Health and Development Impact and Multisectoral Strategies

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Overview. Health and Development RelationshipImpact of HIV/AIDS on Health Implications of deteriorating health status on development prospects.What each sector could do to improve health and achieve its own strategic objectives.Lessons Learnt from USAID efforts in implementing multisectoral pr

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Health and Development Impact and Multisectoral Strategies

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1. Health and Development Impact and Multisectoral Strategies Ishrat Z. Husain HIV/AIDS and Development Workshop April, 28,2003

2. Overview Health and Development Relationship Impact of HIV/AIDS on Health Implications of deteriorating health status on development prospects. What each sector could do to improve health and achieve its own strategic objectives. Lessons Learnt from USAID efforts in implementing multisectoral programs.

3. Health and Development Health is a necessary though not a sufficient condition of development or of attaining Agency’s Strategic Objectives Productivity of workers depends on good health- growing evidence of decline in productivity due to HIV/AIDS and malaria Loss of labor force and absenteeism due to HIV/AIDS and other diseases Increase in poverty and inequities due to morbidity and mortalilty.

4. Development and Health Development is an essential although not a sufficient condition for improving health. Imperative of having adequate water supply, sanitation, basic education, information and nutrition for maintaining health. Development process creates conditions of ill health such as population mobility and inequities in income making populations vulnerable.

5. HIV/AIDS Impact on Health Systems Already weak system is now devastated Crowding out- 48%-70% of hospital beds are occupied by PLWAs in Zambia and Malawi respectively Reallocation of budgets- A large part of the budget has to be allocated for drugs Antiretroviral treatment costs over $500 per patient. Loss of Manpower- Attrition of over 20% of the nurses

6. Impact of HIV/AIDS on Health Status Child mortality is increasing. USAID invested heavily in child survival programs Average life expectancy in sub-Saharan Africa is now 47 years, when it would have been 62 years without AIDS (UNAIDS, 2002). Level of living is the indicator of level of development.

7. Declining life expectancy Changes in life expectancy in selected African countries with high and low HIV prevalence: 1950-2005

8. Implications for Economic Development 10-30% loss of workforce for all sectors in high prevalence countries Loss of rare skills and productivity in key strategic areas agriculture, education, DG, and health The age and sex structures are changing, implying a profound shift in economic and social relationship

9. This slide shows a projection in the percentage of workforce lost due to AIDS by the year 2020. As shown in this slide, all countries in Africa will show an increase in the loss of workforce. This slide shows a projection in the percentage of workforce lost due to AIDS by the year 2020. As shown in this slide, all countries in Africa will show an increase in the loss of workforce.

10. Current and projected age profiles of workers in a typical South African mine This slide shows the projection of miners with HIV/AIDS in South Africa now and in 15 years. As seen here, currently (in red) those miners between the ages of 30-40 are HIV+. In 15 years, those aged 24-29 will be most affected (seen in white). This shows that society will rely on older and younger populations. This slide shows the projection of miners with HIV/AIDS in South Africa now and in 15 years. As seen here, currently (in red) those miners between the ages of 30-40 are HIV+. In 15 years, those aged 24-29 will be most affected (seen in white). This shows that society will rely on older and younger populations.

11. Impact of HIV/AIDS on Women and Girls As shown in the previous slide, women are disproportionately affected by HIV/AIDS. As seen in this chart, according to UNAIDS, 50% of infections worldwide in 2002 are among women. Deaths among in families has lead to youth and female headed households As shown in the previous slide, women are disproportionately affected by HIV/AIDS. As seen in this chart, according to UNAIDS, 50% of infections worldwide in 2002 are among women. Deaths among in families has lead to youth and female headed households

12. What Each Sector Can Do? Mitigate the impact of poor health and HIV/AIDS on the sector itself. Guard against future losses or help prevent the diseases by: Conveying the prevention messages through its own channels such as teachers union. Addressing the basic determinants of the diseases such as low education, inequities

13. What Each Sectors Can Do?- Illustrative Actions- National level Assess the impact of major diseases on the sector or strategic objectives Develop strategic plans that take into account the future impact. Review and modify policies that have adverse impact on health.

14. What Sectors Can Do? At the community level Develop and implement programs to address the basic determinants of health either individually or jointly with other sectors focusing on vulnerable groups: Youth/orphans Women

15. Successes - Zambia Zambia is a “best practice” country for the adoption of a multisectoral program USAID/Zambia has developed an HIV/AIDS Multisectoral Strategic Framework Embassy wide HIV/AIDS Coordination Group HIV/AIDS and Orphan Working Group- participation from each Strategic Objective

16. Successes – South Africa Parliamentarian training for private sector mobilization The Mission also encourages microenterprise programs, some of which are being linked to private sector programs USAID Mission has adopted economic growth strategies that will help reduce inequities in income by generating employment for vulnerable groups.

17. Successes - Uganda In 1993, Uganda adopted a multisectoral approach 12 ministries are involved in responding to HIV/AIDS problems from their vantage point The involvement of different ministries created national ownership and commitment Each sector adopted policies and programs to support HIV/AIDS programming

18. Zimbabwe – Project LEAD Implementing a household garden and nutrition kit aimed at improving the nutritional status of household income of families affected by AIDS. The kit allows families to create and maintain close-in gardens growing crops to increase number of harvests per year Voucher system – to link AIDS-affected families to legal services

19. What the Health Sector Should Do? Health Sector focused on care and cure and not on prevention. If it acted like a private company the focus will be on prevention of major epidemics. Health sector itself responsible to spread the epidemic through infected needles and blood.

20. What the Health Sector Could Do? Greater focus on systematic health system strengthening. Serious efforts to harnessing the energies of other sectors to improve health Multisectoral efforts are confined to HIV/AIDS thus far and can be extended to Health.

21. Lessons Learnt from Multisectoral Efforts Success is defined by 3 Cs. Commitment- AFR organized two consultative meeting and SOTA courses on Multisectoral approaches. It generated Champions. Country level success also associated with the commitment of the Diretor Coordination- A multisectoral working groups chaired by the Director to bring coordination and synergy.

22. Lessons Learnt Concerted Actions- Geographic focus for mutisectoral efforts is important as truncated actions do not produce results. Best practice examples: Zambia, South Africa and Zimbabwe.

23. Lessons Learned (3) Funding constraints- possible solutions Use of DA funds as HIV/AIDS prevention will save cost Health and HIV/AIDS Activities – three kinds Little or no additional funding e.g. policy dialogue Modest Funds e.g.analytical work; relocation of activities Large Funds – leveraging other donor funds Establishment of Multisectoral Fund

24. Conclusion Commitment, Coordination and Concerted Actions are needed to: Strengthen the health systems Create conditions for improved health outcome by addressing the basic determinants of health through multisectoral efforts

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