The World Health Assembly today adopted a new comprehensive Global Health Sector Strategy for HIV/AIDS 2011-2015, spearheaded by the World Health Organization (WHO). The strategy aims to provide a detailed and comprehensive guide to how health sectors can most effectively tackle the epidemic.

Recognizing that the nature of the epidemic has evolved in recent years, and that the AIDS response has to be dynamic and flexible, the World Health Assembly in 2010 called for a new HIV strategy to inform global health sector action. In consultation with some 100 member states, civil society and other key players, a number of whom participated online; a strategy has been formulated which takes into account great strides made in the AIDS response and maps out what needs to be done in the future.

The latest UNAIDS global report has shown that the AIDS epidemic has been halted and that the spread of HIV is beginning to be reversed. New infections have fallen by almost 20% in the last 10 years and between 2003 and 2009 there was a 13-fold increase in treatment coverage. However, in 2009 only a third of people in need of treatment received it and the demand for resources is still outstripping supply.

The new Global Health Sector Strategy for HIV/AIDS, which is fully aligned with, and complements, the UNAIDS strategy 2011-15, Getting to Zero, will operate within this changed landscape to optimize progress towards universal access and the attainment of the Millennium Development Goals. It promotes tailored responses to national and regional epidemics and analyzes the underlying socio-economic and cultural determinants contributing to the spread of the virus.

The strategy seeks to reduce vulnerability and structural barriers to accessing good quality services. It also demonstrates how HIV programmes can play a role in broader health outcomes and recognizes the importance of strong health and community systems to guarantee a sustainable response.

WHO will make five key contributions to the Global Health Sector Strategy:

• Scale up innovation in prevention
• Optimize treatment and care
• Support health for women and children
• Promote strategic health-sector information and planning
• Provide leadership in addressing health equity and HIV (examining inequities in access to HIV services)

The new strategy represents another significant step forward in the global response to HIV.

 

If countries are to guarantee a good quality of life and ensure socio-economic development for people then promoting and protecting health is crucial. Without greater emphasis on health systems financing, however, this goal will remain unattainable for the poor, says the World Health Organization’s (WHO) World Health Report 2010, launched today.

Subtitled Health systems financing: the path to universal coverage, the report provides a detailed analysis of how this can be achieved with the provision of timely access to high-quality, affordable health services.  

The concept of universal coverage emerged from a commitment from WHO member states in 2005 to develop their health financing systems. As the report has it, in an era of “globalisation of diseases” and increasing demands for chronic care from, for example people living with HIV on long term antiretroviral treatment, universal coverage will be of paramount importance.   

According to the World Health Report, the lack of universal coverage has consequences for the poor. In some countries, for instance, the proportion of births attended by a skilled worker can be as low as 10%. This figure is close to 100% for richer nations.

Attaining universal coverage is considered relatively straightforward in principle but difficult in practice, and among others these two key actions are highlighted in the report.

Raising sufficient resources for health

Firstly, countries must raise sufficient funds. For many lower-income nations this may prove impossible in the short-term and the international community will need to financially support their efforts. Such nations currently spend around $US 32 per capita on health. To provide universal coverage this should be raised to US$ 60 by 2015.

Recipient countries can also increase their own health funding by reprioritising their budgets. Few African countries, for example, spend the 15% of their government budget on health they committed to in the 2001 Abuja Declaration. In fact, 20 countries in the region who signed the commitment actually allocate less now than they did nine years ago; although several, including Tanzania and Liberia, have exceeded this goal.

Another example is Rwanda’s donation of US$ 1 million in this year’s replenishment round of the Global Fund to fight AIDS, Tuberculosis and Malaria and South Africa’s announcement earlier this year of a US$ 1.1 million domestic investment in the country’s AIDS response.

“Investing for health must be shared responsibility between development partners and national government,” said Mr Michel Sidibé, UNAIDS Executive Director. 

