Photo credit: Nigel Stead/LSE

As part of the London School of Economics and Political Science’s (LSE) speakers series on AIDS (LSEAIDS), UNAIDS Executive Director Dr Peter Piot delivered a public lecture titled “The future of AIDS: Exceptionalism Revisited” on May 15.

In his lecture, he reviewed the global response to AIDS to date and considered what is needed in the longer term. He also examined the epidemic within the context of pressing wider health and development issues.

LSEAIDS brings together leading social scientists and experts at the LSE to explore some of the long-term effects of AIDS that risk being overlooked. The group defines the AIDS epidemic as a 'long-wave' event whose full social and economic effects will be with us for decades.

This was Dr Piot’s second LSEAIDS lecture; he first addressed this forum in February 2005.

The event was chaired by Professor Tony Barnett, LSEAIDS and hosted by the LSE, LSE Health and the UK Government’s Department for International Development (DfID).

The new International Health Partnership
public web site shares information on
strengthening health systems and services

The International Health Partnership (IHP+) has launched a public web site to facilitate the dissemination of information and tools related to strengthening health systems and services.

The IHP+ is a partnership which includes 13 partner countries, United Nations agencies including UNAIDS, bilateral donors, civil society and private sector partners.

Launched in September 2007, the initiative aims to increase donor, country and international coordination on health and development issues in order to make progress on achieving the health-related Millennium Development Goals—reducing child mortality, improving maternal health, and halting and reversing the spread of HIV.

Participants signed a compact agreeing to work together within countries’ national plans to improve coordination in order to address problems related to health worker staffing, infrastructure, health commodities, logistics, tracking progress, and effective financing.

Each of the 13 participating countries has provided a Country stocktaking report that documents the current state of health systems strengthening and describes progress made to date along with the continued challenges.

The web site will serve as a forum for participating countries to present the results of stock-taking exercises and, in some cases, draft road maps to development of the compact. As these documents become available, they will be added to the web site.

The IHP+ work plan, progress reports as well as meeting minutes and other official documents can all be accessed on this new web site.

It is hoped that this site will become a useful tool to meet one of the objectives of IHP+: “Ensure mutual accountability and monitoring of performance.”

“Sharing knowledge through this partnership can help lead to better coordinated and more transparent responses to strengthening national health care systems,” said UNAIDS Executive Office Director, Tim Martineau.

“UNAIDS is happy to be a partner in this initiative which emphasizes actions which are country-led and country-focused and which will help deliver on our shared goal of achieving universal access treatment targets.”

IHP+ aims to scale-up coverage and use of health services in order to deliver improved health outcomes against the health-related Millennium Development Goals and universal access commitments.

Partners will work together to ensure that health plans are well-designed, well-supported and well-implemented and to make their work more effective and better aligned with developing countries’ established priorities.

Participants will focus on issues such as
poverty reduction, state capacity to
promote and guide development, rising
oil prices and the global credit crisis.

The first session of the Joint Annual Meetings of the African Union Conference of Ministers of Economy and Finance and the United Nations Economic Commission for Africa Conference of Ministers of Finance, Planning and Economic Development is taking place in Addis Ababa, Ethiopia from 31 March to 2 April 2008.

The conference will also mark the start of a yearlong commemoration of the Economic Commission for Africa’s 50th anniversary. As part of the celebrations, participants, including selected African Heads of State and Government and other eminent persons, will be invited to reflect on the theme of the Conference, ‘Meeting Africa’s New Challenges in the 21st Century’.

The conference will begin with an overview of recent economic and social developments in Africa which will include the state of the global economy, overall growth performance in Africa, trends in social development in Africa and the continents economic prospects for 2008.

UNAIDS Executive Director Dr
Piot will highlight ways in
which the AIDS response can
be stepped up in Africa.

Participants will go on to focus on issues such as poverty reduction, state capacity to promote and guide development, particularly in relation to providing adequate infrastructure and social services, rising oil prices and the global credit crisis.

Four high-level thematic debates will be held on; HIV: keeping the promise; Empowering the poor; Growth, employment and poverty; and Climate change and development.

