From: wolda002@umn.edu
Date: Tue Aug 19 2008 - 18:21:24 EDT
AFRICA: Donor AIDS money weakening health systems
''The future of the global HIV/AIDS response cannot be considered
independently from that of national health systems''
Donors can drain already weak local health systems
JOHANNESBURG, 15 August 2008 (PlusNews) - More international aid has been
dedicated to fighting HIV/AIDS than any other disease, but what impact have
all those donor dollars had in countries where HIV/AIDS funding often
exceeds total domestic health budgets?
The three largest HIV/AIDS donors - the Global Fund to Fight AIDS,
Tuberculosis and Malaria, the US President's Emergency Plan for AIDS Relief
(PEPFAR) and the World Bank's Multi-Country AIDS Programme (MAP) - have
spent US$20 billion on combating AIDS since 2000.
But a new report by the Washington-based Centre for Global Development,
"Seizing the opportunity on AIDS and health systems", launched at the
International AIDS Conference in Mexico City last week, suggests that AIDS
donors may actually have weakened the health systems necessary for an
effective AIDS response.
"The big HIV donors are creating AIDS-specific systems that compete for
health workers and administrative talent, share the same inadequate
infrastructure, and further complicate already complex flows of
information," said Nandini Oomman, lead author of the report.
Noting that "The future of the global HIV/AIDS response cannot be
considered independently from that of national health systems," the study
examined interactions between the three donors and health systems in three
countries where they work: Mozambique, Uganda and Zambia.
Focusing on three components of those health systems - health information
systems, supply chains for essential drugs, and human resources - the
researchers found that donors had developed AIDS-specific processes, often
creating a drain on resources essential to the country's broader health
system.
In the area of health information systems, for example, all three donors
have their own reporting requirements, which burden already overstretched
health facility staff with multiple record-keeping duties. "This extra
effort takes away time from helping AIDS patients or providing other health
services," Oomman pointed out.
With the goal of distributing antiretroviral drugs more efficiently, donors
have also supported the development of procedures that are separate from
those for other essential medicines.
The report warns that "As antiretrovirals come to be offered at more and
more facilities, maintaining the separate systems will become increasingly
complex," and recommends integrating the two systems.
All three countries covered in the report are experiencing severe shortages
of qualified health workers, but instead of training additional workers,
the three donors have funded specific training in HIV/AIDS for existing
staff. In some cases, they have rewarded staff for the extra work
administering their programmes with salary top-ups.
"Such top-ups ... focus the attention of clinical staff on HIV/AIDS - in
some cases reducing the time they give to other health services," the
report's authors argued.
PEPFAR has also funded the hiring of large numbers of non-governmental
organisation (NGO) health workers, who often earn significantly more than
their counterparts working for the state. A clerk working for a
PEPFAR-funded programme in Zambia, for example, makes about twice as much
as a registered nurse in the public sector, according to the study.
Not surprisingly, donor funding for better paying jobs with NGOs has
sometimes pulled desperately needed staff away from the state sector.
The report concludes that donors should shift their response from an
initial emergency mode, in which they circumvented weak areas of national
health systems to set up systems that could achieve quicker results.
http://www.irinnews.org/PrintReport.aspx?ReportId=79852
Read more:
Donors call the shots
Is AIDS still an emergency?
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