HIV This Week

Schneider H, Blaauw D, et al. Health Systems and Access to Antiretroviral Drugs for HIV in Southern Africa: Service Delivery and Human Resources Challenges. Reprod Health Matters 2006;14:12-23. http://www.sciencedirect.com/science/journal/09688080

Without strengthened health systems, significant access to antiretroviral therapy in many developing countries is unlikely to be achieved. This paper reflects on systemic challenges to scaling up antiretroviral access in countries with both massive epidemics and weak health systems. The authors draw on their experience in southern Africa and on the WHO framework on health system performance. Whilst acknowledging the still significant gap in financing, the paper focuses on the challenges of reorienting service delivery towards chronic disease care and the human resource crisis in health systems. Inadequate supply, poor distribution, low remuneration and accelerated migration of skilled health workers are increasingly regarded as key systems constraints to scaling up HIV treatment. Problems, however, go beyond the issue of numbers to include productivity and cultures of service delivery. As more countries receive funds for antiretroviral access programmes, strong national stewardship of these programmes becomes increasingly necessary. The authors propose a set of short- and long-term stewardship tasks, which include resisting the verticalisation of HIV treatment, evaluating community health workers and their potential role in HIV treatment access, undertaking international action on the brain drain, and making greater investments in the national human resource functions of planning, production, remuneration and management.