Syndicate content

Responding to HIV/AIDS efficiently and effectively

Kavita Watsa's picture

World Bank President Jim Yong Kim and Bill Gates at the International AIDS Conference, Washington DC

The World Bank’s new President Jim Yong Kim caught the attention of many as the first head of this development institution to speak at the opening of a global conference on HIV/AIDS, where he called for applying the moral energy and practical lessons of the global AIDS movement to the global fight against poverty. Yesterday he returned to the 19th International AIDS Conference now underway in Washington D.C.’s massive Convention Center to join Bill Gates, US Global AIDS Coordinator Eric Goosby, and former Lesotho health minister Mphu Ramatlapeng on a panel that discussed how developing countries can achieve greater effectiveness and efficiency in the fight against HIV/AIDS.

Globally, there has been a lot more money invested in this fight over the past decade than ever before. As a direct result, thousands of lives have been saved and new infections averted, including among newborns whose mothers received treatment. But in today’s challenging financing environment, an increasingly effective and efficient HIV/AIDS response is needed to help countries to sustain their gains, prevent new infections, and continue to get treatment out to people already living with the virus.

President Kim said the Bank's main strengths are its broad involvement across many sectors—spanning health, education, social safety nets, and more—and its close engagement with national policymakers in developing countries, as well as with private sector investors. This breadth of operation positions the Bank to be, as the President said, “a very good partner” in improving health delivery systems that address not only diseases like HIV/AIDS, but also other urgent health needs such as good healthcare for mothers and children.

AIDS in 2012: "We can finish the job"

Julia Ross's picture

Speaking ahead of the XIX International AIDS Conference, World Bank Group President Jim Yong Kim says that ending AIDS—an idea that seemed inconceivable only a few years ago—is within our reach thanks to international efforts by activists and communities. Kim, who will address the conference's opening plenary session July 22, says the lessons learned in the fight against AIDS can be used to eradicate poverty.

 

The World Bank, together with USAID, PEPFAR and The Lancet, will host a debate at 6:30 pm ET on Monday, July 23, on global health funding for HIV/AIDS. Watch the debate webcast, follow the live blog, or follow on Twitter at #WB Live or #AIDS2012.

2012, une année charnière pour le sida et les avancées attendues

David Wilson's picture

Lors de la dernière conférence internationale sur le sida organisée à Washington, en 1987, les États-Unis étaient présidés par Ronald Reagan, l’Union soviétique tenait encore debout, un mur coupait Berlin en deux et la taille de l’économie chinoise était comparable à celle de l’Espagne. Personne n’aurait pu prédire les évolutions de notre planète ni celle de l’épidémie de sida.

 

En cette année 2012 décisive, la conférence est de retour à Washington. Le sida reste le plus grave défi de notre temps sur le front des maladies infectieuses, avec plus de 65 millions de contaminations et 30 millions de décès depuis le début de la pandémie, sans compter les quelque 3 millions de nouveaux cas et les 2 millions de victimes supplémentaires chaque année.

 

Ces statistiques sinistres ne doivent pas masquer les incroyables progrès accomplis. Lors de la conférence de 1987, le monde était démuni face à cette pandémie mortelle alors qu’il n’existait aucun médicament pour atténuer une lente et douloureuse agonie. Aujourd’hui, la palette des outils de prévention à l’efficacité avérée ne cesse de s’étoffer ; les infections sont en recul dans plus de 33 pays ; et jamais l’humanité n’a disposé d’autant de traitements pour lutter contre un virus. Les coûts de traitement annuels ont été divisés par 100 et ils atteignent désormais 8 millions de personnes à travers le monde, soit 60 fois plus. C'est, à ce jour, l'expansion la plus importante d'un traitement qui permet de sauver des vies.

 

Avec l’accélération des progrès scientifiques, des percées encore plus spectaculaires sont attendues.

 

C’est en Afrique surtout que ces progrès incroyables sont le plus visibles. En Afrique de l’Est et en Afrique australe, l’épidémie de sida était responsable à son paroxysme de 50 à 70 % des hospitalisations et des deux tiers des décès dans la population adulte. Imaginez un instant ce que cela signifierait à l’échelle de votre quartier. Dans mon pays, le Zimbabwe, les hôpitaux étaient remplis de mourants décharnés, le personnel soignant transformé en fossoyeurs, les hôpitaux en hospices et toute la vie sociale réduite à deux activités : visites aux malades et funérailles. Les marchands de cercueils, à l’activité florissante, s’installaient le long des routes menant aux cimetières surchargés.

AIDS 2012: In a watershed year, breakthroughs await

David Wilson's picture

When the International AIDS Conference was last held in Washington, D.C. in 1987, Ronald Reagan was U.S. president, the Soviet Union stood, a wall scarred a divided Berlin and China’s economy was roughly the size of Spain’s. The wider world – and the AIDS epidemic – has changed more than anyone foresaw.

