The large amount of donor funding that has gone into Rwanda's fight against HIV has not affected efforts to prevent and treat unrelated diseases, such as malaria and measles, and may in fact have improved overall healthcare, a six-year study has found.
Researchers at Brandeis University in the US compared the performance of health clinics providing HIV services with those that did not by collecting data on the number of vaccines administered, visits to register child growth, and non-HIV/AIDS hospitalizations to monitor the attention given to non-HIV health issues.
"We wanted to examine how AIDS funding interacts with the rest of the health sector in Rwanda," Dr Donald Shepard, a professor at the Schneider Institute for Health Policy at Brandeis and the study's lead author, told IRIN/PlusNews. "There are conflicting views - some thought AIDS funding impacted the wider health system favourably, while others thought it worked the other way."
The fight against HIV has been the one of the best-funded health issues in recent times. A study in 2009 by the UN World Health Organization (WHO) found that funding for HIV/AIDS accounted for almost one-third of total health overseas development assistance between 2002 and 2006.
There has been a backlash against the large amount spent on AIDS, with critics suggesting that funding for HIV is disproportionate to the global disease burden and is using vital resources that could be spent on other diseases.
The proponents of AIDS funding argue that the devastating impact of HIV justifies the high funding to fight the disease, and that the money has been used to strengthen health systems through improvements in infrastructure and functioning. The authors felt that Rwanda was a good case study because it has received strong HIV funding and has been used to support arguments on both sides.
"What we found in Rwanda was that large amounts of AIDS funding had not had an adverse impact, as some feared - there is no evidence that it detracted from the rest of the health system," Shepard said. “On the contrary, the evidence suggests that the benefits have spun off into the rest of the health system. In health centres providing HIV services, for example, BCG [Bacillus Calmette-Guérin, a vaccine against tuberculosis] vaccinations increased at a higher rate than at those health centres that didn't provide HIV services."
The authors found that while there were neither "prominent diversions nor enhancement effects" after introducing HIV services to health centres, there was evidence that the health centres offering HIV services provided better preventive care than those that did not, including better immunization programmes.
According to Shepard, the fact that AIDS funding had been able to work well within the wider health system was no accident, but the result of a deliberate policy by the Rwandan government. "Rwanda made a thoughtful effort to integrate AIDS services into the general health system - staff who treated HIV patients also treated other patients, and systems set up using HIV funds supported other health issues in a systematic way," he said.
Rwanda's community-based health insurance, known as Mutuelle, and its performance-based financing for health centres, contributed significantly to the overall smooth and efficient running of the health system.
Shepard noted that the findings, while specific to Rwanda, meant that donors should continue their funding for HIV.
He suggested that "Other countries should look at Rwanda and adapt its systems to their own settings, using funding for HIV to broadly support the health system and strengthen the response to other diseases."