Preventing and treating HIV/AIDS in poor countries will help deliver better health services through 2005 and beyond
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4 NOVEMBER 2004 | OTTAWA -- Today, the World Health Organization (WHO) announces measures which will ensure that HIV/AIDS prevention and treatment efforts in poor countries will also help deliver better health services. Canada's 100 million Canadian dollars contribution to the WHO this year is key in helping to build these services, which include urgently addressing the shortage of health workers in countries suffering the most pressure from the effects of HIV/AIDS.
"We must ensure that the people who need treatment for AIDS are getting it. Otherwise, they will die," said Dr LEE Jong-wook, WHO Director-General, during his first official visit to Canada. "I am pleased to announce that while countries are rapidly trying to expand access to AIDS medicines and prevention services, funding from Canada will also help them provide better, and more sustainable health services. One key aspect is to train and retain health workers. There simply are not enough in too many poor countries."
In 2003, WHO called the lack of access to HIV treatment a global public health emergency. In May 2004, the Prime Minister of Canada made a clear commitment to the people most at risk of and living with HIV/AIDS in developing countries by announcing a 100 million Canadian dollars grant to the WHO. The funds are supporting WHO to catalyze HIV/AIDS prevention and treatment efforts in countries, including striving to reach the "3 by 5" global target to get three million people on to HIV/AIDS treatment by the end of 2005. WHO stresses that those who begin to receive the life-sustaining medicines will require a steady supply well beyond 2005.
"We are determined to reach as many people as we can - in the world's poorest and most hard-hit countries - with antiretroviral treatment, and information on how to prevent HIV/AIDS. We are also determined to help expand equitable, quality and sustainable health services for people living with HIV/AIDS, their families and their communities," said the Honourable Aileen Carroll, the Canadian Minister of International Cooperation, at a news conference with Dr Lee in Ottawa.
The challenge of continuing care requires developing countries to strengthen the critical 'pillars' of their health system that together constitute the platform for delivering services fairly and which can be sustained. WHO has been working with countries and partners on the "HIV/AIDS health systems platform", which comprises the following key areas: 1) workforce systems to ensure adequate numbers of trained workers, working in the right place and in safe working conditions; 2) systems to buy and distribute drugs and other supplies 3) fair financing systems to protect people from being pushed into poverty when they are sick 4) health information systems that alert health managers and policy makers to the plight of people who might otherwise fall through the cracks. Of all the inputs, none are more pressing than having sufficient health workers.
WHO estimates, for example, that the whole of sub-Saharan Africa has only 600 000 health workers, to serve 682 million people. This is in dramatic contrast to developed countries - Canada, for example, has 500 000 health workers for 31 million people. If the same ratio applied to sub-Saharan Africa, it would have ten million health workers. To provide essential health services to all in sub-Saharan Africa it is estimated that at least 2.5 million health workers are needed- between a tripling and quadrupling of the current workforce.
As part of the platform, WHO, with Canada's support, is spurring practical policies at all levels that will help countries with workforce crises better cope with this constraint. Training is happening now so that clinical officers and nurses as well as doctors can deliver antiretroviral therapy. A further 85 000 health workers are expected to receive training in the next 18 months. The health workforce must also be seen in its international dimension: great numbers of workers are leaving to work abroad: WHO is working with governments, other international agencies and employers to secure better wages and benefits for health workers.
The health systems platform: affordable medicines, better information Ensuring people can afford medicines, including HIV/AIDS treatment, is critical. While HIV/AIDS treatment has fallen in price to 178.00 Canadian dollars (140 US dollars) per year, this is still too expensive for people living on one or two dollars per day. Even when drugs are free of cost, people often have to pay for tests, consultations and hospital care. Evidence suggests that in Africa about ten million people face impoverishment and 27 million face severe financial hardship due to the costs of health care. To help deal with this, as an example, WHO and the International Labour Organization (ILO) are working with the Government of Kenya in an ambitious scheme to develop social health insurance for the entire population. WHO is also providing countries with simple tools to track health information. Many health clinics in poor communities, for example, have no system to keep records of patient's previous visits, their health histories or the effect of medicines they have been taking. Innovative solutions, such as simple electronic medical record systems, are being tested in several African countries with impressive results, and WHO is helping bring those experiences rapidly to more people. The WHO Service Availability Mapping (SAM) tool provides health service planners with an instantaneous map of the state of health and health services, including HIV services, across districts and provinces. A recent SAM in Zambia mapped the location of the fifty HIV treatment centres and health workers by district. |
