Integrated health systems "boost the fight against HIV"

If universal access to HIV prevention, treatment and care is to be achieved, experts recommend an inclusive approach to healthcare, rather than narrow HIV programmes.

"Governments and their development partners ought to adopt a health development approach with a long-term perspective in which HIV is a component," Jonathan Quick, chief executive officer of a public health NGO, Management Sciences for Health (MSH), told IRIN/PlusNews.

"For countries [where] the epidemic is generalized but stabilizing, it is no longer necessary to have special budgets for HIV but rather development budgets in which HIV is included in all aspects."

According to a recent MSH position paper, concerns about the imbalance between investments in HIV/AIDS and other major health needs and about the threat posed to HIV resources by the global financial crisis mean there is a need to move from an emergency AIDS response to a more inclusive health system response.

Critics argue that investment in HIV programming has left other healthcare needs in the developing world underfunded.

Holistic healthcare

According to MSH, some of the components of a “holistic, high-performing health system” are: strengthened leadership, governance and management; decentralized and restructured health service delivery; a larger and better health workforce; strengthened pharmaceutical and laboratory management; improved financing and financial management and integrated health information systems.

"Healthcare performance must be based on health outcomes rather than short-term achievements based on a specific disease," Quick said. "We have to improve coordination, stop duplication of effort and adopt HIV interventions that maximize impact."

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Quick noted that countries such as Ethiopia and Rwanda were already successfully integrating HIV into broader health systems. A May 2009 Rwandan study found that rather than leading to declines in other primary healthcare delivery, the integration of HIV clinical services may contribute to increases.

An evolving response

"AIDS programmes have evolved from the under-funded and often ineffective, early prevention response of the first generation programmes of the 1990s, to the well-funded and results-focused emergency response of the second generation programmes of the 2000s," said Quick.

"The third generation AIDS programmes of the next decade must address the unfinished business of scaling-up effective prevention, while simultaneously meeting the rising resource demands from the success of AIDS care and treatment - all in the context of much more constrained global finances and growing demands to address other major unmet health needs," he added.

Quick said there was a need to make better use of existing funding. "The argument for an integrated, efficient, sustainable health system response is not an argument for more funding, it is an argument for better use of available funds," he added. "We believe that if used efficiently, current funding levels are capable of generating more results in HIV prevention, care and treatment."

Nevertheless, he added, it would be important for donor governments to honour their financial commitments for international development assistance.

The evidence is that donors are becoming more aware of the need to focus on health system strengthening; in its new five-year strategy, the US President's Emergency Plan for AIDS Relief will prioritize the integration and coordination of HIV/AIDS programmes with broader global health and development programmes to maximize impact on health systems.

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