HIV/AIDS Funding and Health Systems: How do AIDS Donors Interact With National Health Systems?
June 12, 2008
A heated debate has emerged in the global health community over whether or not disease-specific funding, particularly the large sums of donor money for HIV/AIDS, is positively affecting health systems in developing countries (my colleagues Ruth Levine, Mead Over, and Danielle Kuczynski have discussed these issues in previous posts on AIDS spending and health systems, vertical health programs, and "diagonal" approaches to health, see here and here).
Is the surge of AIDS money strengthening national health systems? Or is it weakening them by pouring disproportionate funds into systems that target one disease - while neglecting others?
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A forthcoming report from CGD's HIV/AIDS Monitor attempts to contribute some evidence to this ongoing debate through descriptive analysis of how the AIDS programs of three of the world's biggest HIV/AIDS donors—PEPFAR, the Global Fund, and the World Bank Multi-Country HIV/AIDS Program (MAP) - interact with national health systems in Mozambique, Uganda, and Zambia. It does so by focusing on the donors' interactions with three health subsystems - the health information system, the supply chain system for drugs and health commodities, and the human resource system for health workers.
We find that, in all three areas, programs financed by the donors have often established their own systems in each country. These AIDS-specific systems are partially integrated into national health systems. For example, ARVs for donor-funded treatment programs tend to be procured separately from host country procurement systems but stored and distributed though the national medical stores and distribution systems. Similarly, some data for reporting on donor HIV/AIDS programs are drawn from the country's health information system while other data are captured through separate reporting and data management structures.
The good news is that AIDS programs have had some positive spillover effects on national health systems; for example, increased warehouse capacity, better information technology systems, or more technical staff in health ministries. Less encouraging are signs that they are straining already fragile African health systems - in part because of the sheer size of these new programs. For example, instead of compensating for increased workloads by hiring or training new workers, some donor-funded programs, through top-ups, have redirected the attention of public health staff towards AIDS program and away from more general healthcare provision.
Findings from the report, scheduled for release in early August, will be presented at a satellite event at the IAS International AIDS Conference in Mexico City on Wednesday, August 6th from 6:30-8:30pm CDT. Two panels, one comprised of the principal investigators from each country and the CGD HIV/AIDS Monitor team and the other featuring high-level donor and host country officials, will be on hand to discuss and respond to the report's findings and recommendations. Stay tuned!
Disclaimer
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.
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