Community Health Workers Strengthening the Safety Net Dr Badara Samb
Where are we? TARGET TODAY 000 707782
Progress is uneven 68167 Caribbean 81727 Latin America Sources: GARPR 2017; UNAIDS 2017 estimates. 888 6377 Western and central Europe and North America Eastern Europe Central Asia 8166 716683 28373 Western and Central Africa Middle East and North Africa 76783 Eastern and Southern Africa Asia and Pacific
000 target and community health care workers 0 0 0 targets 0 0s 1 0 2 0s 3 0s across Africa Population density of community health care workers varies considerably across Africa
Community support keeps people on treatment: The experience in Mozambique, 20082010 CLINICBASED TREATMENT COMMUNITY TREATMENT MODEL 100% 80% 60% 70% 0% still receiving treatment 20% 0% People receiving ART from specialist clinics Source: Decroo, T. et al, JAIDS, 2011. 0% still receiving treatment after 2 years Mozambique: selfinitiated community model
Retention in antiretroviral therapy Source: UNAIDS/MSF, 201WHO, 2013
0 0 0 achieved in Rural East Africa 10 0 7 0 2 0 Knowledge of HIV status among people living with HIV Baseli ne Followup year 1 Antiretroviral therapy coverage among people previously diagnosed Followup year 2 with HIV Viral suppression among people ever on antiretroviral therapy Progress towards the 0 0 0 targets, all ages, 16 SEARCH intervention communities in rural Kenya and Uganda Source: Petersen M, Balzer L, Kwarsiima D, Sang N, Chamie G, Ayieko J et al. Association of implementation of a universal testing and treatment intervention with HIV diagnosis, receipt of antiretroviral therapy, and viral suppression in
HPTN 071 (POPART) TRIAL: REACHING THE FIRST 0 KNOWLEDGE OF HIV STATUS BEFORE AND AFTER COMMUNITYBASED SERVICES MEN LIVING WITH HIV Round 1: November 2013 to June 201 100 0 Per cent Per cent 100 0 WOMEN LIVING WITH HIV Round 1: November 2013 to June 201 0 18 0 1 2 20 2 2 3 30 3 3 0 6 + 0 60 6 Age (years) MEN LIVING WITH HIV Round 2: June 201 to October 2016 2 20 2 2 3 30 3 3 6 + 0 0 60 6 Age (years) 100 0 WOMEN LIVING WITH HIV Round 2: June 201 to October 2016 Per cent Per cent 100 0 1 18 0 0 1 1 8 2 2 0 2 2 3 3 0 3 3 0 Age (years) 0 6 + 60 6 1 02 2 03 3 0 0 06 + 6 3 2 2 3 6 18 Age (years)
HPTN 071 (POPART) TRIAL: REACHING THE SECOND 0 ANTIRETROVIRAL THERAPY COVERAGE BEFORE AND AFTER COMMUNITYBASED SERVICES MEN LIVING WITH HIV Round 1: November 2013 to June 201 100 0 Per cent Per cent 100 0 WOMEN LIVING WITH HIV Round 1: November 2013 to June 201 0 0 1 2 2 0 1 8 2 2 3 3 0 3 3 0 0 1 6 + 60 6 18 2 20 2 2 3 30 WOMEN LIVING WITH HIV Round 2: June 201 to October 2016 100 0 Per cent Per cent 100 0 6 + 0 0 60 6 Age (years) Age (years) MEN LIVING WITH HIV Round 2: June 201 to October 2016 3 3 0 18 0 1 20 2 2 2 30 3 3 3 0 Age (years) 0 60 6 + 6 1 18 2 20 2 2 3 30 3 3 6 + 0 0 60 6 Age (years)
HCW shortage in Africa Density of physicians, nonphysician clinicians, nurses and midwives in key subsaharan African countries (per thousand population) Cameroon WHO Primary Health Care Worker Threshold Senegal WHO Skilled Health Care Worker SDG Index Threshold Monzambique Tanzania Malawi Ethiopia DRC Côte d Ivoire Lesotho Rwanda Zambia Ghana Kenya Zimbabwe Uganda Swaziland Angola Nigeria Namibia Botswana South Africa 1.00 2.00 Physicians 3.00 NPC.00.00 Nurses & Midwives WHO has made the case for a minimum primary health care worker threshold of 2.28 physicians, nurses and midwives per thousand population WHO, Working Together for Health. For a background on the WHO s analysis, see N. Speybroeck et al., Reassessing the Relationship Between Human Resources for Health, Intervention Coverage and Health Outcomes: Evidence and Resources for Health, Intervention Coverage and Health Outcomes: Evidence and Information for Policy, 2006, http://www.who.int./entity/hrh/documents/reassessing_relationship.pdf. More recently, WHO has developed a higher threshold incorporating SDGs Human Resources for Health Observer, 17 2016. 6.00
The SDG Challenge SDG 1 SDG 3 No poverty Good health and wellbeing SDG SDG 8 Gender inequality Decent work and economic growth
Creating 2 million community health care jobs in Africa Harnessing the demographic dividend, ending AIDS and ensuring sustainable health for all
10 key action steps 1. Political priority 6. Provide fair compensation 2. Reform policy networks 7. Ensure supervision and monitoring 3. Develop national scaleup plan. Empower communities to drive recruitment. Use and adapt existing tools 8. Train other health care workers. Ensure CHWs have a voice 10. Mobilize financing
AVERAGE COST OF HEALTH WORKERS ACROSS EAST & SOUTHERN AFRICAN COUNTRIES* Discounted present value of training plus compensation over 2 years of service *Ethiopia, Kenya, Malawi, Mozambique, Rwanda, United Republic of Tanzania,
Community Health Workers The needs in Africa Total needs: 2,000,000 Average country needs: 36,2 Average starting point: 28,000 All inclusive average annual cost (Ethiopia model): * Excluding pharmaceuticals and medical consumables CHWs CHWs [10 318,000] CHWs [range 03,000] USD 0 M [range USD 0.6 M USD 1,02 M]
1 Million CHWs in subsaharan Africa Productivity gained per year: 1. bn Economic losses averted per year: 0.7 bn Multiplier effect: 1.6 bn All inclusive average annual benefit 21.7 bn * Strengthening Primary Health Care through Community Health Workers: Investment Case and Financing Recommendations, July 201
Return on investment 10:
Possible sources of funding Donor innovations PMI PEPFAR Africa Health Investment Fund Universal health coverage Reprogrammi ng of funding DFID DFTAD RNE GIZ USAID Irish Aid Italian Cooperation Traditional Donor Financing GlaxoSmithKl ine Global Fund EU Trust Fund for Africa GAVI World Bank European Development Fund Domestic Domestic Government Government Financing Financing Innovative Innovative Financing Financing European Union Emergency Trust Fund Pandemic Emergency Facility Africa Community Health Workers Bond
Easily accessible funds Emergency Trust Fund for Africa: 2.8 billion G20 Initiative for Rural Youth Employment: Creating: 1.1 million new jobs by 2022 Health systems windows in COPs and GF
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