Trends in HIV/AIDS Programs and Child Mortality

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1 Trends in HIV/AIDS Programs and Child Mortality

2 Trends in HIV/AIDS Programs and Life Expectancy

3 Reduced Mortality at Bubonong Primary hospital HIV/AIDS mortality reduced from 25% to 13% from 2004 to 2006

4 Impact in Uganda In rural setting in Eastern Uganda with ART and clean water program delivered through lay HCW: -95% reduction in HIV/AIDS mortality -81% reduction in non-hiv infant mortality -93% reduction in orphanhood Mermin et al, Lancet 2008

5 The Power of Partnerships: Building Capacity PEPFAR estimates its investment in network development, human resources and local organizational capacity development and training in FY 2007 is roughly $640 million. PEPFAR partnered with 2,217 local organizations in FY 2007 up from 1,588 in 2004 and 87 percent of partners were local. From FY2004 through FY2007, PEPFAR supported nearly 2.6 million training and retraining encounters for health care workers. In FYs 2006 and 2007, PEPFAR provided approximately $281 million to support training activities. Supporting salaries of 110,000 health care workers and managers The U.S. Government and other international partners can play a vital role, but outside resources for HIV/AIDS and other development efforts must be focused on transformational initiatives that are owned by host nations.

6 Estimates of PEPFAR resources for health systems Preliminary evaluation from Rwandan Ministry of Health: 40 percent of resources were devoted to general health systems

7 The Power of Partnerships: Strengthening Systems In a study of 33 PEPFAR-supported sites providing antiretroviral treatment and associated care in 4 countries, PEPFAR supported 92% of the systems strengthening investments at a typical facility. Source: PEPFAR Fourth Annual Report to Congress, 2008.

8 PEPFAR Support Provided through the Public Sector Partner Public-Private Government Private NGO Africa Centre Africare American Internal Health Alliance (AIHA) Absolute Return for Kids (ARK) Aurum Health Institute BroadReach HealthCare CAPRISA (University of KwaZulu-Natal) Columbia University Catholic Relief Services (CRS) Eastern Cape Regional Training Centre (ECRTC) Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Foundation for Professional Development (FPD) HIVCare Medical Research Council (MRC) Phidisa/SA Military Health Services Perinatal HIV Research Unit (PHRU) Reproductive Health Research Unit (RHRU) Right to Care Rational Pharmaceutical Management (RPM Plus) Solidarity Center Quality Assurance Project (QAP) Integrated Primary Healthcare Project (IPHC)

9 Leveraging HIV Improvements for General Health A study by Family Health International at 30 primary health centers in Rwanda examined 22 non-hiv health indicators before and after the introduction of basic HIV care. Only 1 indicator declined, while 15 improved. Non-HIV Health Indicators Before intro of basic HIV Care After intro of basic HIV Care p value Independent effects New family planning users HIV exp (p <.001) Returning family planning users HIV exp (p <.001) Total family planning users HIV exp (p <.001) 1 st trimester ANC visit HIV exp (p=.010) 2 nd trimester ANC visit <.001 HIV exp (p=.004) ANC Coverage rate (all 4 visits) 3.0% 4.7%.016 HIV exp (p=.020) Syphilis screening 1 79 <.001 HIV (<.001)

10 Leveraging HIV Improvements for General Health In the 7 sites included in the FHI Rwanda study that had been offering ART for more than 2 months, the average number of new hospitalizations decreased by 20.9 percent. Source: PEPFAR Fourth Annual Report to Congress, 2008.

11 Decreased Hospitalizations in Botswana Bobonong primary hospital had reduction in hospital bed occupancy by HIV/AIDS patients from 93% to 52% from 2004 to 2006

12 PEPFAR Support for Renovation of Existing PHCs Before HIV renovation work, October 2006 After HIV renovation work, April 2007 *Photo courtesy of FHI Rutobwe Primary Health Center Lab

13 PEPFAR Support for Renovation of Existing PHCs Before HIV renovation work, October 2006 After Renovations, May 2007 Mukoma Health Center Patient Waiting Area *Photo courtesy of FHI

14 PEPFAR Also Supports Construction of New Facilities Mwananyamla Hospital Care and Treatment Center - Tanzania *Photo courtesy of Still Life Project

15 Building Capacity: Focus on Workforce Training From FY2004 through FY2007, PEPFAR supported nearly 2.6 million training and retraining encounters for health care workers. In FYs 2006 and 2007, PEPFAR provided approximately $281 million to support training activities. Supporting Salaries Namibia PEPFAR supports the salaries of nearly all clinical staff doing treatment work and nearly all of those doing counseling and testing in the public sector. Uganda PEPFAR supports salaries for nearly all the staff of The AIDS Service Organization (TASO), which has increased from 16 employees in the early 1980s to several thousand employees today. Contributing to Overall Workforce Ethiopia PEPFAR supports the Government s program to train 30,000 community health workers to work in rural villages; 16,000 of those have already been trained. Kenya PEPFAR supports the Government s hiring plan to train and deploy retired physicians, nurses and other healthcare workers for the public sector; 800 people were deployed in 2007 In Zambia, Physician Retention Scheme provides incentives such as a hardship allowance, housing, transportation and educational stipends for children of physicians serving in rural areas. Policy Change PEPFAR supports the WHO Task Shifting project, which will provide guidelines on how to safely shift tasks from higher level health cadres to new lower level cadres, such as community health workers.

16 Leveraging HIV Improvements for General Health SCMS regional distribution centers help pool procurement

17 PEPFAR Supports Mapping to Monitor ART Coverage

18 PEPFAR Partnership with the President s Malaria Initiative and the Private Sector In Zambia, by leveraging PEPFAR s existing HIV/AIDS distribution infrastructure, PMI will deliver more than 500,000 bed nets at a 75 percent savings Working country by country with PMI to leverage and expand malaria services Same approach with new NTD Presidential Initiative