In a debate on whether the global AIDS response has had a negative or positive effect on health systems and services in developing countries, experts at a workshop hosted by the Institute of Tropical Medicine, Antwerp, concluded that the negative effects were outweighed by the potential that AIDS programmes have of strengthening health systems and services

A workshop hosted by the Institute of Tropical Medicine (ITM), Antwerp, at the WHO in Geneva, in May 2008, reviewed evidence on the positive and negative impact of the global AIDS response on public health services in low-income countries. It concluded that although there have been some negative effects on health systems, the real question, as noted by the authors of an editorial in an EQUINET Africa newsletter, is: “How can the global AIDS response best contribute to the realisation of comprehensive primary healthcare?”

HIV programmes consume around a quarter of international healthcare aid, says an editorial in Lancet Infectious Diseases. This is disproportionate considering that HIV/AIDS accounts for around 4% of deaths worldwide.

International funding is disease-specific, an approach that Roger England of Health Systems Workshop, Grenada, argues does more harm than good. Spending money exclusively for HIV/AIDS weakens health systems. It creates parallel systems for financing and employment. Countries focus on disease-specific programmes instead of working towards sustainable health systems, he adds (for more on this see http://infochangeindia.org/hivonline/debates_22.php).

At the ITM workshop there was evidence of both the global AIDS response strengthening general health systems and services, as well as evidence of the opposite.

An important point was the overall shortage of health workers. In some countries, the AIDS response was reported to have led health workers to abandon their previous occupations to work on AIDS programmes. In other countries, the AIDS response improved the working conditions of health workers across the board, helping to attract and/or retain more health workers.

General health systems and services can be strengthened if national strategies want this to happen. The workshop tried to identify what measures promote positive synergies and how to avoid negative synergies.

One key issue is the under-funding of healthcare in developing countries for all health programmes and strategies. Scarcity of human and financial resources was observed to drive competition and rivalry.

Some of the recommendations made at the workshop:

1. Governments must live up to their promises: governments of low-income countries must allocate 15% of their domestic government revenue to health while governments of high-income countries must allocate the equivalent of 0.7% of their Gross Domestic Product (GDP) to global solidarity, and 15% of that (0.1% of GDP) to health.

2. These commitments should be open-ended (as long as needed), without aiming for national financial resources to replace international financial resources as soon as possible, as this will undermine the crafting of ambitious health plans, including workforce plans.

3. Ceilings on health expenditure (included in policies imposed by the International Monetary Fund) must not hamper the realisation of the right to health or comprehensive primary healthcare (PHC) for all.

4. People whose right to comprehensive PHC is at stake have the right and the duty to be involved in critical decisions that affect their health.

5. The global aid architecture must be reorganised in such a manner that it supports comprehensive PHC for all, not one part of comprehensive PHC at the expense of another. General health systems and services not only need strengthening but also transforming: involving and working with communities as participants of health systems and services, rather than merely ‘clients’ or passive recipients of health services.

While the global AIDS response has created real challenges for health systems and services, there are ways to tackle and minimise them. The global AIDS response has thrown up real opportunities, which should be maximised.

For a report on the workshop see http://www.itg.be/itg/GeneralSite/Generalpage.asp.

Source: Lancet Infectious Diseases, 2008; 8:457, July 2008
            http://www.equinetafrica.org/newsletter/index.php?category=Editorial, July 2008
           AIDS-India e-group, July 2008