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GLOBAL: Value for money central to achieving universal access

With less cash to go around, efficiency in HIV programming has never been more important
A global shortage of funds for the fight against HIV means universal access to prevention, treatment and care is unlikely unless HIV programmes get better value for their investments, says a new report by UNAIDS, the UN Children's Fund and the UN World Health Organization.

There is a need "to enhance the impact of current investments by improving the efficiency, effectiveness and quality of programmes, strengthening linkages between programmes, and building systems for a sustainable response," say the authors of Towards Universal Access.

UNAIDS has noted that up to 80 percent of treatment costs are spent on getting medication to patients and keeping them on it.

Although 5.25 million people accessed life-prolonging antiretroviral (ARV) medication in 2009 - up 1.2 million from 2008 – the agencies note that funding shortages, limited human resources, weak procurement and supply management systems for HIV drugs and diagnostics, and other bottlenecks continued to hamper the scale-up of treatment.

An estimated 53 percent of pregnant women worldwide in need of prevention of mother-to-child transmission services received them in 2009, but only 28 percent HIV-positive children received treatment in 2009, compared to 36 percent for adults, and just 15 percent of children born to HIV-positive mothers were given appropriate infant diagnostics.

Joseph Kwaka, executive director of Community Aid International, a Kenyan NGO, told IRIN/PlusNews that cheap, practical measures would be needed to improve and increase the level of service.

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"Building the capacity of all cadres of health workers and health facilities in developing countries is important, so that even a local health centre in rural Kenya is able to cater for those women who might not have access to [larger] district health facilities," he said.

Other strategies include task-shifting – where less qualified medical staff are trained to carry out tasks usually performed by doctors – the integration of HIV with maternal and child health services, earlier diagnosis by more widespread and frequent HIV testing, and greater community mobilization.

UNAIDS's proposed new strategy, Treatment 2.0, aims to use treatment as prevention, to develop better treatment and diagnostics for HIV, and drastically increase the numbers on treatment, among other measures, thereby reducing HIV morbidity and mortality, and the cost to health systems in the mid- and long-term.


Even with improved efficiency, significant investment will be needed to achieve universal access. "After years of considerable increases in international assistance from high-income countries for the global HIV response, funding remained essentially flat over the 2008–09 period," the authors comment.

"According to recent estimates, commitments from donor governments totalled US$8.7 billion, the same as in 2008. In comparison, it has been estimated that $26.7 billion would be necessary from all sources, including domestic and international, for the global HIV response in low- and middle-income countries in 2010."

James Kamau of the Kenya Treatment Access Movement, a lobby group based in the capital, Nairobi, points out that "Money plays a critical role in ensuring universal access ... Donors and governments must be pushed to provide more funding, not only to HIV/AIDS programmes, but to health in general."

''Money plays a critical role in ensuring universal access... Donors and governments must be pushed to provide more funding''
Under the Abuja Declaration, made in the Nigerian capital in 2001, African Union member states pledged to raise their domestic health allocation to at least 15 percent of the national budget, but few countries have met that commitment. The report notes that allocations would have to grow by over 50 percent, on average, to meet the Abuja target.

The authors also call on high-income countries, including the Group of Eight industrialized nations, to meet commitments made in Gleneagles in 2005 and reaffirmed at the United Nations General Assembly in 2006.

The Global Fund to fight HIV/AIDS, Tuberculosis and Malaria is due to hold its third donor replenishment conference in October; the report notes that successful completion of the replenishment is "critical to protect and enhance current achievements".

The international medical organization, Médecins Sans Frontières (MSF) has joined calls for more funding to scale up HIV treatment.

"Thanks to the contribution of the Global Fund, countries like Malawi have been able to initiate programmes that save lives and rebuild communities devastated by AIDS," said Marielle Bemelmans, MSF head of mission in Malawi.

"Over 200,000 people are still in need of HIV treatment in Malawi alone, and 10 million people are in urgent need worldwide. If donors miss this opportunity and fail to engage in the fight against the AIDS epidemic, we'll be throwing away all the significant gains already made."


Theme (s): Care/Treatment - PlusNews, Children, Early Warning, Education, Gender Issues, Governance, Health & Nutrition, HIV/AIDS (PlusNews), Prevention - PlusNews, PWAs/ASOs - PlusNews,

[This report does not necessarily reflect the views of the United Nations]

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