Weak health systems and crises in Southern Africa: the impact on access and adherence to ARVs Alan Whiteside HEARD, UKZN &...
Three  Challenges T 1 T 2 Time Numbers A 1 A 2 Prevention B 1 A B Care & Treatment Impacts Source: Barnett, T. & Whiteside...
<ul><li>Public sector strike in SA at time of treatment roll-out </li></ul><ul><ul><li>There will be problems with deliver...
<ul><li>Treatment interruptions pose a problem for: </li></ul><ul><ul><li>The individual – increased risks of illness and ...
<ul><li>Weak Health Systems </li></ul><ul><li>Weak health systems limit access and adherence to ART: </li></ul><ul><ul><li...
<ul><li>Three Crises </li></ul>Situation Date Localised/ Widespread Short term/ long term Floods in Mozambique 2007 Locali...
<ul><li>Results </li></ul>
<ul><li>Results </li></ul><ul><li>Strategies to manage crises were typically less than effective </li></ul><ul><li>Major b...
<ul><li>Conclusions 1 </li></ul><ul><li>Crises amplify weak health systems, therefore: </li></ul><ul><ul><li>Strengthen he...
<ul><li>Conclusions 2 </li></ul><ul><li>Not just in southern Africa though: </li></ul><ul><ul><li>Air travel ban because o...
<ul><li>Acknowledgements </li></ul><ul><li>The co-authors of this work are: </li></ul><ul><ul><li>Nina Veenstra (HEARD) </...
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Countdown to 2015: Whiteside 2010

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Countdown to 2015: Weak health systems and crises in Southern Africa: the impact on access and adherence to ARVs.
Alan Whiteside
HEARD, UKZN and ABBA

Published in: Health & Medicine
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Countdown to 2015: Whiteside 2010

  1. 1. Weak health systems and crises in Southern Africa: the impact on access and adherence to ARVs Alan Whiteside HEARD, UKZN & ABBA
  2. 2. Three Challenges T 1 T 2 Time Numbers A 1 A 2 Prevention B 1 A B Care & Treatment Impacts Source: Barnett, T. & Whiteside, A. (2006) AIDS in the Twenty-First Century. Palgrave MacMillan
  3. 3. <ul><li>Public sector strike in SA at time of treatment roll-out </li></ul><ul><ul><li>There will be problems with delivery, they may not be predicted in any given setting they can be predicted globally. (insurance) </li></ul></ul><ul><ul><li>Other examples </li></ul></ul><ul><ul><ul><li>violence and governmental breakdown – Zimbabwe and Kenya </li></ul></ul></ul><ul><ul><ul><li>Natural disaster </li></ul></ul></ul><ul><ul><li>Individual and population consequences. </li></ul></ul><ul><li>Capacity to look at this and some money to pay. Nina and Andy of HEARD, David Lalloo of LSTM </li></ul><ul><li>Literature review then field work </li></ul><ul><li>Output – publications and policy work </li></ul><ul><li>The story of the study: why RPCs work </li></ul>
  4. 4. <ul><li>Treatment interruptions pose a problem for: </li></ul><ul><ul><li>The individual – increased risks of illness and death </li></ul></ul><ul><ul><li>Public health – emergence of drug resistant viral strains of HIV </li></ul></ul><ul><li>NNRTI-regimens in particular (used most commonly in SSA), drug resistance can develop after unplanned treatment interruptions of just a few days </li></ul><ul><li>Treatment Interruptions </li></ul>
  5. 5. <ul><li>Weak Health Systems </li></ul><ul><li>Weak health systems limit access and adherence to ART: </li></ul><ul><ul><li>Small numbers of doctors and nurses - reduce number of people on treatment </li></ul></ul><ul><ul><li>Limited management and planning skills – e.g. ARV stock outs in Free State, South Africa </li></ul></ul><ul><ul><li>Underfunded health systems – impose ‘user-fees’ for certain treatments and tests </li></ul></ul>
  6. 6. <ul><li>Three Crises </li></ul>Situation Date Localised/ Widespread Short term/ long term Floods in Mozambique 2007 Localised Short term Socioeconomic collapse in Zimbabwe Early 2000s onwards Widespread Long term Public Sector strike in South Africa 2008 Widespread Short term
  7. 7. <ul><li>Results </li></ul>
  8. 8. <ul><li>Results </li></ul><ul><li>Strategies to manage crises were typically less than effective </li></ul><ul><li>Major barriers were: </li></ul><ul><ul><li>Limited patient information and tracking </li></ul></ul><ul><ul><li>Poor management of crises by government </li></ul></ul><ul><ul><li>Patient migration (internal and international) </li></ul></ul><ul><ul><li>Limited number of healthcare workers </li></ul></ul>
  9. 9. <ul><li>Conclusions 1 </li></ul><ul><li>Crises amplify weak health systems, therefore: </li></ul><ul><ul><li>Strengthen health systems generally; </li></ul></ul><ul><ul><li>Identify and support existing approaches to managing crises. Where these do not exist, develop innovative ways of responding; </li></ul></ul><ul><ul><li>Provide information (SA HIV Clinicians Society particularly good at this) . </li></ul></ul>
  10. 10. <ul><li>Conclusions 2 </li></ul><ul><li>Not just in southern Africa though: </li></ul><ul><ul><li>Air travel ban because of ash </li></ul></ul><ul><ul><li>Romania – recent ART shortages </li></ul></ul>
  11. 11. <ul><li>Acknowledgements </li></ul><ul><li>The co-authors of this work are: </li></ul><ul><ul><li>Nina Veenstra (HEARD) </li></ul></ul><ul><ul><li>David Lalloo (Liverpool School of Tropical Medicine) </li></ul></ul><ul><ul><li>Andrew Gibbs (HEARD) </li></ul></ul>

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