What is PHRplus Doing to Improve Systems to Combat HIV/AIDS?
Strong health systems are critical to meet the health and resource needs generated by the HIV/AIDS pandemic. PHRplus is working to strengthen health systems by:
- Providing policymakers with tools and technical assistance to design programs and mobilize resources needed to mount responses to combat HIV/AIDS;
- Building financial analysis skills to improve effective use of scarce resources;
- Increasing access to HIV/AIDS services through community involvement in health financing; and
- Providing technical assistance for Global Fund to Fight AIDS, Tuberculosis and Malaria proposal development.
Promoting Evidence-based ARV Policy Development in Low-resource Countries
As countries begin to scale up access to anti-retroviral (ARV) treatment through the public and private sectors, PHRplus is helping policymakers plan and estimate the costs of comprehensive anti-retroviral treatment (ART) programs. To provide a framework for the ART programs, PHRplus provides technical assistance to assist governments develop national ARV policies. Through technical assistance and an easy-to-use AIDSTREATCOST (ATC) software tool developed by PHRplus, the project is helping governments craft evidence-based, realistic cost estimates for ART programs.
In Uganda, PHRplus is helping the Ministry of Health (MOH), National AIDS Control Program and other stakeholders examine policy options for expanding ART service delivery in the private and public sectors, and plan and cost out a comprehensive ART program. See description of activities under Providing Support to Country Coordinating Mechanisms (CCMs) below.
In Zambia, the project worked with the MOH, Central Board of Health, National AIDS Council, and other key HIV/AIDS and health sector players to estimate resource requirements for the provision of ART in the public sector. Given the expected influx of resources from the Global Fund to Fight AIDS, TB and Malaria (GFATM) and President Bush's Emergency Plan for AIDS Relief, the Government of Zambia is trying to determine the best use of these resources to treat a growing number of patients. One important finding of the PHRplus analysis shows that human resource capacity is a constraint to expanding the ART program. Providing ART to everyone who is clinically eligible would, after five years, require twice the number of laboratory technicians and half the doctors currently available in the public health system.
In Mexico, ARV treatment has been provided to people with social security insurance and to a small number of uninsured people since 1996. Recently, the Ministry of Health approved a strategic plan to expand access to ARV treatment to all uninsured people living with HIV/AIDS by 2006. PHRplus, together with Mexico's National Institute of Public Health (INSP), conducted a study to estimate the incremental costs of scaling up these services. Preliminary findings show that a large proportion of HIV-positive patients are seeking care at relatively late stages of the disease and that the costs of laboratory tests represents an unexpectedly high share of total ARV treatment program costs. In addition, since ARV drugs are the greatest single component within the treatment cost, even a small reduction in drug costs would have significant impact on the overall cost of therapy.
In collaboration with the World Bank, PHRplus assisted the Government of Cambodia examine the costs of scaling up HIV/AIDS services from 2003 to 2007. The analysis examines ARV treatment requirements and identifies existing resource gaps.
Building Financial Analysis Skills to Improve Effective Use of Scarce Resources: National Health Accounts, HIV/AIDS, and TB Expenditures
For national HIV/AIDS programs, an important part of effective management is keeping track of scarce resources. PHRplus has been working with more than 50 countries on National Health Accounts (NHA), a tool that helps program managers and policymakers track the sources and uses of health resources.
In Rwanda, the PHR project adapted the NHA methodology to estimate expenditures for HIV/AIDS and TB in 1999. In January 2003, a Rwandan MOH representative informed a NHA meeting of policymakers from 25 West and Central Africa countries that the data from this HIV/AIDS sub-analysis had revealed for the first time the burden of out-of-pocket HIV/AIDS expenditures placed on poor households, pushing them further into poverty. These findings led to increased allocation of funds by the government for HIV/AIDS services.
Recognizing the importance of on-the-ground estimates of HIV/AIDS expenditures, PHRplus is providing technical assistance to national governments to help conduct in-country surveys and to build government capacity to assess HIV/AIDS and TB expenditures. By disaggregating these disease-specific expenditures from other health service costs, hospital administrators, program managers, and policymakers can review spending patterns and target scarce resources to areas where they are needed most. With funding from USAID's Regional Economic Development and Support Office (REDSO) in Nairobi, Kenya, the project is currently supporting NHA estimation activities and sub-analyses in three countries: Kenya, Zambia, and Rwanda (updating the 1999 estimates).
Exploring the Potential of Community-Based Health Financing for HIV/AIDS
PHRplus works with communities in sub-Saharan Africa to develop alternative financing mechanisms, such as community-based health financing schemes, to help more CBHF plan members access critical health services. Several schemes already either offer limited coverage for HIV/AIDS services or provide referral services, encourage HIV testing, and/or promote HIV/AIDS prevention through health education and outreach.
In Tanzania, PHRplus is continuing to explore how and to what extent the existing national CBHF scheme, called the Community Health Fund or CHF, can include HIV/AIDS prevention, treatment, care, and support services as part of the basic benefits package offered to members. Building on other technical assistance activities with CHF in the northern district of Hanang, the project is working to collect information on HIV/AIDS service utilization, costs of providing services, existing capacity building and referral services. Based on this information, the project will work with the CHF and local health officials to examine options for addressing HIV/AIDS through community mechanisms.
Providing Technical Support to Assist Country Coordinating Mechanisms (CCM) Develop HIV/AIDS Strategies and Proposals
In several sub-Saharan African countries, PHRplus has provided technical support to national counterparts and HIV/AIDS stakeholders for the development of national ART policies and strategies. The Government of Uganda requested PHRplus' technical assistance in producing a consensus-driven ART policy. Technical staff facilitated policy dialogue among five subcommittees organized to pull together clinical, logistics, policy, advocacy, and financing components into a coherent and comprehensive draft. The draft has attained consensus support at the technical level, but awaits political endorsement. It serves as the working policy that underpins Uganda's ART scale-up. Subsequently, the Government of Uganda requested PHRplus' technical input on its third-round GFATM application for scaling up ART and assisting orphans and vulnerable children. Project staff served as facilitators for the decision making process by drafting contributions from a broad group of public and private sector stakeholders, including PLWHA, into a coherent, cogent and successful Fund application. The application was approved by the board of the Global Fund in October 2003.