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[afro-nets] U.S. HIV Funding's Effect on Broader Health Services in Africa

  • From: "David Hock" <DHock@fhi.org>
  • Date: Wed, 14 Nov 2007 14:37:48 -0500

U.S. HIV Funding Improves Broader Health Services in Africa, New Study Suggests

RESEARCH TRIANGLE PARK, NC (Nov. 12, 2007) - New data from Rwanda show a link between the introduction of U.S.-funded HIV services and increases in use of non-HIV primary health services. This study brings evidence to the debate over whether HIV programs benefit or burden the often weak health care systems in developing countries.

"While HIV/AIDS is the focus of President Bush's Emergency Plan for AIDS Relief, the initiative's support for capacity-building has important spillover effects for nations' broader efforts for sustainable development," says Ambassador Mark Dybul, the U.S. Global AIDS Coordinator. "This study confirms these positive effects: when a country strengthens its health systems and workforce to confront HIV/AIDS, it improves overall health care for its people."

The study shows that adding basic HIV services to Rwandan primary health centers through funding from the President's Emergency Plan for AIDS Relief (PEPFAR) contributed to an increase in the use of reproductive health, prenatal, pediatric and general health services. This suggests that U.S. HIV funding has benefited all Rwandans, not just those who are HIV-positive. The research was featured Nov. 8 on the NewsHour with Jim Lehrer, a popular news program of the Public Broadcasting System in the U.S.

"Bringing institutions and development partners together to work on a coordinated national program is essential for HIV services to have positive effects on the health system. In Rwanda our job is to coordinate all activities to make sure that people are getting the care they need, at the best cost and in an integrated manner," says Dr. Agnès Binagwaho, executive secretary of Rwanda's National AIDS Control Commission. "National coordination of institutions is key not only to health care, but also to assuring its integration in the national development plan."

The study was conducted using data from 30 primary health centers that had at least six months of experience providing basic HIV care services and controlled for possible influences from other health initiatives. It found 17 statistically significant increases in delivery of non-HIV services, including a 24 percent increase in outpatient consultations and a rise in syphilis screenings of pregnant women from virtually none offered prior to the introduction of HIV care to, on average, 79 tests per health center per month after HIV services began. Large jumps were also seen in pre-natal care visits and in the provision of family planning services.

As part of Rwanda's national HIV care and treatment program, Family Health International (FHI) provided technical and financial support to the 30 health centers in the study to introduce new HIV services, including counseling and testing, prevention of mother-to-child transmission, preventative therapy with cotrimoxazole and, in some centers, treatment with antiretroviral drugs. The findings are somewhat limited due to the relatively small sample size and the surveying of only FHI project sites, but the study provides the strongest available data on the subject to date.

"HIV services are fundamentally changing primary health care in Africa for the better," says Jessica Price, PhD, Rwanda country director for FHI and one of the researchers who conducted the study. "Yet I'm aware of only two other studies on the topic, both of which are based on findings from single sites. Although we can't assume that findings from this study are generalizable, they do suggest how disease control programs can strengthen health systems if implemented well and thoughtfully."

More research is needed to determine what part of the HIV care integration process led to the increases, but renovations and improvements to health center infrastructure, financial management and human resources are likely the catalysts. "When the population sees the health facility renovating and offering new services, then I think its confidence level in the facility goes up and, with it, a desire to use the services," says Price.

Before and after photos of a renovated health center that was part of this study are available at: http://www.fhi.org/en/HIVAIDS/country/Rwanda/res_HIVServicesAffectPrimaryCare.htm

"These findings are encouraging in that they show that the addition of resources to HIV has not detracted from other necessary public health services in resource poor settings. In fact quite the contrary," says FHI's President of Research Ward Cates, MD, MPH. "Our next step is to assess the quality as well as the quantity of the basic health services delivered to see if quality also has improved as we suspect it has."

The Commission Nationale de Lutte Contre le SIDA (CNLS) is Rwanda's national institution in charge of planning, coordinating, monitoring and evaluating activities in the fight against HIV and AIDS. It is also responsible for providing public education about HIV and AIDS at all levels of Rwanda society. http://www.cnls.gov.rw

The non-profit Family Health International (FHI) has been at the forefront of public health research, prevention, care and treatment in the developing world since 1971. FHI delivers services and conducts research in HIV/AIDS, other infectious diseases and reproductive health to improve the lives and well-being of some of the world's most vulnerable people. www.fhi.org

For more information, write to mailto:media@fhi.org

David Hock