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HEALTH-AFRICA: Maximising the Benefits of AIDS Funding

NAIROBI, Jan 2 2009 (IPS) - Significant new investments in the fight against the AIDS pandemic could have positive impacts on broader health systems in Africa if governments handle them right.

A study of six countries – Argentina, Brazil, Dominican Republic, Zimbabwe, Kenya and Uganda – by the International Treatment Preparedness Coalition (ITPC), titled “Missing the Target 6 – The HIV/AIDS Response and Health Systems” indicates that new investment in AIDS services has exposed existing fragilities in health systems. In some cases it has placed increasing burdens on these systems by expanding demand and stretchied already overextended human resources.

The report, which provides some of the first on-the-ground research documenting the impacts of the AIDS service scale up, shows that the AIDS response has attracted the biggest share of health financing, increased the number of trained medical personnel, improved the management of people living with the virus, and supported the establishment of HIV clinics that treat TB and other opportunistic infections.

The pandemic has spurred the mobilisation of activists and health care consumers themselves and forced global and national leaders to a more vigorous sense of accountability and urgency.

The research also examined claims that the international response to HIV/AIDS has also weakened the primary care in many instances, distorting health systems, and diverting funding and health care personnel.

“To the degree the response to AIDS ‘distorted’ health systems, it did so by increasing the accessibility and quality of services for one devastating disease,” the authors write.

“Before AIDS, health systems suffered from decades of disinvestment due to structural adjustment policies and chronic under-funding, which damaged the entire infrastructure for primary care. Today’s debates about AIDS versus health systems would not have happened 10 or 20 years ago. AIDS has opened up a sense of possibility for change, for progress in providing health care to all who need it.”

The ITPC report shows that HIV and AIDS has placed extra pressure on health systems in each of the countries studied, which is manifested in increased workload for the health workers, whose numbers have not increased in tandem with increasing demands. In Uganda, for example, staff in public health facilities have moved to HIV clinics where they are paid better, creating a deficit in the institutions they are departing from.

Yet the scale-up of AIDS services has also led to improvements in several aspects of health care, including how services were delivered and who received care. In the Wakiso district, community health workers who carry out HIV/AIDS sensitisation also give out anti-malaria medicines, mosquito nets, and treat minor illnesses, such as obvious malaria, and diarrhoea. The Mengo and Rubaga hospitals have outreach programs that focus on HIV testing alongside immunisation, family planning, and prevention and treatment of common diseases.

The report recommends that the donor community should channel more resources into improving infrastructure, with particular focus on increasing the number of laboratory facilities for diagnostic tests. It also calls for the governments in Africa to streamline the supply and logistics chain to ensure a more consistent and uninterrupted supply of ARVs and other essential medicines.

The challenges facing health care systems in Africa are compounded by a shortage of personnel. According to a senior lecturer at Makerere University’s School of Health, Professor Fred Nuwaha, the shortage can only be solved through the regional medical body that should also front for serious research against communicable diseases and the latest disease of the affluent such as heart, high blood pressure and cancer.

“This will also help tame the migration of doctors to Europe and America, a move that is fast derailing the health sector in Uganda and other African countries,” he adds.

Nuwaha reveals that 20 percent of 200 medical doctors that are trained at the university each year end up leaving the country due to the poor working conditions in the country. “As these medics relocate, people in hard to reach rural areas are most affected as the few doctors available find themselves in urban areas,” he notes.

Zimbabwe also faces severe shortages of healthcare workers, aggravated by the economic collapse and political stalemate.

“What we found was that HIV/AIDS services, particularly provision of antiretrovirals, have become a lifeline for the health care system in Zimbabwe,” said Matilda Moyo, who co-authored the report’s chapter on Zimbabwe.

“In the midst of the economic and political crises, a consistent focus on HIV health services has been an oasis in a whole desert of the collapsing health delivery system.”

But another person involved in producing the report cautioned against the diffusion of AIDS funding to support the general public health system.

“The AIDS response in Zimbabwe, Brazil and other countries shows that new investments in health can have dramatic impact,” said Chris Collins, one of the report’s coordinators. “But a simple reshuffling of health resources toward more generalized health functions at the expense of effective disease-specific programs, such as HIV/AIDS, would jeopardize the remarkable advances that have been made and leave the more than six million people who urgently need AIDS treatment without this care.”

*This feature is a joint production with the African Woman and Child Feature Service.

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