Innovative financing may also be explored. Increasing taxes on air tickets, foreign exchange transactions and tobacco could be used to augment health budgets. The report states that, for example, a 50% increase in tobacco excise taxes would generate $US 1.42 billion in additional funds in 22 low income countries for which data are available. In countries such as the Lao People’s Democratic Republic, Madagascar and Viet Nam, the extra revenue would represent a 10% increase or more in total health expenditure, and a more than 25% in crease in the government’s total health budget.

Promoting efficiency and eliminating waste

Finally, the report suggests that inefficiency and waste can be extremely damaging for healthcare systems. It is argued that some 20-40% of resources spent on health are wasted. A 5% saving in health expenditure can be made if unnecessary spending on medicines is reduced, they are more appropriately used and quality control is improved.

Other ways to increase efficiency include; getting the most out of technologies and health services; motivating health workers; reducing medical errors and eliminating corruption.

Secretary-General Ban and Viet Nam Deputy Prime Minister H.E. Truong Vinh Trong talking to people living with HIV on Methadone for drug dependence and antiretroviral treatment at Tu Liem health care centre. 29 October 2010. Credit: UN Viet Nam/Doan Bao Chau

United Nations Secretary-General Ban Ki-moon visited a “one-stop shop” health centre for HIV services in Hanoi, Viet Nam on 29 October together with H.E. Mr Truong Vinh Trong, Deputy Prime Minster and chairman of the National Committee on AIDS, H.E. Nguyen Quoc Trieu, Minster of Health, H.E. Nguyen Thi Kim Ngan, Minister of Labour – Invalids and Social Affairs, and H.E. Le The Tiem Vice Minister of Public Security and delegates of the United Nations Country Team.

The HIV epidemic in Viet Nam is concentrated among key populations at higher risk. While HIV prevalence among adults aged 15-49 is estimated at 0.44%, prevalence is significantly higher among men who have sex with men, people who inject drugs and sex workers in the country.  For example, HIV prevalence among people who inject drug is about 30%, and in some provinces nearing 50%.
Viet Nam’s HIV response has benefited from the increase in political commitment in recent years. During the visit to the Health Centre, the Deputy Prime Minister, H.E. Truong Vinh Trong highlighted that “Viet Nam is considering turning the national response to HIV into a National Target Programme. This will help ensure the sustainability of the response to HIV and the achievement of the Millennium Development Goal on HIV.”

The Tu Liem District Health Centre in Hanoi provides HIV-related services, including HIV counselling and testing, and peer education to key populations at higher risk. The centre also distributes condoms, clean needle and syringes. Recently a government programme was started to provide methadone maintenance therapy, as part of a role out of methadone clinics across the country.

“This health centre is not only preventing the further spread of HIV. You are not just reducing deaths from AIDS in Viet Nam. You are achieving much more,” said Secretary-General Ban to the staff working at the Tu Liem District Health Centre. “You are giving life to people who will contribute to the development and success of Viet Nam.”

Secretary-General Ban also spoke to people living with HIV who were receiving methadone for drug dependence treatment as well as antiretroviral treatment. Many at the centre told the Secretary-General how methadone has changed their lives.

Secretary-General Ban thanked the participants for speaking out on behalf of people living with HIV and he also stressed the importance of addressing issues such as stigma and discrimination to enable people to access HIV services with dignity.

“Viet Nam has significantly scaled up its response to HIV in recent years and has experienced significant progress. I urge the international community to stand by the commitments made to this country to ensure a sustained response to the epidemic and not withdraw their funding,” concluded Mr Murphy, UNAIDS Country Director, speaking on behalf on the UN Country Team.

Botswana’s coordinator of the National AIDS Coordinating Agency, Richard Matlhare, shares his thoughts on Botswana’s progress in MDG 6.

Richard Matlhare of Botswana’s National AIDS Coordinating Agency.

UNAIDS: What would you say is the greatest success to date in Botswana’s AIDS response?

