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Gaps in Knowledge and Research Priorities regarding the Impact of HIV scale-up on Health Systems

The debate on HIV scale-up effect on health systems lacks sufficient evidence. Investment in HIV should bolster primary health care. Recommended research areas include health workforce, care financing, infrastructure, and monitoring. Necessary to understand how HIV programs influence non-HIV service delivery and outcomes. The data can help maximize synergies between HIV response and health system development, aiding universal primary health care goals.

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Gaps in Knowledge and Research Priorities regarding the Impact of HIV scale-up on Health Systems

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  1. Gaps in Knowledge and Research Priorities regarding the Impact of HIV scale-up on Health Systems J. Perriëns HIV/AIDS Department, WHO

  2. "…the debate regarding the relationship between HIV scale-up and health systems strengthening has generated numerous opinions but relatively little evidence." "Instead of endless debate about the comparative advantages of vertical and horizontal approaches, partners should focus on the best ways for investments in response to HIV to also broadly strengthen the primary health care systems."

  3. TopicsRecommended Research to Inform Policy-Making on: • Health Workforce • Health Care Financing • Infrastructure and Clinical Services • Monitoring and Evaluation, Strategic Planning, and Policy Development • Health behaviors

  4. Health Workforce • What trends in the supply of health care workers may be tied to HIV scale-up? • Impact of task-shifting on health care access, quality and outcomes for HIV?, TB?, malaria?, maternal and child health? • Policies or practices associated with retention of health workers? Does funding for HIV services help retain staff? • Does the acquisition of skills and competencies to deliver HIV services help to deliver on the other Millennium Development Goals? • Which and how many HCW FTE's are needed to deliver essential HIV services?

  5. Health Care Financing • Costs associated with delivery of comprehensive HIV services – and effectiveness of different approaches to deliver them • Benefits and costs of adding HIV services to non-HIV health services (i.p. reproductive health) and vice versa? • What is the impact of HIV scale-up on financing for non-HIV services? • What are optimal mechanisms for financing health services that require predictable, long-term support?

  6. Guyana • Uganda – "no new patients" • GFATM • Worldbank - UNAIDS

  7. Infrastructure and Clinical Services "despite claims that investing in HIV decreases the ability of the health system to produce other health outcomes, the evidence that this is actually happening is largely anecdotal and equivocal" • Impact of the infrastructure and service enhancements financed by HIV scale-up on non-HIV care • Changes over time in utilization and quality of HIV and non-HIV health services. • Trends in major health indicators during HIV scale-up • Effect on management of other chronic diseases • Impact on referral systems • What elements in HIV programs enhance non-HIV service delivery and outcomes

  8. Monitoring and Evaluation, Strategic Planning, and Policy Development • Are data systems developed for HIV-related purposes being utilized for non-HIV conditions? • Has civil society become more engaged in monitoring and evaluation and in influencing health priorities and programs? • Impact of donor policies on national program management, implementation and health outcomes?

  9. Health behaviors in the context of HIV scale-up • To what degree have HIV-related peer or community support organizations (e.g., TASO, TAC) influenced experience with other diseases (e.g., pregnancy, malnutrition, diabetes, malaria)? • Can peer support package and multi-disciplinary team approaches developed for HIV programs be adapted for the management of diabetes, hypertension, epilepsy, depression, and other chronic conditions?

  10. Missing/addressed superficially • Access to commodities and technology: • Action research in IP • Improving supply management • Introduction of new tecnologies and standardization • Optimization of service delivery (integration, quality improvement, documentation of health outcomes) • Relationship between service delivery and societal norms and standards (e.g. discrimination on health grounds, health seeking behavior)

  11. Why all this data? • To maintain the momentum brought about by investment in HIV/AIDS: • a good story today sells more action than a ton of data in a distant future • bad news causes paralysis • To rationally maximize synergies between the response to HIV/AIDS and health system development • the response to AIDS can serve as a blueprint for universal primary health care

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