Investment in HIV/AIDS programs: does it help strengthen health systems in developing countries?

Dongbao Yu,Joan Kaufman,Mazuwa A Banda,Joseph H Perriëns,Yves Souteyrand

doi:10.1186/1744-8603-4-8

Dongbao Yu, Joan Kaufman + Show 3 more

Open Access

https://doi.org/10.1186/1744-8603-4-8

Copy DOI

Abstract

BackgroundThere is increasing debate about whether the scaled-up investment in HIV/AIDS programs is strengthening or weakening the fragile health systems of many developing countries. This article examines and assesses the evidence and proposes ways forward.DiscussionConsiderably increased resources have been brought into countries for HIV/AIDS programs by major Global Health Initiatives. Among the positive impacts are the increased awareness of and priority given to public health by governments. In addition, services to people living with HIV/AIDS have rapidly expanded. In many countries infrastructure and laboratories have been strengthened, and in some, primary health care services have been improved. The effect of AIDS on the health work force has been lessened by the provision of antiretroviral treatment to HIV-infected health care workers, by training, and, to an extent, by task-shifting. However, there are reports of concerns, too – among them, a temporal association between increasing AIDS funding and stagnant reproductive health funding, and accusations that scarce personnel are siphoned off from other health care services by offers of better-paying jobs in HIV/AIDS programs. Unfortunately, there is limited hard evidence of these health system impacts.Because service delivery for AIDS has not yet reached a level that could conceivably be considered "as close to Universal Access as possible," countries and development partners must maintain the momentum of investment in HIV/AIDS programs. At the same time, it should be recognized that global action for health is even more underfunded than is the response to the HIV epidemic. The real issue is therefore not whether to fund AIDS or health systems, but how to increase funding for both.SummaryThe evidence is mixed – mostly positive but some negative – as to the impact on health systems of the scaled-up responses to HIV/AIDS driven primarily by global health partnerships. Current scaled-up responses to HIV/AIDS must be maintained and strengthened. Instead of endless debate about the comparative advantages of vertical and horizontal approaches, partners should focus on the best ways for investments in response to HIV to also broadly strengthen the primary health care systems.

Highlights

There is increasing debate about whether the scaled-up investment in HIV/AIDS programs is strengthening or weakening the fragile health systems of many developing countries
Instead of endless debate about the comparative advantages of vertical and horizontal approaches, partners should focus on the best ways for investments in response to HIV to broadly strengthen the primary health care systems
In the past several years, countries have geared up their response to HIV/AIDS, supported by global health initiatives/partnerships (GHIs) such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM); the United States President Emergency Plan for AIDS Relief (PEPFAR); the World Bank Multi-Country AIDS Program (MAP); and bilateral donors [1]

Summary

Introduction

There is increasing debate about whether the scaled-up investment in HIV/AIDS programs is strengthening or weakening the fragile health systems of many developing countries. The introduction of antiretroviral (ARV) treatment, along with other interventions that the health sector has made, exposed the effects of decades of neglect of the health sector, economic crises, structural adjustments, declining public expenditures, and decentralized financing, in Sub-Saharan Africa [2] This is one reason for the recent revival of the long-standing debate on whether scaling up the responses to specific health problems in developing countries, especially HIV/ AIDS, is strengthening or weakening their stretched and fragmented health systems [3,4,5,6,7,8]. We use the 2007 WHO definition of a health system as "all organizations, people and actions whose primary intent is to promote, restore or maintain health," and use WHO's description of six health-system building blocks: (1) effective, safe, and high-quality health services, (2) a responsive health work force, (3) a well-functioning health information system, (4) equitable access to essential medical products, vaccines, and technologies, (5) a good health-financing system, and (6) strong leadership and governance [9]

Results

Discussion

Conclusion