Mr. Matlhare: There are two levels of success: governance and programme performance. In the area of governance, there is strong political will and leadership for the AIDS response. This has translated into domestic financial resource allocation which covers between 70 to 90 percent of the national response needs.

On the programmatic level, success can be seen in the robust antiretroviral treatment and prevention of mother-to-child transmission (PMTCT) programmes that have over 93% and 94% coverage rates respectively. The quality of life for people living with HIV has been enhanced and the number of AIDS deaths averted has significantly reduced by 50% since initiation of the treatment programme. Mother-to-child transmission has been reduced to less than 4%.

Uptake of voluntary counseling and testing services is also high, at 56% among those sexually active, and we have also seen a 90% uptake of testing at health facilities.

UNAIDS: Can you share some of the main obstacles to achieving MDG 6 in Botswana?

Mr. Matlhare: Although we have not been measuring incidence, the proxy indictor of HIV prevalence among 15 to 19 year olds, from ANC Sentinel Surveys, reveals that Botswana has been able to halt the spread of HIV from having an adult HIV prevalence of 24.7% in 2001 to 13.2% in 2009. However, achieving the current national targets of 50% reduction in incidence rates by 2016 is yet to be realized. The recently released “Know Your Epidemic and Response” report shows that low risk heterosexual sex is the main mode of transmission, with contextual factors being the main barrier to behavior change. More focus and efforts are needed to mobilize both communities and individuals for increased and sustained behavior change. But to realize this, a better understanding of the interventions that work best for us is needed.

UNAIDS: How are investments in the AIDS response in Botswana advancing the other MDGs?

Mr. Matlhare: The advent of HIV in Botswana stretched the capacity of our health system, revealing critical gaps that affected health outcomes. The AIDS response has been catalytic in strengthening our health systems. Some of the main benefits include an increase in the number of skilled human resources, the strengthening of the central medical stores in supply chain management, and upgrading of laboratory services. The impact of these improvements is not limited to HIV but across the other health-related MDGs.

Another notable area is the provision of support to orphans and vulnerable children. This has had a direct effect on reducing poverty—MDG 1. Unlike in some countries, Botswana’s AIDS programme does not differentiate between AIDS orphans and non-AIDS orphans; all orphans benefit. In addition, the free provision of antiretroviral treatment means that a person living with HIV does not have to divert his disposable income to purchase these lifesaving drugs. This programme has alleviated poverty and increased life expectancy. These are just a few examples of the impact of the AIDS response on the other MDGs.

UNAIDS: Should Botswana’s AIDS response be addressed as a stand alone public health issue or in tandem with other global health movements?

Mr. Matlhare: The focus on HIV in the first national strategic framework was critical to galvanize and mount an effective response, and we should be careful not to lose focus on the gains of addressing HIV as a stand alone health issue. However, as we enter into the era of the second national strategic framework, there is a need for a more holistic approach through integrated service delivery while still utilizing a multi-sectoral approach. This will ensure that the gains so far are consolidated while cost efficiency and economies of scale are achieved.

UNAIDS: What is happening in Botswana to make HIV prevention a priority?

Mr. Matlhare: In our new HIV policy and the second national strategic framework, prevention has been singled as the top priority. In addition, Botswana has developed a prevention plan that provides guidance to all stakeholders. To ensure success at the community level, partners have been mobilized to embark on proven prevention initiatives. The country is fully committed to increasing prevention resource allocation to match this prioritization. For instance, male circumcision has been adopted and its roll-out will complement other prevention efforts.

UNAIDS Executive Director Mr Michel Sidibé (left) met with H.E. Dr Tedros Adhanom Ghebreyesus, Minister of Health Ethiopia at the Ministry of Health, Addis Ababa, Wednesday 28 July 2010

The Executive Director of UNAIDS, Michel Sidibé paid a visit to Ethiopia to discuss ways of accelerating progress towards achieving universal access to HIV services and reaching the Millennium Development Goals in the country.

