INTEGRATING HIV IN DEVELOPMENT PLANNING

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INTEGRATING HIV INDEVELOPMENT PLANNING

• By
• Rafiqul Huda Chaudhury
• August 2003

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INTEGRATING HIV INDEVELOPMENT PLANNING

• 1.0 Definition
•  
• Integration can be defined in both functional and
  organizational term.

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• In functional term it is a series operations
  concerned with bringing together otherwise
  independent administrative structures, and
  functions in such a way as to combine these into
  a whole.
• In organizational terms, integration means
  bringing together those services necessary for
  the health protection/poverty reduction and
  provided under a single administrative unit or
  under several agencies with proper provision for
  their coordination.

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• 2.0 Why to Integrate HIV/AIDS Prevention into
  National/Sectoral Development Planning
•  
• HIV/AIDS is a development issue and therefore it
  should be integrated into national, sectoral and
  local development planning.

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• It is closely linked to broader aspects of
  development and its role in spreading the
  infection and the impact on sustainable
  development.
• Because of its impact on individuals and
  families, HIV/AIDS is a threat to agriculture and
  rural development, to business and the labour
  force, and overall health and economic
  development.

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• High numbers of young and productive members of
  society becoming infected with HIV will impact on
  the welfare of children and the elderly, thus
  engendering greater social costs for communities
  and governments.
• To reduce the burden of HIV/AIDS, prevention
  campaigns require national development inputs,
  most notably financial and human resources. These
  can only be met if the country is on a stable
  development path.

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• Government cannot improve development indicators,
  including MDG and ICPD goals, if it cannot
  demonstrate a reduction in HIV/AIDS and its
  socio-economic impact.
• Working at national and local levels to achieve
  improvement in development indicators such as
  better rights, more access to education or lower
  fertility can also contribute to HIV/AIDS
  prevention and impact reduction.

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• 3.0 Context of National Development Planning
•  
• Once the need to integrate HIV/AIDS prevention in
  national population/development is realized, the
  next step is to determine how it should be
  positioned within the context of national
  development planning framework or approach.

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• There are various approaches to development
  planning centralized planning, sectoral
  planning, inter-sectoral planning and holistic
  planning. Each requires a set of distinct
  HIV/AIDS prevention strategies.

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An outline of HIV/AIDS prevention strategies in
the context of a national development planning.
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• Thai Experience of Holistic Approach
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• HIV/AIDS problem which was affecting the quality
  of life of all of the Thai people. Special
  attention was therefore placed on the following
  elements, which also demonstrated the
  interrelatedness of the HIV/AIDS situation with
  that of the nation's development as a whole.

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• Build on the capacity of the people and target
  groups in particular to bring about increased
  public awareness of HIV/AIDS convince people to
  change behaviours that put them at risk of
  infection.
• Generate a positive socio-economic environment,
  which would diminish the risk of infection,
  including, e.g., rural job creation to reduce
  poverty, advocating safe and appropriate
  recreational activities, abating the use of
  sexually provocative programmes and
  advertisements in the media and in "selling"
  entertainments venues.

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• Promote greater comprehensive delivery of health
  care and health services for people living with
  HIV/AIDS, improve the attitudes and care-giving
  abilities of hospital staff at all levels
  strengthen the capacity of communities and
  families to care for people living with HIV/AIDS.
• Mitigate the socio-economic impacts of AIDS,
  e.g., by providing suitable vocational training
  and social welfare services for people living
  with AIDS and their families, particularly those
  in difficult social and economic circumstances.

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• Strategies Developed to Deal with the HIV/AIDS
  Crisis
•  
• 1. Strategies for developing the potential of
  the individual, the family and community in
  prevention and alleviation the AIDS problem.
•  
• 2. Strategies for developing the social
  environment to be conducive to prevention and
  alleviation of the AIDS problem.

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• 3. Strategies for psycho-social development that
  will enable persons living with HIV/AIDS lead a
  normal life within the society.
•  
• 4. Strategies for modifying basic components of
  the social and economic systems to be more
  effective in dealing with the AIDS problem.
• 5. Strategies for applying health promotion and
  targeting medical care services.

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• 6. Strategies for utilizing cultural wisdom and
  available knowledge and promoting relevant
  research.
•  
• 7. Strategies for enhancing international
  cooperation.
• 8. Strategies for revising and strengthening the
  managerial process and related mechanisms.

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Checklist for mainstreaming HIV/AIDS in poverty
reduction strategies
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Source Modified from UNDP (2002a).
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Check-list for Integrating HIV/AIDS in Education
Sector

• A. Loss of Human Resources
• How does HIV/AIDS affect supply of teachers and
  other school staff, e.g., headmasters, school
  managers, teacher trainers, and Ministry staff at
  different levels?

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• Is staff planning built on good estimates of
  current and expected mortality and morbidity
  among school staff?
• How many classes have lost their teachers? What
  is the trend of the student/teacher ratio?

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• Are certain geographical areas more affected than
  others? How can these areas be supported?
• Has there been a change in the policy to post
  teachers e.g. close to home or with their
  families?

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• B. Fewer Pupils
•  
• Have enrolment rates declined? School attendance?
  Have drop out rate gone up? How are girls and
  boys, respectively, affected?
•  
• What regions are hardest hit?

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• Is there a policy to secure that AIDS-orphans
  continue school?
• Has the school system changed to facilitate for
  vulnerable children to attend school e.g.
  flexible hours to meet labour needs, school
  feeding, school health, help with homework?

