hiv & mnch: can we do one without the other? key issues & emerging evidence presentation for...
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HIV & MNCH: Can we do one without the other? Key Issues & Emerging Evidence
Presentation for the XVIII International AIDS Conference-AIDS 2010Rights Here, Right Now
July 18, 2010
Ann Starrs, PresidentFamily Care International
Presentation Outline
• Brief background on MDGs 4, 5 & 6• Program linkages: target populations,
common needs, comprehensive services• Policy harmonization: focus on health
systems nationally and globally• Funding integration: moving toward a
common platform?
The health MDGs are integrally linked
• Inadequate progress on MDGs 4, 5 & 6 (5 furthest off track)
• HIV, TB, malaria are significant factors for maternal and child mortality
• Weak health systems limit potential for progress
• Funding is inadequate to meet health system and program needs
Background/Context
Maternal and child mortality worldwide
Source: Countdown to 2015, from WHO, UNICEF, UNFPA, World Bank
MDG4: Trends in child mortality, 1990-2015
On track
Insufficient progressNo progress /reversal
No data
Low maternal death ratio
Medium maternal death ratio
High maternal death ratio
Very high maternal death ratio
No data
MDG5: 2005 MMR estimates
Background/Context
Global HIV prevalence, 2007
Source: UNAIDS, 2008 Report on the global AIDS epidemic
Background/Context
MDG6: Sub-Saharan Africa hardest hit, also central Europe
SRH/MCH-HIV program linkages
• Major overlap in core target populations• Diseases/health problems often
concurrent or linked• Basic services provided through same/
similar channels• Common health system needs• Similar underlying gender/cultural/social
factors
Program Linkages
Target populations –the overlap
Women of Reproductive Age
1.8 billion
Children <5 642 million
PregnantWomen
210m/yr
HIV+39 million
Newborns136 million
High Risk Groups
(MSM, IDU, CSW)
Program Linkages
Sources: UN Population Division, USAID and UNFPA
Interconnected problems & interventions
SRH/MCH
Sexuality education
Family planning/ safe abortion
Antenatal care
Skilled care at childbirth
Postnatal care, incl. immunization and
Family planning
HIV
Risk reduction, esp. among young people
Prevention of HIV, STIs
Voluntary counseling & testing
PMTCT (ARV prophylaxis)
Ongoing PMTCT, b’feeding counseling, ART for mother
Program Linkages
Health systems strengthening needs
SRH/MCH HIV/AIDS
Health workforce
Infrastructure
Commodities
Management/supervision
Health education/ community engagement
Health information system
Program/Policy Integration
Benefits of program/policy integration: principles
• Improved access and increased utilization of services
• Reduction of stigma and discrimination• Better protection of individuals’ rights• Improved quality of care• Greater program effectiveness/efficiency• Better utilization of health workforce
Program/Policy Linkages
Source: IPPF et al, “SRH and HIV Linkages: Evidence Reviews and Recommendations”
Focus on ‘health’ MDGs as a wholeWithin global mechanisms:• High Level Task Force for Innovative
International Financing for Health Systems• Secretary General’s Joint Action Plan for
Women’s & Children’s Health
Among major funding sources:• Health systems Platform (GAVI, GFATM, WB)• Global Fund Decision Point on MCH• USG’s Global Health Initiative, MASSIVEGOOD,
G8/Muskoka Initiative
Policy/Funding Integration
Annual funding shortfalls for the health MDGs, 2011-2015
Source: UN Secretary General’s Joint Plan of Action for Women’s and Children’s Health
Policy/Funding Integration
Effective funding mechanismsfor SRH/MCH-HIV
• Be responsive to country needs/plans, fill gaps• Reward performance/results• Minimize administrative burdens• Allow for multi-sectoral participation• Take a rights-based approach• Promote/facilitate integrated approaches• Strengthen health system capacity to provide high
impact, high quality care
Policy/Funding Integration
Possible discussion questions• Do we have enough evidence on
programmatic benefits of integrated approaches? Where/when does integration not work?
• What is the role of funding mechanisms? Is integrated funding necessary for integrated programming?
• Can the SRH/MCH and HIV communities come together effectively?
Come talk about the UNSG’s Joint Action Plan
Breakfast panel
When: Wednesday, July 21, 2010
7:30am – 9:00am
Where: Restaurant Waggon 31, near the Wheel
Panelists from: UNAIDS, UNFPA,
Civil Society