High on the agenda was exploring the progress and challenges Ethiopia is facing in preventing mother-to-child HIV transmission (PMTCT).

Mr Sidibé visited the HIV treatment centre and maternity ward at St Paul’s hospital in Addis Ababa where nutritional support is integrated with health service delivery for people living with HIV. While there, Mr Sidibé had an opportunity to participate in the “Mother Support Group Discussions,” a peer support group of HIV positive women who meet fortnightly for psychological support by sharing their experiences and exchanging views on a range of social issues including experiencing stigma, positive living, telling their partners about their HIV status, clinic attendance, and family planning.

On conclusion of his visit, Mr Sidibé met with the journalists to highlight the need for renewed commitment towards the virtual elimination of mother to child transmission of HIV and the need for innovative approaches to sustain the response.

Mr Sidibé praised the efforts being made by the government of Ethiopia towards eradicating mother-to-child HIV transmission and called on the leadership to intensify efforts to increase access to PMTCT services while addressing the factors undermining access to these services including gender inequality, stigma and discrimination and the insufficient involvement of the community.

Mr Sidibé also urged for enhanced integration of HIV prevention and treatment into maternal, newborn and child health programmes.

Earlier, the UNAIDS executive director had paid a visit to one of the HIV urban projects supported by the World Food Programme (WFP) which provide food and nutritional assistance to pregnant and lactating women living with HIV who are accessing PMTCT services. He met with a group of mothers who participate in this project and commended the initiative which supports lives of mothers and babies through the provision of food and nutritional support.

From left: Ambassador Eric Goosby, United States Global AIDS Coordinator; Professor Michel D. Kazatchkine; Executive Director, The Global Fund to Fight AIDS, TB and Malaria; Anthony Lake, Executive Director of UNICEF; Michel Sidibé, Executive Director of UNAIDS; Hiroki Nakatami, Assistant Director General of WHO; at the UNAIDS PMTCT Satellite at the 18th International AIDS Conference in Vienna, Austria on 19 July 2010. Credit: UNAIDS/Heimo Aga

UNAIDS hosted a satellite at AIDS 2010 on preventing mother-to-child transmission of HIV 19 July. It was co-chaired by Antony Lake, Executive Director of UNICEF and Hiroki Nakatani, Assistant Director General of World Health Organization (WHO) and coordinated by Gottfried Hirnschall, Director of the HIV department (WHO). Opening remarks were delivered by Michel Sidibé, Executive Director of UNAIDS and Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, TB and Malaria, and Ambassador Eric Goosby, United States Global AIDS Coordinator.

The call to eliminate mother-to-child transmission of HIV was first made by UNAIDS Executive Director Michel Sidibé and he has since been joined by leaders of nations, heads of multilateral, bilateral, regional and national bodies, presidents of foundations, members of civil society, and even captains of football teams in the FIFA 2010 World Cup.

From left: Professor Michel D. Kazatchkine; Executive Director, The Global Fund to Fight AIDS, TB and Malaria; Anthony Lake, Executive Director of UNICEF; Michel Sidibé, Executive Director of UNAIDS; Hiroki Nakatami, Assistant Director General of WHO; at the UNAIDS PMTCT Satellite at the 18th International AIDS Conference in Vienna, Austria on 19 July 2010. Credit: UNAIDS/Heimo Aga

Addressing the satellite, Mr Sidibé noted that many African countries like Botswana, Namibia and Swaziland are already leading the way towards virtual elimination if mother-to-child transmission, and many others are close behind.

This groundswell of support is lending hope to the possibility that transmission of HIV from mothers to children can be virtually eliminated in the highest-burden countries by 2015. At the same time, the WHO has issued new recommendations on the use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants and HIV and infant feeding. The main purpose of the new recommendations is to improve maternal and child survival by drastically reducing risk to around 5%, including in breastfeeding populations.

