Scaling up treatment access risks damaging national health systems, says WHO/UK report
3 February 2004. Related: Treatment access.
Graham McKerrow, HIV i-Base
The HIV epidemic is increasing demands on already struggling health systems and undermining their capacity to provide services, says a review of the provision of antiretroviral therapy in poor countries, published in November 2003 by the World Health Organisation and the UK government. The problem is that the extra pressure leads to the breakdown of services because of “the attrition of health sector workers”.
The HIV epidemic is increasing demands on already struggling health systems and undermining their capacity to provide services, says a review of the provision of antiretroviral therapy in poor countries, published in November 2003 by the World Health Organisation and the UK government. The problem is that the extra pressure leads to the breakdown of services because of “the attrition of health sector workers”.
However, the 105-page report goes on to say that if there is proper investment to address infrastructure, human resources and logistics weaknesses, “scale up of ART provision has the potential to strengthen systems and improve outcomes for non-HIV related conditions.”
The report highlights a pilot programme in Thailand that has resulted in a stronger HIV service system, more commitment from health workers and greater community involvement.
Most countries, especially in sub-Saharan Africa, are taking a phased approach to the introduction of ART through the public sector, starting with provision through selected provincial and regional hospitals. For example, Botswana, the first African country to offer ART through the public health system, is rolling out the programme through hospitals at four sites. Nigeria started with an ARV programme operating at 25 health centres in 2002 and will expand it to 100 centres.
The report identifies shortage of staff as “a major constraint” to scale up, and says that in many countries, including those with high HIV prevalence rates, “the health sector is facing a crisis in human resources”.
The report concludes that paying for the provision of ARVs solely through public sector financing is “unrealistic” in most poor countries. Many countries introducing ART will need to charge for services unless external funding is provided by the Global Fund to Fight AIDS, TB and Malaria or other sources.
Reference:
Attawell K and Munday J. Provision of antiretroviral therapy in resource-limited settings: a review of experience up to August 2003. WHO and the UK’s Department for International Development, November 2003.
The full report can be downloaded as a pdf file from:
http://www.who.int/3by5/publications/documents/dfid/en/print.html