UNAIDS Executive Director, Dr Peter Piot will lead the debate on HIV and highlight that in spite of efforts to address the epidemic in Africa, AIDS remains a significant challenge which is hampering efforts to achieve the Millennium Development Goals. Dr Piot will highlight ways in which the AIDS response can be stepped up in Africa and will outline some specific recommendations for sustainable financing.

Photo credit: G. Bekele

The Global Health Workforce Alliance (GHWA) held the first ever Global Forum on Human Resources for Health in Kampala, Uganda from March 2-7, 2008. The GHWA, hosted and administered by the World Health Organization (WHO), has been created to identify and implement solutions to the health workforce crisis.

UNAIDS Executive Director  Dr Peter Piot gave the following plenary speech on "Partnerships and linking for action".

Download speech as PDF

Plenary speech by Dr Peter Piot, UNAIDS Executive Director

Kampala, Uganda 5 March, 2008.

UNAIDS Executive Director Dr Peter Piot addressing plenary at the Global Forum on Human resources for Health, in Munyonyo, Kampala, 5 March 2008
Credit: UNAIDS/C. Opolot

Thank you Sigrun – and thank you for inviting me here today.

I came to Kampala for three reasons. Firstly, this Forum is one of the most important meetings in public health to take place this year. We are starting to build a coalition to address one of the greatest obstacles to health.

Secondly, I am here to pledge the firm support of UNAIDS to this initiative.

Thirdly, it is time to de-polarize this debate. Whether we invest in the AIDS response or in strengthening health systems. It is not a question of one or the other. Even when it comes to AIDS, it is not simply a question of strengthening health services but also community mobilization. We must not forget about people or health outcomes

The issue of human resources for health is complex. But we all know it’s not a new one. I lived it myself in the mid-70s in rural Zaire. But nor is it limited to Africa. Last week I was in India where this is an enormous maldistribution of human resources for health.

The shortage results from decades of under-investment by governments, donors and international agencies. It has been intensified by globalization, but globalization may also bring some of the solutions. Responsibility for the current situation is shared – between donors, national governments, NGOs, research organization and international organizations among others. We therefore have a shared duty to address it. That’s why this afternoon’s panel, with its focus on partnership, is so vital.

The debate we are having now is long overdue. And a major reason for its happening at all is AIDS!

One of the peculiar characteristics of AIDS is that it exposes injustices. AIDS - more than any other issue - has thrown a spotlight on the urgent need to strengthen human resources for health, for three reasons.  Firstly, AIDS represents a significant burden on health systems. In some countries, half of all hospital beds are occupied with patients with AIDS-related illnesses. Secondly, to expand ART, and to make ART sustainable, we need strong health systems. Thirdly, being a health worker does not protect you from becoming infected. Botswana, for example lost approximately 17% of its healthcare workforce to AIDS between 1999 and 2005.

There have been good examples of how AIDS investment has helped overcome the human resources for health crisis. I remember well going to Malawi in 2004 with Sir Suma Chakrabarti, then Permanent Secretary of the UK’s DFID. AIDS had brought the health workforce literally to its knees. There was no way it could cope. It was an emergency that required exceptional measures. DFID and other donors financing the sector agreed to fund a groundbreaking initiative, the Emergency Human Resources Programme, to top up salaries for nurses and other health care workers as an incentive not to leave the country. This was totally novel: donors usually resist paying salaries, but in this case we managed to break the taboo.  I’m glad to say that the Global Fund to Fight AIDS, Tuberculosis and Malaria is now supporting this programme.

This is just one example of another characteristic of AIDS: it forces us to do things differently. WHO’s “Treat, train, retain” initiative for health-workers with HIV is another new and pragmatic approach. I don’t know of any other programme that starts by addressing the health of the workers involved. It provides wins all round – to the health workers themselves, to the people who need their services, and to the health sector as a whole. So, when we are talking about strengthening health systems, let’s first make sure that people stay alive! But good partnerships require more than processes. There are too many partnerships that are not enough about results and outcomes.

AIDS funding and programming enhanced essential infrastructure for health facilities. Where HIV services have been integrated into existing service delivery sites, AIDS money helped renovate health facilities, upgraded clinics and laboratories and provided training opportunities for health care workers.