WHO, UNICEF, UNFPA and UNAIDS have developed a PMTCT strategic vision through the UNAIDS Outcome Framework for 2009-2011, aiming at defining joint commitment to support scale up of PMTCT of HIV services and integration with maternal, newborn and child and reproductive health services.

A long way to go

Despite this momentum, many nations have a long way to go. The majority of pregnant women in low- and middle-income countries do not know their HIV status. This knowledge has risen from 7% in 2004 to 21% in 2008. Also, the majority of HIV-positive pregnant women who need antiretrovirals (ARVs) for preventing transmission of the virus to their child. Only 45% of women in need of ARVs received it in 2008, although this is up from 10% in 2004.

UNAIDS PMTCT Satellite at the 18th International AIDS Conference in Vienna, Austria on 19 July 2010. Credit: UNAIDS/Heimo Aga

The quadrupling of the proportion of women receiving this important service is good news. But children continue to be left behind. Around 32% of infants born to HIV-positive mothers received antiretroviral for PMTCT in 2008, up from 20% in 2007 and 6% in 2004.

Update

Yesterday’s satellite provided an update on global commitments to virtual eliminate mother-to-child transmission of HIV. Participants highlighted key policy and operational considerations in implementing comprehensive PMTCT services integrated with maternal health and family planning services, including the WHO 2009 guidelines on ARV drugs for treating pregnant women and preventing HIV infection in infants which were reviewed by Nathan Shaffer of WHO.

To put theory into perspective country experience was shared by Mpolai Moteetee, the PMTCT focal point in Lesotho's Ministry of Health and Social Welfare Family Health Division who spoke of the experience of rapid scale-up of PMTCT services in Lesotho.

Marie Deschamps of GHESKIO (Groupe Haïtien d’étude du Sarcome de Kaposi et des Infectieuses Opportunistes) presented on the importance of integration of broad range of services of maternal health, family planning, PMTCT, and HIV treatment for maternal and child survival

Lilian Mworeko of ICW (International Community of Women with HIV/AIDS) Uganda shared her personal perspective as an activist and a person living with HIV.

Mother-Baby Pack

UNICEF, in collaboration with WHO and global partners, has developed an innovative simple, user-friendly and affordable packaging mechanism to deliver PMTCT preventive medications, the Mother-Baby Pack (MBP). Chewe Luo, a UNICEF Senior Advisor, presented the Pack which contains medicines for prophylaxis, ARVs and Co-trimoxazole, for the mother and for the infant in line with WHO 2010 PMTCT Guidelines. It also intends to help streamline procurement and supply management of PMTCT medicines.

The Global Fund has also declared preventing mother-to-child transmission (PMTCT) a priority and is currently assessing the possibility of reprogramming existing grants to accelerate scale-up in 20 countries (Angola, Botswana, Burundi, Cameroon, Côte d'Ivoire, the Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Lesotho, Mozambique, Malawi, Namibia, Nigeria, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe).

Caroline Ryan of PEPFAR shared how their efforts will contribute towards virtual eiliminaiton. PEPFAR II has aligned its target to the UNGASS targets aiming to provide PMTCT services to 80% of all pregnant women living with HIV and exposed infants in their country programmes. All these commitments fall within the context of integrated programming for improved maternal and child health and survival coordinated with current US Global Health Initiative.

Closing remarks at the session were delivered by Antony Lake and Hiroki Nakatani.

UNAIDS Executive Director Michel Sidibé and Prof. Jeffrey Sachs, Director of the Earth Institute, signing the agreement. 21st September, New York.
Credit: UNAIDS/B.Hamilton

UNAIDS and the Millennium Villages Project signed an agreement in New York to strengthen efforts to eliminate mother-to-child transmission of HIV in Africa. The aim of the partnership is to help local governments create “Mother to child transmission-free zones” in 14 ‘Millennium Villages’ across ten African countries.

