6th International AIDS Society Conference
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Transcript of 6th International AIDS Society Conference
6th International AIDS Society Conference
Non-communicable diseases and chronic care models: Can the MCH platform deliver?
Chewe LuoSenior AdviserTeam Leader, Program Scale upHIV/AIDS
Increasing leadership and commitments - 1
• UN Secretary General Global Strategy for Women’s and Children’s Health – Reinforce commitments and collective efforts to
accelerate progress toward reaching MDG 4 , 5 and 6
• United States government (USG)’s Global Health Initiative:– $US 63 billion over six years focusing on improving
maternal, newborn and child health
• Heads of Agencies June 2010 DC meeting: – Endorsement of the MTCT elimination goal - recognized
the importance of PMTCT as a natural platform for bridging and integrating responses for MNCH and HSS .
Leadership and commitments - 2
• PMTCT prioritized for major and implementation by PEPFAR, the Global Fund, CIDA and UNITAID
• CEE/CIS, TACRO, Asia and Africa have all developed regional frameworks on elimination of MTCT
• Development of a Global Action Framework for MTCT elimination (IATT)
• Launch of Global Plan towards elimination new HIV infection among children by 2015 and keeping their mothers alive
Duration, timing ART regimen within the continuum
of care: Can the MCH platform deliver
Maternal ARV prophylaxis
Sd-NVP
sc AZT + Sd-NVP Daily Infant NVP
Maternal therapeutic ART
WORLD HEALTH ORGANIZATION
Two continuums of care at the centre of maternal and child Survival agenda
A continuum that spans life's beginnings:
…from before conception to childhood through pregnancy, childbirth, and infancy.
A continuum that goes from:
…the home (empowering families);…through the health centre (bringing care closer to home);…and, when needed, to the hospital (facilitating referral).
Antenatal Care Performance for effective delivery of interventions: 77% >1 visit, 47% at least 4 visits
, State of the Worlds’ Children Report 2009
Delivery Care Performance 62% skilled attendant; 54%
institutional State of the Worlds’ Children Report 2009
Intervention uptake variable across the care continuum
Source: Lancet Countdown Coverage writing group, Lancet Countdown special issue, 2008
9
0
20
40
60
80
100
120
140
Receive Results
HIV+ infants
Enrolled in counseling &
treatment
Infants still active after
1 year
76%
48% of HIV+ infants never received results. Several died prior to receiving results. Not
all infants were on CTX.
Of those who enroll in HIV services, almost
1/3 are no longer tracked at the site.
Without investment through the entire follow-
up continuum, the maximum impact of Early Infant Diagnosis (EID) will
not be realized.
Early Infant Diagnosis Cascade
Follow up of infants testing HIV+ Jinia Regional Hospital, Uganda Jan 1, 2008 – December 1, 2009
BOTTLENECK: Less than 1/3 of infants tested for HIV at birth receiving treatment after one year
48%
68
34%
29%45
32
131
The poorest women are substantially less likely than the richest women to deliver with assistance of a doctor, nurse or midwifePMTCT delivery is dependent upon ANC and skilled birth attendants
11
Why women do not access health services
WCA regional averages (Source: DHS data)
56%
40%
37%
23%
19%
17%
12%
0% 10% 20% 30% 40% 50% 60% 70%
Cost (money)
Distance
Transport problems
Not wanting to go alone
No female provider
Don't know where to go
No permission to go
Sources: Anthony Hodges. Presentation at the ACSD meeting, Dakar, 22-26 June 2009
12
Importance of out-of-pocket payments in health expenditure in WCA
Composition of national health expenditure, 2006
Govern-ment
35.5%
Private64.5%
Composition of private health expenditure, 2006
Pre-paid , 4.5%
Other, 3.0%
OPPs, 92.2%
Sources: Anthony Hodges. Presentation at the ACSD meeting, Dakar, 22-26 June 2009
13
Countries with critical shortage of health services providers
14
HR crisis
• Estimated shortage of almost 4.3 million doctors, midwives, nurses and support health workers worldwide
• 57 countries mostly in Sub-Saharan Africa have critical shortages
Macro-Level: Policies and
Financing
Meso-level:Health system & other
sectors
Framework and Production Functions for Health MDG’s
MDGs :MalnutritionU5MRMMRMalariaHIV/TBWASH
MDGoutcomes
Micro-level:Households/ Communities
Family/
Community
based Care
Population
Oriented
schedulable
services
Individual
oriented
non schedulable
services
Family
behaviors
availability
access
utilisation
compliance
quality
Efficacy
SWAP
Protection of Household Revenue
Com
mu
nity
S
up
port Budget
Support
Medium Term Expenditure Framework
PRSP
National Health- Nutrition Policy
MDG focused + Child friendly:
Comparison of Expected Impacts & Costs between Intervention Packages
Expected Impacts & Costs of phased scaling up of all Intervention Packages
Estimated Impacts & Costs to scale up high impact intervention packages and reduce bottlenecks
$4.95
$15.83
$31.43
0%
20%
40%
60%
80%
100%
Phase I Phase II Phase II I
-$2
$2
$6
$10
$14
$18
$22
$26
$30
$34
$38
$42
$46
$50
Anaemia Reduction of Low Birth weight Estimated reduction in stunting
U5MR reduction IMR reduction NNMR reduction
MMR reduction 1 in Lifetime Risk of Dying % total demand for Family P lanning met
Reduction of Malaria Mortality Reduction in AIDS mortality Reduction in TB Mortality
Quality of drinking water Use of sanitary latrine Supply of safe drinking water
Cost per capita per year in US$
MDG 1 MDG4 MDG7MDG 6MDG5
ZZ-Africa TF all countries
Bottlenecks: Skilled human resources
Physical accessQuality
Cost
Individual Oriented non-schedulable
services
High asymmetry of informationTransaction intensive
High discretion
Levers:Direct control of users
Self RegulationSophisticated purchasing
capacity
Providers:
Hospitals
Clinics
Individual practitioners (licensed or not…)
Bottlenecks: Low demand
Poor continuityOpportunity Cost
Population Oriented Schedulable Services
Lower Asymmetry of informationLess Transaction intensiveLow discretion: standards
Public good nature or network externality
Levers:Collective action:
Government Primarily
Providers
•Integrated in clinical services (clinics, GP)
•Integrated in schools, workplace•Outreach health post
•Mobile Activities
•Home visits, door to door activities
Bottlenecks: Knowledge
Availability and cost of commodities
Family/Community based Care
Low asymmetry of informationTransaction light
High discretion in taste/ values
Levers:Imitate the market
Direct control of users
Providers
Retail
Community based organizations/ associations
Cooperatives
Social marketing, media,
Women’s groups, associations etc