AIDS has also helped promote “task shifting”, an old concept/idea in public health – moving responsibility for certain tasks to other health-workers and community members to free up doctors and nurses to take care of other patients and to deliver other essential health services. Here in Uganda, there is an increasing trend for people living with HIV to take on tasks such as counseling for testing, adherence support, treatment literacy and to produce good quality outcomes.  In Kenya, several organizations have been implementing prevention, treatment literacy and home based care programmes, which are led by people living with HIV at the community level.  Women Fighting AIDS in Kenya, supported by UNICEF in Kisumu and Port Reitz General Hospitals, trained PLWHAs who were then used as PMTCT champions to provide counseling to ante-natal mothers and their partners.

We also see, particularly here in Africa that faith-based organizations play a major in the fight against AIDS providing vital HIV care and treatment services. For example, Christian hospitals and health centers are providing about 40% of HIV care and treatment services in Lesotho and almost a third in Zambia. In other countries, the formal and informal private sector is also very important.

AIDS has brought in new resources, to benefit not only HIV programmes but health systems more widely. Take for example the Haitian “accompagnateurs” – community workers who have been brought into the health workforce through the AIDS programmme. Or in Rwanda, HIV treatment and care was integrated with regular health services, resulting in better coverage for maternal and child health according to a study by Family Health International (FHI) presented at last year’s PEPFAR Implementers Meeting in Kigali.  Les Mutuelles de Santé is another example of financing scheme to mobilize resources for health services.

So I have serious issues with the current wave of statements like “There’s too much money going to AIDS” or “Donors should prioritize health system strengthening”. They completely ignore the growing body of evidence that AIDS expenditure strengthens the health sector and contributes to broader development programmes, besides the fact that AIDS programmes are having measurable results, saving millions of lives. Indeed, AIDS has been an advocate for health systems strengthening.

They also seem to assume that dealing with HIV is mostly about treatment. It isn’t! For every one person we put on antiretroviral therapy, another four or five become infected with HIV. If we don’t radically enhance HIV prevention, demands for treatment will just keep on growing, placing an even greater burden on health systems in the future.

And prevention – except for PMTCT – is far more than a health issue. Prevention is a community based action. Effective HIV prevention derives from a range of multi-sectoral interventions (governments, nongovernmental organizations, faith-based organizations, the education sector, media, the private sector and trade unions and people living with HIV).

A lot of the recent surge of funding started as a direct consequence of the AIDS epidemic. AIDS advocacy did not only succeed in mobilizing money, but it also highlighted the profound disparities in health services that separated the developing countries from the developed world. It is however true that  there are examples where AIDS related activities and AIDS funding are taking away health workers from other tasks. AIDS funding created new and more interesting job opportunities for doctors and nurses with NGOs and foreign aid agencies and thus can be a drain on the public sector. We have seen it happening in Malawi and in Zambia where focus of disease programmes shifted to HIV. However, and certainly in the heavily affected countries, the AIDS burdens for health services is also a reality. We need to find common solutions and ways of working together.

This brings me to my next point. AIDS has taught us about the critical value of partnerships. Tackling AIDS is one of the toughest challenges the world faces today. Like dealing with climate change, it’s tremendously complex - way beyond the capacity of any single sector or institution. It’s one of those issues that jolts us out of our comfort zone, and forces us to create new alliances with a variety of constituencies – across sectors and at state and non-state level.

UNAIDS itself is a joint programme. We are working with a wide range of constituencies – government, scientists, business, labour, and the media. One of the most important partnerships of all has been our relationship with civil society. It was the activists who kick-started the AIDS movement. Without them, we wouldn’t have achieved anything like the progress we’ve made.  It’s thanks to these partnerships that we have been able to mobilize political momentum around AIDS, to leverage funding to $10 billion per year.

In the twelve years since UNAIDS was created, we’ve learnt a lot about partnerships. We’ve seen the advantages of being able to convene diverse actors from public, private, and non profit sectors – all with different strengths. They have the potential to achieve spectacular results – way beyond anything they could hope to achieve on their own.

