Systems Approaches to HIV/AIDS: Implications, Results, and Lessons

1. Systems Approaches to HIV/AIDS: Implications, Results, and Lessons Paurvi Bhatt, M.P.H. Senior Associate Abt Associates Informal Discussion: UNESCO April 26, 2004

2. Systems and HIV/AIDS:Why Now? • Rapid increase in resources • Dramatic diversity of sources • Heightened focus on scale and coverage • Increased recognition of multi-sectoral response • Essential need for evidence-based results and financial responsibility

3. Health Systems and HIV/AIDS:The Elephant in the Room • Remarkable attention to constraints of health systems • Lack of clarity on function of health systems related to HIV/AIDS • Key Issues: • Absorptive Capacity • Infrastructure Limitations • Human Resources • Safe, Effective, and Integrated Service Delivery • Sustainability

4. The Health Systems Bridge & HIV: HIV Areas Linked with Health Systems* STI ART VCT OI & PAL Health Systems Bridge Policy Reform Workers Commodities Financing Information *Slide adapted from USAID Community: NGO/CBO Interventions, Mobilization, & Referral

5. Systems Approach to HIV:Key Policy and Financing Questions • What are we trying to accomplish? • What resources are needed? • How will policy and financing options be implemented? • Where did the resources go? Who ended up paying for what? • What can be adapted to be more effective? What policy decisions can lead to sustainability?

6. The Systems Toolbox: • Resource Estimation Models • Resource Source and Flow Tracking • Costing Techniques • Economic Analysis

7. Question 1: What are we trying to accomplish? • Impact through scale, coverage and quality • Policy Reform • Infrastructure Strengthening • Skills Building • Community Mobilization • Service Delivery

8. Question 2: What resources are needed? • Interest in scaling up programs at international and national levels • Accurate cost and resource information critical to guide policy decisions on financial sustainability, resource mobilization, targeting

9. Systems Tool:AIDSTREATCOST (ATC) What is it? • Estimates total resources required to support policy decisions, program planning, and budgeting for a national ARV treatment program. • Prioritizes a systems perspective to consider all costs involved to implement ART- using data on • Demography and epidemiology • Human resources • Commodity and facility requirements etc. • Draws on national experience, is easily adaptable, and generates results quickly

10. Key Results and Lessons • Annual per patient costs involve more than drugs alone • VCT costs are substantial • Opportunistic infection costs will remain • Key human resources are limited • Environment is very dynamic • Financial sustainability and absorptive capacity are critical • Need for extension of model to estimate resources for complex multisectoral programs • Home-based care • Orphans and Vulnerable Children

11. Question 3: Where did the resources go? • Understand absorptive capacity • Demonstrate allocation of funds • Strengthen integrity of resource flow and improve accountability • Monitor changes in policy and resource allocation • Determine equity of service reach

14. Systems Tool: Economic Analysis • Equity Issues: Large divide in use of services and expenditures • Rich spend 13x more than the poor • Men spend 2x more than women • Urban more than rural • Households rely on local resources to minimize impact • Grant assistance from church or family • Loans from family and friends • Sale of household assets

15. Question 4: What can be adapted to be more effective? • Use of tools to answer key HIV questions critical in policy dialogue and resource mobilization • Systems Tool: Cost Analysis • Generates reliable cost and coverage data • Improves dialogue across Ministries • Clarifies intervention areas • Home-based care

16. Future Considerations: • Applying Systems Approach to Multisectoral Programs • Estimating Resource Needs and Flows for Complex Programs • OVC • Adapting Methods from Diverse Mix of Disciplines to Leverage Sustainable Impact