International Treatment Preparedness Coalition (ITPC) Treatment Monitoring

1
International Treatment Preparedness Coalition
(ITPC)Treatment Monitoring Advocacy Project
2
Why monitoring through Missing the Target (MTT)?

• Started with need to track 3 by 5 initiative
  from a civil society perspective
• Recognition scale up dependent on politics,
  money and implementation issues
• Need to make governments and global agencies
  accountable for progress
• Focus on outcomes, identify specific barriers
  be solution-oriented
• Inform advocacy with objective research

3
Research Approach and Methods

• Civil society teams based in countries
• Standardized research template
• Research based on confidential interviews with
  diverse informants civil society, local and
  national government, health workers, policy
  makers
• Centralized editing, coordination, global and
  domestic media
• Focus on recommendations to change national
  policies and response of global agencies

4
MTT 1, 2 3 Findings

• November 2005, May 2006, November 2006
• Reports cover Dominican Republic, India, Kenya,
  Nigeria, Russia, South Africa
• Lack of urgent, global strategic plan driving HIV
  treatment scale up
• Inadequate national leadership in response to ARV
  treatment access gap
• Specific barriers (and solutions)
• Technical support needs of government and civil
  society unmet
• Pervasive HIV-related stigma
• Very limited or no connections between HIV and TB
  responses

5
Findings MTT 4 5

• July 2007, November 2007
• New countries join Morocco, Pakistan, Uganda,
  China, Belize, Cameroon, Kenya, Cambodia,
  Argentina, Zambia, Zimbabwe, Malawi, Philippines
• Need for increased attention to marginalized
  populations, supportive services including
  nutrition, human resources, free access to
  medications and testing, integration of
  prevention and treatment services
• MTT 5 documents that treatment regimens in many
  countries do not meet new WHO standards for 1st
  and 2nd line care

6
MTT Outcomes

• The report ignited a debate with policy makers.
• The reporting process strengthened the network
  of PLWHA and focused the efforts of treatment
  advocates.
• The scrapping of user fees for ARVs followed
  recommendations we made in the report.
• The report has opened up dialogue with the AIDS
  and TB program in the Ministry of Health.
• Informs domestic and international media coverage
  and dialogue on AIDS
• Recommendations endorsed by The Lancet covered
  in The New York Times, FT, IHT as well as
  national media in the countries studied

7
(No Transcript)
8
MTT 6 AIDS and Health Systems

• Six civil society country research teams in
  Zambia, Zimbabwe, Uganda, Dominican Republic,
  Argentina, Brazil
• Country teams selected through competitive
  process based on demonstrated capacity, expertise
  
• Project coordinators also strive for geographic
  representation

9
MTT 6 Methodology

• Interviews and focus groups using standardized
  questionnaires
• Questionnaire template developed in collaborative
  process with all country teams participating
• Respondents People with HIV, grassroots level
  key informants, hospital administrators,
  government officials (disease specific and health
  in general), caregivers, health workers, national
  heads of multilateral agencies, national civil
  society, etc.
• Literature review, including of key national
  health documents (eg Ugandas HSSP II)

10
MTT 6 Main findings

• AIDS response has far-reaching positive impacts
  on health care service access building
  infrastructure, raising quality, and extending
  the reach of health care to socially marginalized
  groups (eg sexual minorities, drug users,
  migrants, poorest)
• AIDS response has revealed existing fragilities
  in health systems in some cases has increased
  burdens on systems because AIDS response has not
  yet been used to create additional capacity (eg
  GHIs rarely used to fund additional health
  workers)

11
MTT 6 Main findings

• Engaging advocates and health consumers has
  increased accountability and urgency of response
• Expansion of resources requires simultaneous work
  to increase on human resources, transparency, and
  strengthen infrastructure
• Untapped opportunities to improve broader
  delivery of comprehensive primary health care
  services using GHI funding
• Scaling up coverage in rural/peri urban/remote
  areas extremely challenging must use GHIs to
  strengthen health systems in order to extend
  impact of AIDS programs

12
MTT 6 Main findings

• Civil society plays a vital role in helping
  service users demand their health rights and in
  providing HIV and health care services
• External funding for HIV can result in a country
  viewing HIV treatment programs as separate from
  health system, undermining integration--no
  requirement by GHIs to do so

13
Positive Synergies

• Civil society involvement in monitoring,
  governance and implementation at the country
  level
• Civil society identifies existing opportunities
  that are not being used to leverage positive
  synergies, using funding to fight AIDS while
  improving health outcomes for the larger
  communities
• In particular, health worker shortages critical
  barrier in countries studied, while GHI funding
  not used to address problem

14
MTT 7 to be released Oct. 6
15
Where to next?

• Budget monitoring training for all teams in Cape
  Town and Bangkok in 2008
• One minute audio comments by all CCM Advocacy
  report researchers on itpcglobal.org
• MTT 7 on PMTCT (6 countries) March 09
• Goals for the future
• Closer tie to advocacy all teams to implement
  advocacy plans
• Fully integrated research and monitoring,
  advocacy, and ongoing capacity building,
  mentoring and training for country teams
• Integration of budget monitoring and other skills
• Advocate on access to health services while
  keeping AIDS focus

16
www.itpcglobal.orgwww.aidstreatmentaccess.org
17
MTT 6 Uganda

• AIDS claims the biggest share of health financing
  of any single disease in the country
• Massive inflow of funds from foreign donors for
  AIDS programs has resulted in broader
  improvements to public health but significant
  additional funding is needed to meet health care
  needs
• AIDS programs have improved community
  mobilization, including TB and village health
  teams
• Limited successful examples of integrating AIDS
  care into primary health care services

18
MTT 6 Uganda

• AIDS has placed increased workload and strain on
  medical personnelwhose numbers have not
  increased proportionally to the demandand on
  existing weak infrastructure
• Personnel working in often AIDS are better paid,
  and their facilities better equipped leading to
  further attrition
• An increase in AIDS funding has not led to the
  efficient delivery of services and commodities
  (eg stock-outs persist)

19
MTT 6 Uganda

• Urgent need to train and equip health workers and
  devolve ARV treatment to lower-tier health
  facilities, engaging communities in health
  service delivery and planning

20
MTT 6 Zambia

• Ongoing ART roll out has reduced HIV related
  hospital admissions, reducing workloads
• Basic health services and supplies still not
  available in public system, forcing poor patients
  to go without
• Serious health worker shortage exacerbated by
  IMF-imposed conditionalities

21
MTT 6 Zambia

• High reliance on donor support, often
  conditional, but donor funds not being used to
  increase capacity of local health workers and
  implementers, or increase overall number of
  health workers
• Donors should train additional health workers to
  compensate for those hired from the public system
  to work in their projects
• Low levels of community mobilization to demand
  better access to comprehensive health care
  services