But coordination and accountability are still important. That’s why UNAIDS established the Three Ones principles, as a framework for partnerships on AIDS.  Just to remind you, these are: one agreed national action framework, one national coordinating authority and one agreed monitoring and evaluation system.

The lessons we’ve learnt through implementing the Three Ones are salutary – and very relevant to the aims of this Alliance. The Agenda for Action is right to highlight the need for “national responses to be guided by a national leadership that convenes all actors around one agreed national effort”, and to point to the importance of accountability. The challenge is to engage serious commitment at all levels – in-country, in donor capitals and international organization headquarters. This requires time and effort. But it will be time and effort well spent.

I began today by saying that addressing the shortage of human resources for health was a joint responsibility. It is something that no institution can tackle alone. It is complex, cross-sectoral and long-term. And, like AIDS, it is not a quick-fix problem and there is no one solution that fits all. This may be a major reason why so little has been done before. Another reason may be the fact that the current crisis of human resources for health is also a highly political issue and therefore any possible solutions need to have full political support. But coming together in this alliance is in itself a tremendous step forward. There is a lot at stake; therefore our response must address the emergencies of today and to draw up longer-term plans for the future.

The Agenda for Action offers a comprehensive menu of activities, but I want to suggest some very concrete actions where we can all work and benefit together.

The first is that we must build partnerships far beyond the public sector. Partnerships are crucial for the success of any solution. We must also look at the critical role of non-state actors in the provision of services and their role in the training of human resources. In many countries, 40 to 60% of health services are delivered by the private sector. We have to establish more private/public partnerships with greater engagement of the private sector, beyond workplace programmes. Equally, in many countries, particularly here in Africa, many clinics and health centers are run by faith-based organization. We need to bring them all into the policy dialogue of heath services provision.

The second is to engage the full participation of civil society. As I mentioned earlier, civil society has been at the heart of the AIDS response from the very beginning. And its presence there has been vital. Not only does civil society activism mobilize action, but community members are an invaluable source of knowledge about what works and about how to reach people. We must listen and learn from them, and at the same time invest in building their capacity to deliver alongside that of public sector.

The third is for health ministries to make improving human resource management a priority. This is implicit in the Agenda for Action. But I think we need to spell it out more clearly. Today’s crisis has come about for two reasons. Lack of investment and lack of management. There’s a lot to do, but one of the first steps should be to establish incentives for performance and raise health-worker morale.

Fourth, we need to work together to question and challenge our concepts of fiscal space, predict medium term expenditure frameworks and the suitability of salary supplementation. We have to involve ministries of finance in the discussions of solutions. We should also work together with the World Bank and IMF on these constraints.

There is also the need to address the issue of public sector pay and work conditions. To address issues such as poor infrastructure, lack of equipment and drugs, long hours and heavy workloads and lack of career development in addition to poor remuneration. This needs to be combined with putting human resources for health on the agenda of civil service reform and donor willingness support and invest in supplementing health workers’ salaries and training. Donors and countries should consider the lessons learnt from the Malawi experience.

These issues are at the heart of any assessment of countries’ ability to scale up the response and the achievements of the MDGs. They are relevant for all of the health MDGs and need close examination and a common assessment of the risks and opportunities.

Press conference at the close of Global Forum on Human resources for Health, Kampala 5 March, 2008. (From left): Chair of the board Global Health Workforce Alliance, Dr Lincoln Chen; UNAIDS Executive Director, Dr Peter Piot and Representative of Women Living with HIV in Uganda, Beatrice Were.
Credit: UNAIDS/C. Opolot

We can be very ambitious, but need clear targets, goals and a partnership, where put the institutional interest aside. Fight for common good and common goal. We need to re-set the rules and to put into practice what has been discussed globally at country level. Every research programme must include overhead (/indirect costs for strengthening capacity. This is starting to be done among largest investors in heath (GAVI; GF; PEPFAR etc).

We also need to find a practical way to compensate low and middle-income countries that are losing their skilled staff in whose education they have invested.

