Representatives from G8 and non-G8 countries, international organizations, foundations and civil society are in Tokyo, Japan to further health systems strengthening. The International Conference on Global Action for Health System Strengthening took place from 3-4 November as a follow-up to the July 2008 Toyako G8 Summit. The conference aims to keep global health high on the agenda of G8 leaders and to develop a coordinated framework to better align global health initiatives.

On 3 November UNAIDS Executive Director Dr Peter Piot spoke at a session on the role of major stakeholders in strengthening health systems. In his presentation, Dr Piot elaborated on the impact of AIDS – and other disease specific programmes – on health systems in low- and middle-income countries. Dr Piot outlined how the AIDS response has bolstered weak health systems, such as through the provision of essential treatment, care and support services for people living with HIV. During his intervention, Dr Piot also underlined the need to improve coordination among international health partners, make existing money work more effectively, and secure predictable long-term funding.

One of the major constraints to addressing both the AIDS epidemic and global access to essential health care services is the serious shortage of healthcare workers. Insufficient healthcare workforce is the 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.

The need for an active and more coordinated compilation of health information as well as the importance of sustainability and predictability of funding were also identified as two major areas for improvement in order to strengthen health systems worldwide. There is a need for a better global data monitoring that in turn will allow for a more effective use of the existing resources.

As the current holder of the G8 presidency, Japan continues to place health systems strengthening high on the agenda. It has encouraged the other member nations to provide full support in realizing greater action on the issue through the hosting of several high level meetings and formation of working groups to address priority areas of the health systems debate such as financing, information and data collection, and the workforce.

Japan has committed to ensuring a smooth transition of the health systems dossier to the next holder of the G8 presidency – Italy in 2009.

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.

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".

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Plenary speech by Dr Peter Piot, UNAIDS Executive Director

Kampala, Uganda 5 March, 2008.

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.

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.

One of the major constraints to addressing both the AIDS epidemic and global access to essential health care services is the serious shortage of healthcare workers. WHO, UNAIDS and the US President’s Emergency Pan for AIDS Relief (PEPFAR) are launching innovative new guidelines to help strengthen health systems through ‘task shifting’ among the health workforce, at the first ever Global Conference on Task Shifting being held in Addis Ababa from 8-10 January 2008.

‘Task shifting’ is the name given to a process of delegation whereby tasks are moved, where appropriate, to less specialized health workers. By reorganizing the workforce in this way, task shifting presents a viable solution for improving health care coverage by making more efficient use of the human resources already available and by quickly increasing capacity while training and retention programmes are expanded. Several countries are already using task shifting to strengthen their health systems and scale up access to AIDS treatment and care.

The Global Conference on Task Shifting will convene health ministers and other senior government officials, opinion leaders, United Nations agencies and non-governmental organizations from both industrialized and resource-constrained countries.

Read more on the conference on WHO’s web site

Leaders from donor countries, funding organizations, developing nations, and international agencies came together in London on Wednesday 5 September to launch a new international partnership to help improve healthcare systems in the developing world.

Led by the government of the United Kingdom, the International Health Partnership was launched formally by UK Prime Minister Gordon Brown at an event at 10 Downing Street, London.

The initiative aims to increase donor, country and international coordination on health and development issues in order to drive forward work on the health-related Millennium Development Goals (MDGs) – reducing child mortality, improving maternal health, and halting and reversing the spread of HIV.

Following a roundtable discussion focusing on implementation, participants signed a compact to work within countries’ national plans and improve coordination in order to address problems related to health worker staffing, infrastructure, health commodities, logistics, tracking progress, and effective financing. 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.

In a statement released on Wednesday 5 by the United Kingdom, Prime Minister Gordon Brown said, “There is no greater cause than that every man, woman and child in the world should be able to benefit from the best medicine and healthcare. Today we come together – donor governments, health agencies and developing countries – with the certainty that we have the knowledge and the power to save millions of lives through our efforts.”

In an initial phase, seven ‘first wave’ countries – Burundi, Cambodia, Ethiopia, Kenya, Mozambique, Nepal and Zambia – have joined the partnership and participated in the London event. Also attending were Heads of State and ministers from donor countries such as Norway and Canada and senior figures from international agencies, including UNAIDS. Philanthropist Bill Gates attended on behalf of the Bill and Melinda Gates Foundation.

Speaking at the event, UNAIDS Deputy Executive Director Michel Sidibe underlined the importance of the partnership. “To improve global health, it is critical that we have better coordination and mutual accountability from all parties: countries, donors, and the international organizations.” he said. “The International Health Partnership will be crucial in order to deliver on our commitments to the targets of Universal Access to HIV prevention, treatment, care, and support, and in reaching all the health-related Millennium Development Goals. The global response to AIDS has shown us that increased coordination can lead to progress. We also need to stay focused on the concrete results that we are all committed to, at the same time putting in place predictable, scaled-up financing for a long-term sustainable response.”

A joint statement from international health partners – UNAIDS, The GAVI Alliance, Global Fund to Fight Aids, Tuberculosis and Malaria, UNICEF, United Nations Population Fund, World Bank and the World Health Organization – welcomed the initiative: “We, as international health partners committed to improving health and development outcomes in the world, welcome and fully support the International Health Partnership's mission to strengthen health systems, and we congratulate those involved for setting it in motion.”

“We will be coordinated and accountable in this work and take every opportunity to capture knowledge and lessons learned in improving health programmes,” the partners stated.

The International Health Partnership is the first of several complementary initiatives being launched by donor countries over the next several weeks as part of a new Global Campaign for the Health Millennium Development Goals. More information will be featured in the coming weeks on the UNAIDS website.

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Links:

Read the joint statement by international health partners
Read the UK press release
More on the International Health Partnership

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.

Significant progress towards reducing child and maternal mortality is being made but to meet the Millennium Development Goals 4,5,6, strategies aimed at reaching the world’s most inaccessible, marginalized and vulnerable populations will be required, health leaders said today.

The World Health Organization (WHO) report, Global

National health ministers, public health leaders and HIV/AIDS experts convene today at the first-ever international conference on task shifting to scale up access to HIV/AIDS treatment and, at the same time, expand the global health workforce.