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Preventing AIDS Deaths Need Not Be a Fight: A Health Systems Approach

This post was originally published on the CapacityPlus blog.

In the Washington Post article “Rage, panic in AIDS fight”, David Brown alleges that the goal of health systems strengthening is “hard-to-define.” In fact, it is not.

Whatever the disease or health sector of priority—be it HIV/AIDS, malaria, family planning, labor and delivery, or pneumonia—six components of the health system must be functioning and integrated in order for health impacts to be maximized. These components are:

  • Service delivery
  • Medical products, vaccines, and technology
  • Financing
  • Health information systems
  • Leadership and governance
  • The health workforce—arguably most important of all.

The challenge has not been that health systems are hard to define, but rather that advocates for funding for specific diseases are generating parallel health systems that are not integrated, not sustainable, and not cost-effective.

While HIV/AIDS activists lobby for funding in the face of 2.5 million people who die each year from HIV/AIDS, Ezekiel J. Emanuel, President Obama’s special adviser for health policy, rightfully points out the 2.2 million children die each year from pneumonia, which can be prevented with a $1 vaccine. How do we choose between diseases to receive our attention and funding? Why must we? Why should those who fight to prevent maternal-to-child transmission of HIV compete with those who fight to ensure that all children are immunized against measles, tetanus, polio, etc.?

Alternatively, Emanuel articulates a rationale for a health systems focus in the Obama Administration’s Global Health Initiative (GHI):

What it takes to save lives of those with HIV and of those most at risk to contract it is a comprehensive approach that recognizes the roles of other diseases (many inexpensively preventable), child and maternal health, and strong health systems play in saving lives and solidifying health gains in developing nations.

The GHI’s focus on integrated and comprehensive care through a systems approach is the key to prevention of all diseases over the long term, for as Emanuel claims, “After all, patients don’t come to doctors with one disease or condition, and our response shouldn’t focus on one as well.”

Therein lies the cornerstone of the health system—the health worker. In one case, it is the doctor. In another case it could be the nurse, midwife, community health worker, pharmacist, or lab technician. Yet in every case, health workers are needed—the right ones in the right place at the right time.

CapacityPlus looks forward to playing an important role in supporting the Obama Administration to define and implement the GHI’s goals, strategies, and metrics for ensuring the success of the health systems focus and maximizing health outcomes and impact.