De mange støttekroner, der er gået til at bekæmpe hiv/aids-epidemien i Afrika, har formentlig haft den positive sideeffekt, at de afrikanske landes sundhedsvæseners kapacitet generelt er blevet større.
JOHANNESBURG, 6 March 2013 (IRIN): The HIV/AIDS epidemic arrived in sub-Saharan Africa after decades of neglect had left healthcare systems dangerously weak, barely able to cope with the onslaught of patients.
Then the money started pouring in – funding for HIV programmes rose from 5,5 percent of health aid in 1998 to nearly half of it almost 10 years later.
But the jury is still out on whether the large sums of AIDS funding have made healthcare systems more resilient (stærke), whether “the capacity gains conferred over the past decade will be durable as donors pull out [and whether] previous, pre-aid boom fragilities in service delivery and volatility (udsving) in public spending would be reduced in the post-donor period,” noted Amanda Glassman.
She is director of global health policy and research at the Washington-based Center for Global Development.
Some have argued that the AIDS epidemic has helped generate an overall increase in health funding and mobilized an international push for more equitable healthcare access.
But others maintain that the billions of donor dollars spent fighting HIV/AIDS in the last decade have done little to strengthen fragile national health systems.
In the initial, emergency phase of the epidemic, donors bypassed weak areas of national health systems to set up structures that would yield faster results.
On the ground, this meant modern HIV/AIDS clinics, fully staffed and equipped, offering free services in one corner of a public hospital, while the rest of the hospital limped along with inadequate infrastructure, high user fees and staff shortages.
“It was appropriate and inevitable at the time. We had to react the way we did. Now, we need to be responsive to the current situation and what we learned,” said Alan Whiteside, executive director of the Health Economics and HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal.
Lessons learned
It is difficult to assess whether donor funding has increased resilience.
But gains in health status and HIV/AIDS service coverage – such as the number of eligible people receiving antiretrovirals (ARV = livsforlængende medicin) and the number of pregnant women receiving services to prevent mother-to-child transmission of the virus – suggest that health-system capacity has been strengthened, Glassman told IRIN.
Even with its health sector crippled by tuberculosis (TB) and HIV epidemics, South Africa’s antiretroviral programme is now the biggest in the world – over 1,7 million HIV-positive people are treated by the government.
And in this year’s budget speech, Finance Minister Pravin Gordhan announced plans to put an additional 500.000 people on treatment each year.
“The [treatment programme] has added staff and resources to the base of the health system, brought in a whole lot of technical assistance from the outside, and, in an intangible way, it has raised hope amongst [healthcare] providers,” said Helen Schneider of the School of the Public Health at the University of the Western Cape.
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