The Millennium Villages Project, a partnership between The Earth Institute at Columbia University, Millennium Promise, and UNDP, seeks to end poverty by working in rural areas throughout Africa. The new initiative will use the existing infrastructure, human capacity and technical resources in the villages, to help rapidly expand family- and community-centered heath services with focus on stopping new HIV infections among children.

UNAIDS Executive Director Michel Sidibé and Prof. Jeffrey Sachs, Director of the Earth Institute, signed the agreement in the presence of business and African leaders. The ceremony was held under the auspices of President Yoweri Museveni of Uganda and President Abdoulaye Wade of Senegal.

“I salute this partnership to help protect mothers and their children from HIV. This initiative will mobilize resources and generate political will to save young lives, leading to a generation of African children born free of HIV,” said President Wade.

(L to R): President Abdoulaye Wade of Senegal, UNAIDS Executive Director Michel Sidibé, Prof. Jeffrey Sachs, Director of the Earth Institute and President Yoweri Museveni of Uganda.
Credit: UNAIDS/B.Hamilton

Also speaking at the ceremony were Dr Lydia Mungherera, a Ugandan HIV prevention activist representing the organizations HIV+ and TASO. The Executive Director of UNICEF, Ms Ann M. Veneman, the Minister of State of Mali, Mr. Abou Sow; the South African Minister of Health Dr. Aaron Motsoaledi; and Ambassador Eric Goosby, MD, the United States Global AIDS Coordinator participated in a panel discussion at the event.

Each day 1,200 children under the age of 15 are infected with HIV; 90% of these infections occur in sub-Saharan Africa. According to Mr. Sidibe, “In all of Western Europe there were fewer than 100 mother-to-child transmissions (MTCT) in 2007, whereas in sub-Saharan Africa, there were more than 370,000.”

The top priorities outlined in the memorandum include measures to ensure that women of child bearing age avoid getting infected, those that are infected avoid unwanted pregnancy; increase access to antenatal care services; HIV testing and counselling to expectant mothers; and expanded access to HIV prevention and treatment services for children.

The agreement will bring together the Millennium Village Project’s multi-sectoral and science-based development and primary healthcare strategy with UNAIDS’ expertise in community and family-centred prevention strategies in order to create ‘MTCT-free zones’, whose progress will be monitored by both entities.

Executive Director of UNICEF, Ms Ann M. Veneman, South African Minister of Health, Dr. Aaron Motsoaledi, and UNAIDS Executive Director Michel Sidibé.
Credit: UNAIDS/B.Hamilton

“We hope that the creation of ‘MTCT-free zones’ in the Millennium Villages will serve as a model that can be used throughout Africa whereby communities are engaged, men and young people are active partners, and children are born free from HIV,” Mr Sidibé said.
In 2007, there were 2 million children under 15 years living with HIV, up from 1.6 million in 2001 and less than 15% in need of treatment were getting it. In sub-Saharan Africa, only a third of pregnant HIV-positive women received the antiretroviral treatment (ART) to prevent transmitting the infection to their infants, compared with nearly 100% in Western Europe.

Operating in 14 sites in 10 sub-Saharan African countries, the Millennium Villages project has been working with local governments to introduce a model primary health system which will cover approximately 500,000 people.

The Villages work on a model primary health system and include education, nutrition and economic development. The primary health systems include; free services at the point of care; trained professional community health workers; a network of adequately staffed primary clinics; access to a mobile communication network and emergency transport services to facilitate referrals; and a local referral hospital to support second-tier care. The system houses a monitoring and evaluation platform that can readily assess the adequacy, uptake and impact of HIV testing and counselling and family centered HIV prevention services.

“Phones for Health” is a partnership between a healthcare software provider Voxiva, a phone producer Motorola, a telecom company MTN, the GSMA Development Fund, PEPFAR, CDC Foundation, Accenture Development Partnerships and several governments. The integration of mobile technology and health applications enables health workers on the road to input and transfer health data to a central database where the data can be analysed. In addition, they can order medicines, send alerts, download guidelines, or access training materials.