The final – and most relevant for this afternoon’s session - is to be serious about applying the Three Ones principles, for all parties to come together and align around a single strategic plan for strengthening human resources for health that focuses clearly not just on process but on results.  One National AIDS Coordination authority and one agreed country-level monitoring and evaluation system. Such a framework has been invaluable for a well coordinated AIDS response. We are not there yet, but we have made progress.

If we make progress on action plan, it will be because have worked together. It is through diversity we will success. Pragmatic approach is needed, one step at a time, and strong leadership which will hold us together. I believe we have that leadership.

That may sound ambitious. But if we can come back in a year’s time and say we’ve made progress in these four areas, the world’s health workforce will look a lot more robust than it does today – and its population will be fitter as a result.

We have to act now and “to work together to ensure access to a motivated, skilled, and supported health worker by every person in every village everywhere.” Dr. LEE Jong-wook

Thank you.

The Global Health Workforce Alliance (GHWA) is convening the first ever Global Forum on Human Resources for Health in Kampala, Uganda from March 2-7, 2008.

The GHWA, hosted and administered by the World Health Organization (WHO), has been created to identify and implement solutions to the health workforce crisis. What is this crisis and how does it impact on the AIDS response?

Healthcare systems depend on trained staff

One of the major obstacles identified to scaling up access to HIV prevention, treatment, care and support in a country is a weak national healthcare system.

The question of human resources for health is a critical factor in any effective response to AIDS. A shortage of trained health care workers, particularly in low and middle-income countries, presents a real challenge to the ability of a country to respond to the HIV prevention, treatment and care needs of their populations.

In parts of sub-Saharan Africa shortages are so acute that they limit the potential to scale up programmes aimed at achieving health-related Millennium Goals including the roll-out of treatment for AIDS. - World Health Assembly, 2005

WHO estimates that more than 4 million additional doctors, nurses, midwives, managers and public health workers are urgently needed to avert serious crises in health-care delivery in 57 countries around the world—26 of these in sub-Saharan Africa. WHO estimates that at least 1.3 billion people around the world lack access to even the most basic health care.

Insufficient human resources has been identified as a primary obstacle to the delivery of antiretroviral treatment and other HIV-related services in many countries in Eastern Europe, Africa and Asia. Many healthcare systems have poor availability and quality of pre- and post-test counselling, health education, home care, diagnosis and treatment of opportunistic infections.

Governments pledge to increase capacity

At the 2006 High Level Meeting on AIDS, UN Member States reaffirmed their commitment to fully implement the 2001 Declaration of Commitment on HIV/AIDS and further strengthened international commitment on AIDS by:

“Pledging to increase capacity of human resources for health, and committing additional resources to low- and middle-income countries for the development and implementation of alternative and simplified service delivery models and the expansion of community-level provision of comprehensive AIDS, health and other social services.” However translating government commitment to increasing capacity into more health workers on the ground is a challenge of some complexity.

Balancing macroeconomic stability and staff retention

While AIDS funding has increased in recent years, simply pouring this into the healthcare system of a country to strengthen capacity is not the solution.

Most economists agree that a high rate of growth of a money supply causes a high rate of inflation - a rise in the general level of prices of goods and services in a given economy over a period of time.

Governments believe that fiscal and monetary policies – to keep inflation low - are needed to control and manage their economy to prevent potentially damaging sharp shocks and fluctuation in growth.

Low-income countries with high HIV-prevalence have to juggle the need to invest in their healthcare systems with a responsibility to maintain macroeconomic stability – nationally and regionally.

These economic policies include keeping salaries low and so constrain the hiring of the doctors, nurses, community health-care workers. Low salaries lead to low worker morale and low productivity and make it extremely difficult for some countries to retain their staff.

Open labour markets mean skilled professionals are migrating in record numbers to high-income countries, draining human capacity where it is most needed.

Global Forum on Human Resources for Health

Consensus is growing that this is a global crisis which calls for coordinated action.

The Global Health Workforce Alliance (GHWA) has been established to explore and implement solutions to this health workforce crisis. It is hosted and administered by the World Health Organization (WHO).

As a first step in the process, the GHWA are holding the first Global Forum on Human Resources for Health in Kampala this week. This meeting brings together government leaders, health and development professionals, civil society and academics from around the world who hope to consolidate a global movement on this.