 

The conference returns to Washington in a watershed year. AIDS remains the greatest infectious disease challenge of our age: more than 65 million people infected and 30 million deaths since the epidemic began, and roughly 3 million new infections and 2 million deaths a year.

 

These are grim statistics, but they belie the incredible progress made. When we met at the 1987 AIDS conference, the world had few tools to prevent deadly infections and no drugs to commute slow, agonizing, wasting death. Today, there is an expanding armory of proven prevention tools; new HIV infections have been reduced in more than 33 countries; and there are more drugs to treat HIV than for every retrovirus in history combined.  Annual treatment costs have been reduced 100-fold and AIDS treatment has been expanded 60-fold to reach 8 million people worldwide in the largest-ever expansion of lifesaving treatment.

 

As the pace of scientific progress accelerates, even greater breakthroughs await us.

 

Nowhere is this amazing progress more evident than in Africa. At its peak in Eastern and Southern Africa, AIDS was responsible for 50-70% of bed occupancy and two-thirds of all adult deaths. Let each of us simply try to imagine experiencing this in our own neighborhoods. In my country, Zimbabwe, hospitals overflowed with emaciated, dying people, nurses and doctors were undertakers, hospitals were hospices, and an entire society’s social life rotated from hospital beds to funeral gravesides. Coffin-making was the fastest growing business, lining miles of roads to overcrowded cemeteries.

Transitions in financing HIV/AIDS programs

Patrick Osewe's picture

(Portrait of mother and child. Botswana. Photo: Curt Carnemark / World Bank)

While participating in a study of HIV spending efficiency in South Africa, I met a young HIV-positive mother who had just received the joyful news that her new-born daughter was healthy and HIV-free. Wiping away tears of relief, she described the gratitude she felt for the antenatal clinic staff, who had helped start her on antiretroviral treatment (ART) and thanks to whom she now had the hope of a bright future for her daughter. This encounter was just one among many similar incidents during the study – and, as our preliminary data show, is representative of the positive impact of the Government’s strong commitment to bringing down rates of HIV.

 

South Africa has mounted one of the strongest responses to HIV in the world. Its most dramatic success has been the scale-up of ART since 2003, growing from almost nothing to the country’s largest health program that treated about 1.5 million people in 2011 (out of a total HIV-infected population of 5.6 million).

 

The impacts of this treatment drive are already showing, with overall mortality, maternal and infant deaths all on a downward trend following their HIV-related peaks in the early-to mid-2000s. However, the cost of sustaining this success is huge: South Africa has committed to putting an estimated target of almost 10% of the entire population on a life-long course of expensive drug treatment. And, even with government negotiators bringing down ART drug prices by 65% since 2008, successful testing campaigns coupled with the worrying increase in resistance to first-line therapies look set to further raise the financial risk.

 

These challenges extend beyond South Africa. An analysis of the fiscal dimensions of HIV/AIDS released by the World Bank earlier this year in a number of countries concluded that without significant additional investments in prevention starting now, the cost of treatment will rapidly become unaffordable for even the most cash-rich countries on the African continent.

Health information systems in developing countries: Star Wars or reality?

Patricio V. Marquez's picture

(Doctor at the GP office working with prescriptions. Kirov, Russia. Credit: Dmitry Kirillov/World Bank)

In the late 1990s, an international consultant told me that a proposed electronic health information system in the Dominican Republic was “like Star Wars and will not work in this country.”

 

Our objective was to improve service delivery by virtually connecting health providers to share medical records with one another as patients moved from health centers to hospitals. We learned that this was much more than an overnight task, requiring a sustained medium-term effort by the government to get the system fully up and running.

 

In recent years, I’ve seen similar efforts realized in the Russian Federation, Georgia, Azerbaijan and Botswana. In two Russian regions, Chuvash Republic and Voronezh Oblast, for example, electronic records are helping coordinate the flow of clinical and financial information across the health systems as facilities, departments within hospitals, and health insurance agencies have been “virtually” connected through broadband networks. The electronic records are supporting clinical decision-making, facilitating performance measurement and pay-for-performance initiatives, and ultimately the continuity of care as patients move across the health system. Inter- and intra-regional medical consultations and distance learning activities are also being supported by telemedicine networks that connect specialized hospitals with general facilities.

Laboratory accreditation: Critical to quality care

Miriam Schneidman's picture

The quest for an accurate, timely and affordable medical diagnosis remains elusive in many developing countries.  In East Africa, laboratories are often poorly staffed; ill-equipped; and lack quality systems. Obsolete equipment clogs up limited space. Clinicians often resort to presumptive diagnoses rather than requesting lab confirmations. Individuals suffering from infectious diseases, such as tuberculosis, run the risk of going undetected and transmitting the disease to others, or being misdiagnosed, which in turn leads to compromised care and higher health care costs. 

