Dr. Mark Dybul: HIV/AIDS Programs don’t Compete with National Health Systems in Africa; They Strengthen them. 15/3/10

The theory is this:  now that the sub-Saharan African AIDS epidemic has been contained by PEPFAR and its sister programs, we can divert some spending to the general health systems in African countries – the term of art for this is “health system strengthening.”

It’s not so simple.   Mark R. Dybul, M.D., the Bush Institute’s Fellow in Global Health (and the  former U.S. Global Coordinator for AIDS and the first director of PEPFAR), seconds the message brought to Washington last week by Uganda’s Dr. Peter Mugyeni, which we noted earlier, that flat-funding African AIDS treatment programs will harm medical services for all.

“Dr. Mugyenyi, probably the first clinician to bring antiretroviral drugs into Africa, makes an important point. One contribution of HIV programs to strengthening health systems that is not often noted is the significant decline in demand. Data showed a 21 percent reduction in hospitalizations in Rwanda within two months of introducing antiretroviral therapy; in an area of Uganda there was a 50 percent in hospital bed occupancy in 2 years, and; in Brazil there was an 85 percent reduction in HIV-related hospitalizations. Health system capacity – health workforce, stocks and supplies, resources, etc – increases by at least the same level as demand is reduced.

“HIV itself reduces the capacity of an already strained and stretched health workforce in countries hard hit by the epidemic. In Kenya, health workers are twice as likely to be infected as the general population. In Zambia, 38 percent of exits from the work force were due to HIV. In Swaziland, 4 percent of nurses are lost each year from HIV. Unless prevention, treatment and care of HIV are available and effective, there is little hope of building a strong health work force and, therefore, a strong health system.”