Participants will explore solutions to improving education, training, and health sector management as well as looking at recent trends in migration.

L to R: Timothy E. Wirth, President, United
Nations Foundation and Better World Fund,
Jim Yong Kim, Harvard Medical School,
David Baltimore (moderator), AAAS
President, California Institute of
Technology and UNAIDS Executive
Director Dr Peter Piot.

The 2008 Meeting of the American Association for the Advancement of Science took place in Boston, USA from 14-18 February and brought together science and technology professionals from 56 countries to discuss the latest scientific breakthroughs and challenges.

President of the AAAS, Nobel Prize winner Mr. David Baltimore, said that the event was the ‘largest and most important interdisciplinary scientific gathering of the year’. The main focus of the conference was on the power of science, technology and education, to assist less developed segments of world society while improving cooperation among developed countries and spurring knowledge-driven transformation across scientific disciplines.

Some 10,000 people attended the conference including leading scientists, engineers, educators, and policy-makers as well as members of the national and international media.

The meeting ran under the umbrella theme of "Science and Technology from a Global Perspective" and the program highlighted areas of research, new developments, and cross-cutting activities in support of science, technology and education around the world.

UNAIDS Executive Director Dr Peter Piot
spoke on a plenary panel session on
Global Health Challenges on Monday 18
February.

Among the 150 symposiums and presentations was a round table discussion on the state of public health which focused particularly on AIDS and tuberculosis; presentations on the search for a global AIDS vaccine and the challenge of comprehensive HIV control in sub-Saharan Africa.

UNAIDS Executive Director Dr Peter Piot spoke on a plenary panel session on Global Health Challenges on the closing day of the conference together with Jim Yong Kim from the Harvard School of Public Health and Timothy Worth, President of the UN Foundation and Better World Fund. The session was moderated by AAAS President David Baltimore.

HIV strategies work best when there is a clear understanding of the relationship between AIDS, poverty and human development. In an article published in leading scientific magazine PLoS, UNAIDS examines this relationship and the often called ‘vicious circle’ within which the impacts of AIDS increase poverty and social deprivation, while socio-economic inequalities increase vulnerability to HIV infection.

At the Women Deliver conference in London (18 – 20 Oct 2007), UNAIDS Executive Director called for renewed political support and increased funding to make sure that women’s health become a national priority across the world. He stressed that healthy mothers and children are key to slowing down the AIDS epidemic.

Every minute of every day, a woman dies needlessly during pregnancy or childbirth, most in the developing world. Ten million women are lost in every generation. Huge disparities exist between rich and poor countries, and between the rich and poor in all countries. At the same time, four million newborn babies die every year, also from causes that are mainly preventable. Evidence and experience shows that with increased political will and adequate financial investment, most women and newborns can survive so that families, communities and nations can thrive.

Bringing to light the critical connection between women’s health, rights, education and poverty reduction, the global conference on maternal health ‘Women Deliver’ is taking place in London from 18 to 20 October 2007.

Co-Chaired by Mary Robinson, president of Realizing Rights, former president of Ireland, and former United Nations High Commissioner for Human Rights and by Asha Rose Migiro, Deputy Secretary-General of the United Nations, the conference encourages governments to integrate women’s health and rights into national plans and strategies.

At the Conference opening, UNAIDS Executive Director Peter Piot, underlined a number of similarities between the response to women’s health and the AIDS response. He cited the prevention of mother to child transmission of HIV as an intervention with proven results that is a potential catalyst to strengthen health systems.

Dr Piot noted that women are paying a heavy price today as a result of years of under-investment – including within the AIDS response. Despite accelerating progress in AIDS over the past few years, women and girls are still being left behind. About 18 million women are living with HIV today – many of them poor, most of them stigmatized, some at risk of violence, and too few are able to access HIV treatment. Only one in ten women in developing countries has access to drugs to prevent transmission of HIV to their children.

In his conclusion, Dr Piot suggested that the world should start talking about women’s health, morbidity and mortality and not just maternal mortality. He underlined that taking the issue beyond the health sector and focussing on socio-economic implications would attract governments’ attention in ways that women’s health has not.

