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World AIDS Day 2011

Kristina Nwazota's picture

Thirty years after the HIV/AIDS virus first appeared, more than 34 million people world-wide are living with HIV. Sub Saharan Africa is most heavily impacted; some 68 percent of all those living with HIV live in the region. Despite the high prevalence, the HIV incidence rate declined by more than 25 percent between 2001 and 2009 in 22 Sub-Saharan Africa countries. In West and Central Africa, HIV prevalence remained under two percent in 12 countries.

UNAIDS Executive Director Michel Sidibé outlines what the global community is doing to further fight HIV/AIDS in Africa.

 

AIDS at 30: continuing the fight

David Wilson's picture

Timeline: AIDS at 30

Today is the most mixed World AIDS Day in our 30-year fight against this devastating disease.

AIDS continues to reverse decades of human progress, particularly in Africa. As of 2010, 30 million people have died of AIDS-related causes, and another 34 million are living with HIV. And with HIV/AIDS funding flat-lining, we’re all facing the challenge of doing more with less.

But after a decade of concerted global effort and remarkable successes in treatment and prevention, there’s cause for hope: More countries are seeing HIV decline, and we’ve witnessed incredible scientific breakthroughs that are changing the course of the epidemic. This week, we announced that India, with the support of the World Bank and other partners, is averting 3 million HIV infections, thanks to targeted prevention interventions.

Harmonization and alignment in development assistance for health: now what?

Cristian Baeza's picture

SDM-NP-101 World Bank

The International Health Partnership (IHP+) has done an exceptional job the last three years in bringing together countries, donors, international financial institutions, civil society, the United Nations, and many other partners to agree on how, concretely, we would implement the principles of the Paris Declaration on Aid Effectiveness. It’s a complex, demanding, and crucial task.

We support countries’ efforts to improve the lives of millions of people—but we often accompany this support by burdening countries with many different reporting, fiduciary, monitoring, evaluation, and other systems. Five years ago, we didn’t have a venue to discuss, or know, what good harmonization and alignment could look like, and we hadn’t agreed to common fiduciary, monitoring, and evaluation systems.

But today, in large part to our shared efforts in the context of IHP+ and country leadership, we’ve agreed on a joint assessment of country health strategies, a common financial management approach, and on some aspects of monitoring and evaluation. And we have outstanding country examples such as Nepal.

Why, then, isn’t this happening at a speed compatible with the urgency of the task? If we have examples and agreements, what’s stopping us?

What does a “developed” health system look like?

Owen Smith's picture

SDM-TR-052 World Bank

It’s hard to say with much precision. Or at least that’s one of the main impressions you get when scanning a 2010 report on OECD health system institutional characteristics. The results are from a survey of 29 mostly high-income countries, based on responses to 81 questions about their health systems, including various aspects of financing, coverage, service delivery organization and governance. It is proving to be a useful reference point as we undertake a stock-taking of reforms across Europe and Central Asia.

The fact that there are many varieties of advanced health systems is hardly surprising, of course, but it runs much deeper than the old Beveridge vs. Bismarck dichotomy. How countries approach issues like coverage rules, facility ownership status and provider payment methods cannot be neatly divided into two groups. Once you look across a large number of characteristics and countries, similarities would seem to be the exception, not the rule.

Reforming health systems: leadership matters

Patricio V. Marquez's picture

I was in Tbilisi last week for the launch of Georgia’s new five-year health strategy, "Affordable and Quality Health Care," the first strategy since 1999. It’s a milestone in the country’s ambitious health reform program, summarizing what has been achieved, the challenges ahead, and options to address them. And more importantly, the strategy reflects the government’s commitment to continue redesigning the health system and improving the health status of the population through the adoption of multisectoral actions.

The Georgians should be proud. Since 2006, the government has radically transformed the health system, moving rapidly from a budget-funded direct provision of medical care in public facilities to subsidizing health insurance premiums for the poor. Private health insurance cum services providers, who are increasingly operating as integrated health management organizations, are delivering services in the benefit plan. The initial results are promising: Health insurance coverage has risen steadily from about 2 percent to 40 percent of the population, and out-of-pocket health care expenditures among the poor have been decreasing, particularly after a basic drug benefit was added to the health insurance plan.

You may say that the Georgian experience is nothing new because many countries across the globe have adopted or are adopting similar arrangements—and some countries have more to show. However, this experience shows us how unwavering leadership is a key to persevering on the sometimes rocky path of health system reform.

