Increased resources for HIV prevention and care may have little impact if health systems in developing countries remain weak. This is the conclusion of an analysis by the Belgian Institute of Tropical Medicine, the Population Council and University of the Witwatersrand.

The paper addresses two questions:

• Can strengthening of health systems increase the impact of HIV/AIDS programmes?
• What are the likely effects on health systems of increased efforts in AIDS prevention and care?

It reveals that health services play a secondary role in changing community norms and behaviour and in sex education for young adolescents, but play a crucial role in:

• health education for high-risk groups and vulnerable groups, such as patients with sexually-transmitted infections (STIs), female sex workers and adolescents
• HIV counselling and testing
• detection and management of other STIs
• prevention of mother-to-child transmission of HIV (MTCT).

The contribution of health systems to care of patients with HIV is more complex in settings, such as sub-Saharan Africa, where public health services are barely able to cope with the workload of HIV-negative patients. In the poorest countries, health ministries are struggling to provide psychosocial support and management of opportunistic infections for all HIV-infected people whilst facing increasing demand for antiretroviral treatment.

The authors argue that strengthening of health systems is a necessary prerequisite for improving HIV prevention and care, particularly by:

• improving the capacity of existing basic health services in the management of common reproductive health problems, including sexually transmitted infections
• increasing the use of health services by STI patients
• providing additional resources (personnel, laboratory capacity, drugs) for antenatal clinics and obstetric services
• training, motivating and supervising health personnel dealing with common HIV associated conditions and ensuring regular supplies of the necessary drugs and diagnostics.

Scaling up of anti-retroviral treatment calls for massive investments in health systems, including safe drug distribution systems, staff training in prescribing and follow-up, laboratory facilities and systems to counsel patients and ensure compliance.

The researchers also point out that investment in HIV/AIDS prevention and care programmes, if well integrated into public health services, can contribute to the strengthening of health systems by:

• restoring community confidence in health services
• boosting staff morale
• providing training and supplies
• investing in training and laboratory equipment
• setting up distribution systems for drugs and medical supplies.

However, the health system must be approached in an integrated way. If not, an uneven amount of resources might be spent on HIV-infected patients while other patients continue to suffer from inadequate care. If this can be avoided, any activity in the area of HIV/AIDS prevention and care within the health service can have a ripple effect on other healthcare activities and vice versa.

Source(s):
‘Stronger health systems for more effective HIV/AIDS prevention and care’, International Journal of Health Planning and Management 18: S41-S51 (edited by M. Segall and B.M.A.J. Gryseels), by A. Buvé, S. Kalibala and J. McIntyre, 2003

Funded by: Belgian Directorate-General for Development Cooperation

id21 Research Highlight: 2 April 2004

Further Information:
Anne Buvé
Institute of Tropical Medicine
Nationalestraat 155
B-2000 Antwerp
Belgium

Contact the contributor: abuve@itg.be

Prince Leopold Institute of Tropical Medicine, Belgium

Malcolm Segall
Institute of Development Studies
University of Sussex
Brighton
BN1 9RE
uk

Contact the contributor: M.Segall@ids.ac.uk

Population Council

University of Witwatersrand, South Africa

Other related links:
'Can it be done? Prospects for improving health of the global poor' >

'Economies of scale-up? The cost of expanding access' >

'Insights Health Editorial: Delivering the goods - HIV treatment for the poor' >

'Getting better – improving public health services in South Africa' >

See id21's collection of links relevant to HIV/AIDS.

See id21's collection of links relevant to health systems and economics.