This is one of several public-private initiatives showcased in a new UNAIDS report that looks at the contribution of AIDS-related public-private partnerships* to the six building blocks of health systems: service delivery; human resources; information; medicines and technologies; financing; and leadership.

HIV-related Public-Private Partnerships and Health Systems strengthening, highlights how the AIDS response has been a strong catalyst in the establishment of public-private partnerships for health, particularly in Africa. Many of these partnerships initially focused on HIV but they later expanded to cover wider health issues.

“This publication is innovative as it approaches public-private partnerships via a very specific angle: their applicability to strengthen the public sector,” said UNAIDS Private Sector Partnerships Chief, Regina Castillo. “We hope the report will provide some guidance on critical steps private and public actors need to take to maximize the potential of public-private partnerships for the benefit of public health,” Ms Castillo added.

UNAIDS has noted in its Outcome Framework 2009-2011 that substantial progress on a number of the Millennium Development Goals can be achieved by taking the AIDS response out of isolation and integrating it with efforts to achieve broader human development including the goal of health.

Research and interviews with representatives of private and public organization stakeholders as well as development partners were carried out. Twelve public-private partnerships with a strong collaborative relations with government institutions in the country of implementation were identified to present insider perspectives on catalysts and hurdles which may be encountered in developing collaborations. Good practices have been identified taken into consideration their sustainability, their integration in the national AIDS control plan, their measurable results, etc.

Some of the partnerships presented in the publication include North Star Foundation, BD’s Wellness Centres relieving the pressure on nurses in sub-Saharan Africa, DataDyne and Vodaphone Foundation developing health surveys with EpiSurveyor, Abbott Fund’s laboratory support from national to regional level in Tanzania, Mars supporting the National Health Insurance Scheme of Ghana, Fondation Sogebank managing Global Fund grants as Principal Recipient in Haiti, etc.

The topic of public-private partnerships was the focus of a breakout session of the Thematic Segment of the 23rd UNAIDS Programme Coordinating Board Meeting in Geneva on 15 December 2008. UNAIDS governing board then commissioned the Secretariat to compile “best practices and lessons learnt to support and facilitate public-private partnerships with respect to their applicability for strengthening the public sector in low and middle income countries”. “HIV-related Public-Private Partnerships and Health Systems Strengthening” is the result from this process.

To receive printed copies of the report, please contact Marie Engel, email engelm@unaids.org

* A Public-Private Partnership is defined as an “institutional relationship between the state and the private profit and/or the private non-profit sector, where the different public and private actors jointly participate in defining the objectives, methods and implementation of an agreement of cooperation”.

A short report by UNAIDS on AIDS and Global Health examines the role that the health sector should play in helping to attain the goal of universal access to HIV prevention, treatment, care and support. Credit: UNAIDS/P.Virot

The High-Level Forum on Advancing Global Health in the Face of Crisis is taking place at United Nations Headquarters on Monday, 15 June 2009. The Secretary-General is hosting the day long forum in order to elevate the global health debate and engage multisectoral representatives from around the world.

A short report by UNAIDS on AIDS and Global Health made available for this event examines the role that the health sector should play in helping to attain the goal of universal access to HIV prevention, treatment, care and support. Over the past decade the AIDS response has played a major role in producing better health outcomes for people in developing countries and has mobilized a whole range of stakeholders in efforts to build health systems worldwide. However, much work still needs to be done.

The AIDS epidemic is part of the global health landscape, just as the global health agenda is part of the AIDS response. The new report shows that the response to AIDS is an opportunity to improve health systems worldwide. Also discussed is that other areas that contribute to health solutions, such as human rights, the law and education, need to be embraced if we are to maximize outcomes, and that health equity must be addressed.