The Women Deliver Conference runs until 20 October 2007

Links:

View the video by the Global Coalition on Women and AIDS that is being shown at the conference

Global Health Initiative of the World Economic Forum and the World Bank are calling for continued support for Business Coalitions in sub-Saharan Africa to back companies in tackling pandemic.

1st November 2006, Geneva, Switzerland: In the first ever study of its kind, “The State of Business Coalitions in Sub-Saharan Africa”, which is released today, shows how 27 countries are supporting businesses in addressing HIV/AIDS. At least 20 coalitions exist in Sub- Saharan Africa today with more than 16 having been established in the last 5 years to meet growing demands. The study provides guidance to newly launched and those soon to be formed coalitions, shares best practices, benefits, achievements, and highlights the key challenges facing coalitions. Other businesses and donors are now being urged to back the approach and help strengthen Business Coalitions as an important part of the solution to the epidemic, which is devastating Africa’s people and economy.

Business Coalitions create critical mass for businesses wanting to respond to the crisis. Although the set-up and running can vary dramatically from country to country, they are successfully mobilizing business efforts in a coordinated way, facilitating the sharing of best practices and serving as the voice of the private sector in calling for increased action and facilitation of treatment programmes. They provide a way for businesses to engage with other coalition partners in their country in fighting the disease, and channeling resources from both the private and public sectors.

For five years, The Global Health Initiative’s (GHI) and the World Bank’s AIDS Campaign Team for Africa (ACTafrica), have worked together to catalyze public private partnerships in health, by building and supporting business coalitions across Africa, and well placed to coordinate the mapping and evaluation of the work done to date. This was achieved with additional cooperation from Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ), UNAIDS, Corporate Council on Africa, and PharmAccess. Francesca Boldrini, GHI Director, commented, “This study highlights the richness of the business response in Africa that groups like the World Bank have been able to stimulate. It is fantastic that so many Business Coalitions have formed across Africa in recent years. It presents a huge opportunity to strengthen further the business response to AIDS - an opportunity we should not miss.”

All these new Business Coalitions have made excellent progress to date. In total, the coalitions have reached 1,950 organizations in sub-Saharan Africa. In order to sustain and keep growing their efforts a number of challenges need to be overcome.

The study reveals key challenges facing Business Coalitions today which include financial sustainability, with unpredictable funding from donors; the difficulty in meeting increasing company demands with limited staff and a lack of relevant skills; and reaching out to engage small and medium enterprises (SMEs), who employ the majority of Africa’s workers, but don’t have the resources and expertise of multinationals.

“In the global battle against HIV/AIDS, business has an obvious and important role to play”, says Elizabeth Ashbourne, Focal Point for Private Sector and HIV/AIDS in Africa, at the World Bank. “This study provides an excellent overview of how Business Coalitions can work effectively to overcome the challenges they face. I hope it acts as a motivator for all stakeholders – businesses, governments, donors – to recognize the value of National Coalitions and to work together with our development partners and country clients to strengthen their initiatives across Africa.”

The study concludes that strengthened HIV/AIDS Business Coalitions have the potential to meet the demands of companies today.

To download a copy of the full report and the individual country coalition profiles, highlighting the activities and successes, please visit the GHI website, http://www.weforum.org/en/initiatives/globalhealth/index.htm

Notes to editors:

About the Global Health Initiative (GHI) of the World Economic Forum
The GHI provides a unique platform for catalysing public-private partnerships in health and driving action on HIV/AIDS, tuberculosis and malaria at the regional, national and international levels. To achieve this goal, the GHI works closely with the World Economic Forum’s member and partner companies as well as UNAIDS, the boards of the Global Fund and the Global Partnership along with the World Health Organization’s Stop TB and Roll Back Malaria partnerships. In addition to these, the GHI successfully engages with a broad range of NGOs and other members of civil society, as well as governments from across the world, effectively stimulating public-private dialogue in world health.

The World Economic Forum is an independent international organization committed to improving the state of the world by engaging leaders in partnerships to shape global, regional and industry agendas.
 
Incorporated as a foundation in 1971, and based in Geneva, Switzerland, the World Economic Forum is impartial and not-for-profit; it is tied to no political, partisan or national interests.

