Health and Development Impact and Multisectoral Strategies

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Health and DevelopmentImpact and Multisectoral
Strategies

• Ishrat Z. Husain
• HIV/AIDS and Development Workshop
• April, 28,2003

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Overview

• Health and Development Relationship
• Impact of HIV/AIDS on Health
• Implications of deteriorating health status on
  development prospects.
• What each sector could do to improve health and
  achieve its own strategic objectives.
• Lessons Learnt from USAID efforts in implementing
  multisectoral programs.

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Health and Development

• Health is a necessary though not a sufficient
  condition of development or of attaining Agencys
  Strategic Objectives
• Productivity of workers depends on good health-
  growing evidence of decline in productivity due
  to HIV/AIDS and malaria
• Loss of labor force and absenteeism due to
  HIV/AIDS and other diseases
• Increase in poverty and inequities due to
  morbidity and mortalilty.

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Development and Health

• Development is an essential although not a
  sufficient condition for improving health.
• Imperative of having adequate water supply,
  sanitation, basic education, information and
  nutrition for maintaining health.
• Development process creates conditions of ill
  health such as population mobility and inequities
  in income making populations vulnerable.

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HIV/AIDS Impact on Health Systems

• Already weak system is now devastated
• Crowding out- 48-70 of hospital beds are
  occupied by PLWAs in Zambia and Malawi
  respectively
• Reallocation of budgets- A large part of the
  budget has to be allocated for drugs
• Antiretroviral treatment costs over 500 per
  patient.
• Loss of Manpower- Attrition of over 20 of the
  nurses

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Impact of HIV/AIDS on Health Status

• Child mortality is increasing. USAID invested
  heavily in child survival programs
• Average life expectancy in sub-Saharan Africa is
  now 47 years, when it would have been 62 years
  without AIDS (UNAIDS, 2002).
• Level of living is the indicator of level of
  development.

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Declining life expectancyChanges in life
expectancy in selected African countries with
high and low HIV prevalence 1950-2005
Source UNAIDS, 2002. Report on the global
HIV/AIDS epidemic
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Implications for Economic Development

• 10-30 loss of workforce for all sectors in high
  prevalence countries
• Loss of rare skills and productivity in key
  strategic areas agriculture, education, DG, and
  health
• The age and sex structures are changing, implying
  a profound shift in economic and social
  relationship

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(No Transcript)
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Current and projected age profiles of workers in
a typical South African mine
The Impact of HIV and AIDS on Africa's Economic
Development BMJ 2002324232-234
( 26 January )
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Impact of HIV/AIDS on Women and Girls
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What Each Sector Can Do?

• Mitigate the impact of poor health and HIV/AIDS
  on the sector itself.
• Guard against future losses or help prevent the
  diseases by
• Conveying the prevention messages through its own
  channels such as teachers union.
• Addressing the basic determinants of the diseases
  such as low education, inequities

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What Each Sectors Can Do?-

• Illustrative Actions- National level
• Assess the impact of major diseases on the sector
  or strategic objectives
• Develop strategic plans that take into account
  the future impact.
• Review and modify policies that have adverse
  impact on health.

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What Sectors Can Do?

• At the community level
• Develop and implement programs to address the
  basic determinants of health either individually
  or jointly with other sectors focusing on
  vulnerable groups
• Youth/orphans
• Women

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Successes - Zambia

• Zambia is a best practice country for the
  adoption of a multisectoral program
• USAID/Zambia has developed an HIV/AIDS
  Multisectoral Strategic Framework
• Embassy wide HIV/AIDS Coordination Group
• HIV/AIDS and Orphan Working Group- participation
  from each Strategic Objective

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Successes South Africa

• Parliamentarian training for private sector
  mobilization
• The Mission also encourages microenterprise
  programs, some of which are being linked to
  private sector programs
• USAID Mission has adopted economic growth
  strategies that will help reduce inequities in
  income by generating employment for vulnerable
  groups.

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Successes - Uganda

• In 1993, Uganda adopted a multisectoral approach
• 12 ministries are involved in responding to
  HIV/AIDS problems from their vantage point
• The involvement of different ministries created
  national ownership and commitment
• Each sector adopted policies and programs to
  support HIV/AIDS programming

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Zimbabwe Project LEAD

• Implementing a household garden and nutrition kit
  aimed at improving the nutritional status of
  household income of families affected by AIDS.
• The kit allows families to create and maintain
  close-in gardens growing crops to increase number
  of harvests per year
• Voucher system to link AIDS-affected families
  to legal services

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What the Health Sector Should Do?

• Health Sector focused on care and cure and not on
  prevention. If it acted like a private company
  the focus will be on prevention of major
  epidemics.
• Health sector itself responsible to spread the
  epidemic through infected needles and blood.

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What the Health Sector Could Do?

• Greater focus on systematic health system
  strengthening.
• Serious efforts to harnessing the energies of
  other sectors to improve health
• Multisectoral efforts are confined to HIV/AIDS
  thus far and can be extended to Health.

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Lessons Learnt from Multisectoral Efforts

• Success is defined by 3 Cs.
• Commitment- AFR organized two consultative
  meeting and SOTA courses on Multisectoral
  approaches. It generated Champions. Country level
  success also associated with the commitment of
  the Diretor
• Coordination- A multisectoral working groups
  chaired by the Director to bring coordination and
  synergy.

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Lessons Learnt

• Concerted Actions- Geographic focus for
  mutisectoral efforts is important as truncated
  actions do not produce results.
• Best practice examples Zambia, South Africa and
  Zimbabwe.

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Lessons Learned (3)

• Funding constraints- possible solutions
• Use of DA funds as HIV/AIDS prevention will save
  cost
• Health and HIV/AIDS Activities three kinds
• Little or no additional funding e.g. policy
  dialogue
• Modest Funds e.g.analytical work relocation of
  activities
• Large Funds leveraging other donor funds
• Establishment of Multisectoral Fund

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Conclusion

• Commitment, Coordination and Concerted Actions
  are needed to
• Strengthen the health systems
• Create conditions for improved health outcome by
  addressing the basic determinants of health
  through multisectoral efforts