Shortfall in health resources

Investment in global health has increased significantly in recent years, and investment in the AIDS response has grown from US$ 300 million in 1996 to nearly US$ 14 billion in 2007. However, resources are still falling short for all health needs, and AIDS is no exception. With 7400 new HIV infections each day, the shortfall grows ever greater, and to achieve universal access in 2010 will require US$ 25 billion: US$ 11 billion more than is available today. Advocates for global health must therefore find ways to increase sound investments in health and the AIDS response.

Community services strengthened

It has been shown that there are many beneficial effects from an increase in AIDS resources being spent on health and community systems. A case study described in the report looks at how increased funding for HIV in Nigeria has trickled down to improvements at the local level in a whole range of areas, which in turn helps in the fight against many other diseases. Focusing on a hospital in Jengre, Nigeria, the case study shows that AIDS funding has helped provide free services for children and pregnant mothers enrolled in antenatal care, in addition to enabling major improvements in the hospital’s infrastructure and its ability to tackle the other poverty diseases: tuberculosis and malaria.

Linking AIDS treatment and HIV prevention to other health issues, such as sexual reproductive health, tuberculosis and safe motherhood, has meant that they themselves receive more attention. AIDS responses have also strengthened hospital infection control and improved blood safety and transfusions. The issue of paediatric AIDS has contributed to the debate on better medicines for children, and new opportunities have emerged to challenge those social norms that contribute to ill health.

HIV: health issue and social issue

AIDS and global health notes that HIV is both a health issue and a social issue. By involving the education, agriculture, business, media, labour and other social service sectors, the AIDS response has been able to leverage better health outcomes, just as efforts to eradicate polio and reduce tobacco use have done in recent years. HIV has highlighted the underlying causes of poor health: social determinants such as gender inequality, stigma, migration and lack of education. A lesson learned is that social determinants must be addressed when addressing global health needs.

Sections of the report on tuberculosis and HIV, climate change and HIV and A (H1N1) influenza stress the diverse areas that global health and AIDS cut across.

In conclusion, the report reminds us that much has been accomplished under the emergency conditions of the past 25 years, but that the global response is at a crossroads. The AIDS response and the health response should not work in isolation, but should be united around one common goal: results for people.

Dr Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, TB and Malaria
Credit: UNAIDS/Jacky Daniel Ly

Sustainable investment in health is crucial for African countries’ successful development stressed Dr Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, TB and Malaria.

“The world has finally understood that health is a priority for development and not a consequence of development,” said Dr Kazatchkine. “Investments in health have an impact and have saved lots of lives”.

Dr Kazatchkine was speaking at the 15th International Conference on AIDS and STIs in Africa (ICASA) where he highlighted the need for a long-term approach to the reinforcement of health systems in sub-Saharan Africa.

Financial resources for AIDS have increased significantly in the last five years because donors and the international community recognize how health can be a key investment in development. Dr Kazatchkine said that this investment coupled with an unprecedented mobilization of civil society has been showing results.

However sustainability is crucial argued Dr Kazatchkine. More predictable resources for countries generate the necessary environment that would allow countries to design programmes with the confidence that they will be sustainable. “If money is made available to countries, more programmes would be implemented and therefore the investment on AIDS would generate better results,” said Dr Kazatchkine.

UNAIDS Executive Director Dr Peter Piot and HRH Princess Matilde of Belgium co-chaired the plenary
Credit: UNAIDS/Jacky Daniel Ly

Dr Kazatchkine also stressed that addressing the challenges of weak health systems is critical. “Donors have contributed to strengthening health systems all over the world but more resources are required to address the health systems challenges such as infrastructures, facilities or health workers,” said Kazatchkine.

Finally, he added that there is a need for more than resources. The promotion of evidence-based responses that reach out to those most in need, human rights, strengthened social protection and strengthened global and local partnerships are responsibilities shared by countries and the international community.

UNAIDS Executive Director Dr Peter Piot and HRH Princess Matilde of Belgium co-chaired the plenary which was held on Friday.