An imperative: reforming medical and public health education

Patricio V. Marquez's picture

Albania-08054400011 - World Bank

My recent work in Azerbaijan convinced me that reforming medical and public health education programs is critical to revamping clinical processes and public health practices for effective prevention, diagnosis and treatment of diseases and injuries. In this small Caspian Sea country, improving physicians, nurses and public health specialists’ educational programs—which are hampered by outdated conceptual and methodological structures and practices—is starting to receive priority attention in the country’s quest to improve health system performance.

The challenge is shared globally, as different countries are struggling to sufficiently staff their health systems with well-trained, deployed, managed and motivated physicians and nurses to provide quality medical care, and competent staff to manage service delivery and carry out essential public health work such as disease surveillance.

With few exceptions, such as the 2010 Lancet commission report*, medical, nursing and public health education reform has failed to appear in the international health agenda—yet we continue to focus on employment and remuneration of existing personnel. This has to change. Why? Simply because the adoption of and adaptation to local conditions of new knowledge, country experiences and good practices help accelerate social and economic development.

Latin America: Putting a human face on health systems

Keith Hansen's picture

Latin America: Crying out for good health systems. Photo: Marie Chantal Messier

It takes a health system to raise a healthy child—or nation. And this is true here in Latin America or anywhere else in the world.

That’s the big message of a small video the Bank has recently launched, featuring an adorable animated newborn named Maya. In it, Maya cries profusely, many times, but her tears are not the sad consequence of disease or discomfort but of the baby feeling well. Maya’s are happy tears –the product of a healthy baby. You can follow her journey into adulthood on her own Facebook page

Earth hits 7 billion mark, Brazil’s clinics provide hope to the poor

Carlos Molina's picture

As the world’s population hits today the 7 billion mark, unleashing mixed emotions across the globe, Latin America can consider itself lucky that overcrowding is not that big of a deal in our neck of the woods.

Or is it? Experts point out that while the region’s share of the world’s population is a mere 8% -or 560 million- a great concern is that the vast majority of those people –up to 75%- live in cities, leading to overstressed basic services, such as healthcare. My colleague James Martone of the Broadcast Unit, went to Northern Brazil to film a project about a community that has found innovative ways to provide healthcare for the poor.
 

At 7 billion, realizing the economic benefits of family planning

Cristian Baeza's picture

JE-GH060621_32957 World BankSlideshow: At 7 Billion Mark, Reproductive Health Critical

With the 7 billionth baby joining the planet, many of us are rightly concerned about the challenges posed by a growing population and its impact on health care, climate change, food security, jobs, and poverty.

Here at the World Bank, we’ve been talking recently about the critical link between population change and economic growth. In some countries, where falling fertility rates have led to expanding working-adult populations and a smaller proportion of dependent children, the economic and social impact has been transformative.

For example, Thailand’s Minister of Finance said at a Bank panel last month that after his country introduced a national family planning policy in the 1960s, more women had the time and opportunity to access education, and take jobs in manufacturing and services. This shift was matched by greater government investment in health, education, gender equality, and skills training for women and the growing young population, together with reforms improving the country investment climate, all resulting in a generation of healthier, more educated and more productive citizens.

As a result, people’s opportunities and quality of life improved. This way, Thailand put in place long-term policies to ensure economic benefit from its demographic transition—it harnessed the “demographic dividend.”

But Thailand isn’t alone. Other countries, such as Indonesia and South Korea, have followed similar paths.

A new approach to measuring the impact of global health aid

Cristian Baeza's picture

AV17-33 World Bank

We in the global health community have been successful during the past decade in advocating for additional funding for health. We saw huge increases in development assistance for health, and our work has attracted support from political leaders, celebrities, and taxpayers alike. But now in 2011 we face a number of challenges, with donor governments facing significant fiscal pressures to reduce their aid budgets, and increasing scrutiny on how we measure the real impact of these investments.

Last week I was pleased to brainstorm with several of our key health partners to discuss what we can do.

During the past few years, the World Bank and leading global health agencies have relied on a fairly simple but compelling metric–lives saved–to demonstrate the impact of our work. Of course, talking about lives saved is compelling, and it has helped make global health work better understood by non-health experts. But there are a few challenges with this approach thus far.

First, the way we currently measure lives saved tends to downplay the importance of a well-functioning health system in saving a person's life. Measuring lives saved as a result of specific commodities such as a bednet, vaccine, or antiretroviral treatment only tells us one part of the impact story. For these commodities to be effective, we need the full value chain of a good health system, including the motivated and trained health worker, the well-equipped clinic, the cold-chain storage, the affordable financing, clean water and infrastructure, and the right policies, logistics and more–all of these things must be in place to achieve the desired health impact.


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