For more information:
Richard Elliott
Senior Media Officer
Tel.: +41 (0)22 869 12 92
Fax: + 41 (0)22 869 13 94
richard.elliott@weforum.org 
www.weforum.org

L to R: Dr Jarbas Barbosa da Silva Jr (Government of Brazil), Dr Sania Nishtar (Heartfile), Dr Paul De Lay (UNAIDS), Dr Richard Horton (the Lancet), Dr Margaret Chan (WHO), Dr Masato Mugitani (Government of Japan), Dr Ariel Pablos-MÉndez (USAID).
Credit: UNAIDS/Y.Gripas

Advances in HIV care and treatment that keep people alive while controlling, although not curing, their conditions have led to growing numbers of people surviving with chronic illnesses including HIV infection.

A satellite session at the 19th International AIDS Conference in Washington, DC, examined how service delivery has evolved in addressing HIV as a chronic health issue, and what can be learned from the experience when it comes to preventing and controlling other chronic conditions. Titled "Care and treatment for people with chronic conditions: What can we learn from the HIV experience?” the meeting also identified synergies across HIV, Non-communicable diseases (NCDs)–– such as cardiovascular diseases, cancers, diabetes and chronic respiratory diseases—and other chronic conditions when it comes to health systems strengthening. 

As access to antiretroviral therapy expands, the HIV response is evolving from a disease-specific emergency response to a chronic disease management challenge which needs to be addressed within the context of other chronic health conditions. This epidemiological transition, coupled with a fast growing number of people with other chronic diseases has considerable implications for health systems and societies.

Non-communicable diseases (NCDs)––in particular cardiovascular diseases, cancers, chronic respiratory diseases and diabetes––are the biggest cause of death worldwide. More than 36 million people die annually from NCDs, including 9 million people who die before the age of 60. More than 90% of these premature deaths occur in developing countries and could have largely been prevented.

People living with HIV often also have high rates of non-communicable diseases. With HIV programmes rapidly expanding, people with HIV are living longer and ageing, and are developing non-HIV-related chronic conditions similar to the rest of the population.

In this context, the UNAIDS Secretariat and WHO have signed a Letter of Agreement to accelerate collaboration to address common agendas of HIV and non-communicable diseases. Both organisations will now collaborate to facilitate low- and middle-income countries to successfully address their diseases burden of HIV and non-communicable diseases.

“UNAIDS is committed to take AIDS out of isolation and strengthen integration with NCDs by accelerating collaboration with WHO and partners,” said UNAIDS Deputy Executive Director, Programme, Dr Paul De Lay. “2011 United Nations Political Declaration on HIV/AIDS demands that we link and integrate our HIV response to Non Communicable Diseases. We need to take on our biggest health and development challenges of our time HIV and NCDs together,” he added.

In a number of settings, it has already been possible to use the HIV lessons learnt and synergize with NCD programmes. In Ethiopia, for example, lessons learnt from HIV have served to support diabetes services. In Cambodia, two MÉdecins Sans Frontières (Doctors Without Borders) clinics combined HIV, diabetes and hypertension care services, while in Kenya, FHI 360 has added non-communicable diseases care to existing HIV programmes. In South Africa, a massive unified health testing campaign for HIV, elevated blood pressure and diabetes is underway.

HIV and other chronic diseases

Experience in addressing HIV and non-communicable diseases shows that many of the challenges are common: organizing and delivering adequate prevention services; chronic treatment and care; addressing the social and environmental determinants of these health issues; and reaching people without access to services.

The benefits of an integrated approach are reflected in better access to comprehensive care, cost savings and reduced morbidity and mortality. However, a lot still needs to be done.

According to participants at the session, summarized by Dr Masato Mugitani, Assistant Minister for Global Health, Japan and Board Chair of the Global Health Workforce Alliance, activities need to be coordinated across the continuum of care, from prevention to treatment, care and support. A particular challenge is ensuring a prepared, motivated, supported and well-functioning health workforce. Other areas of equal importance are creating equitable access to medicine and technologies; effective and integrated information systems; and robust population based surveillance.