 

Many laboratories are not adequately prepared to respond during public health emergencies, yet their services are critical to detecting new pathogens and containing disease outbreaks. 

 

World Laboratory Accreditation Day, observed recently, offers a good opportunity to draw attention to the critical role of laboratories in health, and the importance of accreditation in promoting quality.  Accurate and reliable laboratory services are critical for conducting clinical diagnosis, guiding treatment, and responding to disease outbreaks.  There’s a growing recognition of the importance of laboratory services, and several important initiatives have been launched, including the WHO-AFRO Stepwise Laboratory Improvement Process towards Accreditation (SLIPTA).

Pour un accès plus équitable à la planification familiale en Asie du Sud

Julie McLaughlin's picture

Le 11 juillet, lors de la Journée mondiale de la population, des acteurs mondiaux de premier plan dans le domaine de la santé se réunissent à Londres pour tenter de mettre la priorité sur l’enjeu de la planification familiale. Cet enjeu est au cœur des travaux du personnel de la Banque mondiale chargé des questions de santé en Asie du Sud, qui s’emploie à trouver les moyens qui lui permettront d’aider plus efficacement les femmes et les familles à espacer les naissances et à éviter les grossesses non désirées.

 

Même si les pays d’Asie du Sud ont progressé dans l’élargissement de l’accès à la contraception moderne et dans le recul global de la natalité, la région accuse la deuxième plus forte mortalité maternelle du monde. Dans ces pays, les ménages pauvres, marginalisés et non instruits n’ont pas accès aux services de santé génésique dont ils ont besoin, et notamment à la planification familiale.

 

En Inde, au Népal et au Pakistan en particulier, les taux de fécondité et d’utilisation de contraceptifs diffèrent considérablement d’une catégorie socioéconomique à l’autre : en Inde, alors que le taux de fécondité n’est que de 1,8 chez les femmes les plus aisées, il se maintient à 3,9 parmi les plus démunies. Au Népal, les femmes instruites ont, en moyenne, 1,9 enfant, contre 3,7 pour les femmes non instruites. Au Pakistan, la prévalence de la contraception atteint aujourd’hui 32 % chez les couples riches et seulement 12 % chez les couples pauvres. En Inde, dans l’État du Meghalaya, 36 % des couples désireux de recourir à la planification familiale n’ont pas accès à une contraception efficace.

Planificación familiar en Asia meridional: Mejorar la igualdad de acceso

Julie McLaughlin's picture

 

El 11 de julio, Día Mundial de la Población, mientras los líderes mundiales de la salud se reúnen en Londres para debatir sobre el otorgamiento de una mayor prioridad a la planificación familiar, el personal del Banco Mundial que trabaja en el sector de salud en Asia meridional estará pensando en cómo respaldar más eficazmente a las mujeres y las familias de esta región para espaciar los nacimientos y evitar los embarazos no deseados.

 

Aunque los países de Asia meridional lograron aumentar el acceso a la planificación familiar moderna y reducir los índices totales de fecundidad, la región sigue teniendo la segunda tasa más elevada de mortalidad materna. Los hogares pobres, marginados y sin educación no cuentan con los servicios de salud reproductiva que necesitan, incluida la planificación familiar.

 

En India, Nepal y Pakistán, en particular, las diferencias en la fertilidad y el uso de anticonceptivos entre los grupos socioeconómicos son sorprendentes: en India, la tasa de fecundidad en la parte más rica de la población es de 1,8, mientras que sigue siendo de 3,9 entre los más pobres; en Nepal, las mujeres con educación tienen en promedio 1,9 hijos, mientras que las menos educadas tienen un promedio de 3,7; en Pakistán, la prevalencia de anticonceptivos es del 32% en las parejas más ricas y de apenas el 12% entre las parejas pobres, y en el estado indio de Meghalaya, el 36% de las parejas que quiere practicar la planificación familiar carece de acceso a métodos anticonceptivos eficaces.

Maya’s second birthday: Celebrating strong health systems

Cristian Baeza's picture

We’ve got something to smile about this week at the World Bank: Our baby Maya, who has shown us the importance of having a strong health system and access to quality maternal and child health care, has reached her second birthday!

 

To mark this special occasion, we’re launching a new video about the things that helped Maya achieve this milestone, including access to family planning and proper nutrition. These are two key services provided by well-functioning health systems that create healthy futures for mothers and their children—along with other affordable services, trained health workers, clean water, vaccines, well-equipped clinics, and many other moving parts.

 

The video—the second in a series that began with Maya’s birth—comes as the global health community holds a summit on family planning this week in London. I hope Maya’s story underscores what a difference access to effective family planning can make. By giving women the means to space the births of their children by three years, for example, deaths of children under-five would decrease by 35%.

Pages