensions: 

Tensions Expansion of ART - improvement of other essential health care services Top-down, vertical, selective health care programmes – Bottom-up, integrated health services development Short term / Ambitious - Long term / Cautious Global Health Initiatives - Ministries of Health

Slide3: 

ART / HIV programmes Detract from comprehensive health systems development - - Weak and unsustainable delivery of ART and PHC

Slide4: 

ART / HIV programmes Strengthened health systems + + Improved delivery of ART and PHC

Two key questions: 

Two key questions How do we know which cycle we are in? If we set out to establish a virtuous cycle, what would a strengthened health care system look like?

Slide6: 

Indicators of impact on other services HIV/AIDS treatment versus prevention IMR, PNMR, immunisation coverage, growth monitoring and promotion Treatment of curable STIs TB treatment completion Indicators of impact on health care system Health care equity Internal brain drain Policy coherence and crowding out ‘Parallelism’

Health care systems : 

Health care systems Source of health care financing Organisation and management of health care financing Resource allocation and planning system Organisation, management and payment of health care provision Governance / regulation Public Non-government Commercial Global resource envelope

Targets for health systems development: 

Targets for health systems development Level of tax revenue to be at least 20% of GDP Public sector health expenditure (government and donor finance) to be at least 5% of GDP Government expenditure on health to be at least 15% of total government expenditure Out-of-pocket payments < 20% of total health care expenditure Expenditure on district health services to be at least 50% of total public health expenditure, of which half on primary level health care Expenditure on district health services at least 40% of total public and private health expenditure

Health systems development agenda: 

Health systems development agenda Human resource planning Resource generation Sector-wide approach for public / external financing Abolish user fees Strengthening health sector management Managing the tension between vertical, selective health care with comprehensive health systems development Public and community involvement An organizational framework – the DHS Regulating and shaping the private sector