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•  
• Are there any innovative activities such as
  school based programmes for income generation?
• What do schools do to enhance the pupils'
  possibilities to practice what they learn about
  protecting themselves against HIV?

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• C. HIV/AIDS Education
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• Is there a compulsory HIV/AIDS education policy?
  Does it cover teachers, other personnel and
  pupils?
• Is HIV/AIDS part of compulsory teacher training?
  In-service training?

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• Does HIV-teaching start before pupils are
  sexually active/start drug injecting behaviour?
•  
• Is there resistance or support from the
  community/parent associations to HIV/AIDS
  education at primary level?
• Has coverage and effectiveness of HIV prevention
  and life skills programmes been evaluated? Have
  they been strengthened wherever appropriate?

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• D. Community Involvement
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• Can schools become centers for dissemination of
  HIV/AIDS information?
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• Is there any established cooperation between the
  community and school?
• How can schools reach out-of-school youth with
  preventive education?

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• E. Reduced Financial Resources
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• How can you ensure that pupils learn what they
  should, in spite of HIV/AIDS?
•  
• How are the finances of the education system
  income and/or expenditure affected by HIV/AIDS?

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• Has AIDS led to any changes in the government
  budget to the education sector?
• Will funding from the community and parents
  decrease?
•  
• Are funds tied down by salaries for sick,
  inactive teachers and other staff, financial
  support to dependants, funerals, etc.?

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• What do other donors do in relation to HIV/AIDS
  and education?
• How is coordination taking place UN, bilateral,
  NGOs?

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Check-list for Integrating HIV/AIDS in Health
Sector

• A. More Patients
•  
• Does the number of patients increase at clinics
  and hospitals? What is the male/female ratio?
  Does the length of stay increase?
•  
• Are disease increasingly HIV-related? Does
  mortality in hospitals increase?

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• Is there any plan nationally, regionally,
  locally to handle increasing number of patients?
• At what level of care are HIV/AIDS patients cared
  for?

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•  
• How does the public health care co-operate with
  community based care?
• Are women recognized for their role as health
  care providers?

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• B. Additional Tasks
•  
• Prevention
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• What resources are spent on prevention of STD?
  Urban/rural areas? Efforts to reach the poorest?
  People with risk behaviours?
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• What does the health services do to reach young
  people boys and girls, respectively?

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• Is there access to drugs to prevent
  HIV-transmission from mother to child?
• Has the health system in any way adapted to
  increasing numbers of AIDS orphans?
•  
• Can the health sector reach commercial sex
  workers with information, counseling and service?

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•  How can the health service get involved in
  activities against sexual coercion?
• Are there any harm reduction programmes for
  intravenous drug users?

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• Treatment
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• Have guidelines for prescription of drugs been
  adapted to the situation caused by HIV/AIDS?
• What is the official policy towards
  antiretroviral treatment (ARV)? How is the real
  situation?

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• How is the access to drugs against opportunistic
  infections?
• How are TB-patients treated? Are there any
  special efforts directed towards the poors?

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• Coordination
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• How does the health sector at various levels
  cooperate with schools, work-places and other
  sectors in societies in order to prevent
  HIV/AIDS?
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• How does the health sector cooperate with the
  traditional health sector?

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• How are different actors coordinated? How is
  communication handled between care-givers in the
  public and private sector, traditional health
  care, pharmacies?

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• Loss of Human Resources
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• How has training plans for doctors, nurses etc.
  been affected by HIV/AIDS?
•  
• Has training of different staff categories in the
  health sector increased? Been reduced? Is it
  unchanged?

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• Is there any plan on how to meet increased staff
  turnover?
• Is there a policy on testing of health staff? How
  is HIV-infected staff being treated helped to
  continue work, supported, fired?
• What kinds of HIV/AIDS preventive information and
  services do staff get for themselves?

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•  Do staff have access to post-exposure
  prophylactics? How can HIV-infected staff be
  protected against TB infection? Prophylactics?
  Can health staff get access to ARV?
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• How do you address "burnout" among health staff?
• How has staff policies been affected by HIV/AIDS
  has the staff placement policy changed?

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• Financial Situation
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• How has the national health budget accommodated
  HIV/AIDS?
• What other important actors provide support to
  the health sector for HIV/AIDS? How?

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• What should UNFPA do?
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• Advocacy
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• Promote and/or support efforts at the country
  level to increase leaders' awareness of the need
  for strong multi-sectoral HIV/AIDS prevention
  policies and programmes.

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• Promote and/or support evidence based policy
  dialogues at different levels to operationalize
  the findings of data collection and research
  initiatives on HIV/AIDS related issues,
  especially its impact on poverty and the MDG
  targets.

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• Technical Support
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• Advice and technical support to preparation of a
  broad, clear national strategy for HIV/AIDS
  prevention.
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• Advice and technical support to integration of
  HIV/AIDS into national and sectoral development
  frameworks, including PRSPs, CCA, UNDAF, national
  budget and sectoral development plans,
  projections and impact assessment.

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• Advice and technical support in designing,
  monitoring and evaluation systems to ensure
  providing timely results to programme managers,
  procedures and mechanisms for tracking financial
  resources spent on HIV/AIDS.

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• Thank You!

G\Rafiqul\Hiv_AidsIntegrating_Dev_Planning, 26
August 2003