Health Alliance International

From Vienna: When Does HIV Funding Strengthen Health Systems?

Posted: Jul 22, 2010 · Posted by: Barrot Lambdin, Technical Advisor for Implementation Science

On Wednesday I attended a symposium where participants tackled the question: when does HIV funding strengthen health systems?

A response to this question came from Ruairi Brugha of the Global HIV/AIDS Initiatives Network (GHIN), who shared the findings of a recent GHIN study on three global health initiatives: PEPFAR, Global Fund to Fight AIDS, TB and Malaria, and the World Bank Multi-Country AIDS Program (MAP). The study looked at Uganda, Malawi and Zambia to see how the HIV-focused funding from these initiatives affected the overall health system.

Some of the findings were:

1. The scale-up of global health initiative funding has not translated into significant increases in the health workforce.
2. In all 3 countries, the national health workforce has not grown proportionately to the increasing number of clients seeking care and treatment for HIV/AIDS. (Our own research at HAI suggests that this is leading to poor retention in HIV treatment.)
3. Time set aside for trainings (1- to 2-week courses of already trained health personnel) has stretched an already overburdened workforce, leading to high levels of absenteeism from work.
4. Low salaries for government health workers make it difficult for employers to retain staff who are attracted by the higher wages offered by global health initiative-supported NGOs. (This is something we've also seen in our work, and is one of the reasons for the development of the NGO Code of Conduct for Health Systems Strengthening.)

In the panel discussion part of the session, Lesotho Health Minister Mphu Keneiloe Ramatlapeng touched on a subject integral to HAI's mission and values: the need for programs to work directly with governments to achieve results instead of in autonomous parallel systems.

Ramatlapeng said that when partners come into the country and set up parallel HIV/AIDS programs outside of the government's services, those do not end up supporting the larger health system. In addition, a sort of catch-22 exists where HIV funding can't be used to develop human resources, yet the government gets criticized for not having the capacity to effectively deliver treatment. To address these problems, she highlighted the importance of supporting health programs and services as well as overall health systems.She complimented the Global Fund and the Irish government for their support of human resources for health.

She also mentioned the need for donors to coordinate so that reporting can be more streamlined and efficient. Finally, she called on donors to trust the governments of developing countries if they really want to build capacity. Rather than having a large portion of aid funding return to donor countries through consultant salaries and the like, "build capacity of the people who live in those countries. Empower them with education. Empower them to remain in their countries. (...) What we really would appreciate [is] our nurses and doctors to be assisted to remain home."

A number of presenters emphasized the need to have national priorities and plans -- such as for overall health systems strengthening, integration of services and health workforce development -- to better make the case to donors that funding those particular areas will build a stronger system as part of a coordinated plan.

Finally, Jean-Paul Moatti, professor of health economics at the University of the Mediterranean in France, made a compelling argument for the need for more funding for all the health MDGs. As he said, greater efficiency is a good goal, but it should not be a pretext for flat or reduced funding. He called for countries to pursue a financial transactions tax, which some organizations in Europe and the US have been working on.

There was a lot of good discussion in this session, and a lot of energy around finding ways to make sure HIV programs continue and are funded, and that they are implemented in a way that builds overall health systems for the long term.

 

You can find the session description and links to slides here (click on "slides with audio" since the PowerPoint links don't seem to be working). A transcript of the session is available here. And you can watch a webcast below, or find it here.