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Positive spill-over effects of ART scale up on wider health systems development: evidence from Ethiopia and Malawi
BACKGROUND: Global health initiatives have enabled the scale up of antiretroviral treatment (ART) over recent years. The impact of HIV-specific funds and programmes on non-HIV-related health services and health systems in genera has been debated extensively. Drawing on evidence from Malawi and Ethio...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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The International AIDS Society
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194148/ https://www.ncbi.nlm.nih.gov/pubmed/21967809 http://dx.doi.org/10.1186/1758-2652-14-S1-S3 |
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author | Rasschaert, Freya Pirard, Marjan Philips, Mit P Atun, Rifat Wouters, Edwin Assefa, Yibeltal Criel, Bart Schouten, Erik J Van Damme, Wim |
author_facet | Rasschaert, Freya Pirard, Marjan Philips, Mit P Atun, Rifat Wouters, Edwin Assefa, Yibeltal Criel, Bart Schouten, Erik J Van Damme, Wim |
author_sort | Rasschaert, Freya |
collection | PubMed |
description | BACKGROUND: Global health initiatives have enabled the scale up of antiretroviral treatment (ART) over recent years. The impact of HIV-specific funds and programmes on non-HIV-related health services and health systems in genera has been debated extensively. Drawing on evidence from Malawi and Ethiopia, this article analyses the effects of ART scale-up interventions on human resources policies, service delivery and general health outcomes, and explores how synergies can be maximized. METHODS: Data from Malawi and Ethiopia were compiled between 2004 and 2009 and between 2005 and 2009, respectively. We developed a conceptual health systems framework for the analysis. We used the major changes in human resources policies as an entry point to explore the wider health systems changes. RESULTS: In both countries, the need for an HIV response triggered an overhaul of human resources policies. As a result, the health workforce at health facility and community level was reinforced. The impact of this human resources trend was felt beyond the scale up of ART services; it also contributed to an overall increase in functional health facilities providing curative, mother and child health, and ART services. In addition to a significant increase in ART coverage, we observed a remarkable rise in user rates of non-HIV health services and an improvement in overall health outcomes. CONCLUSIONS: Interventions aimed at the expansion of ART services and improvement of long-term retention of patients in ART care can have positive spill-over effects on the health system. The responses of Malawi and Ethiopia to their human resources crises was exceptional in many respects, and some of the lessons learnt can be useful in other contexts. The case studies show the feasibility of obtaining improved health outcomes beyond HIV through scaled-up ART interventions when these are part of a long-term, system-wide health plan supported by all decision makers and funders. |
format | Online Article Text |
id | pubmed-3194148 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | The International AIDS Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-31941482011-10-17 Positive spill-over effects of ART scale up on wider health systems development: evidence from Ethiopia and Malawi Rasschaert, Freya Pirard, Marjan Philips, Mit P Atun, Rifat Wouters, Edwin Assefa, Yibeltal Criel, Bart Schouten, Erik J Van Damme, Wim J Int AIDS Soc Research BACKGROUND: Global health initiatives have enabled the scale up of antiretroviral treatment (ART) over recent years. The impact of HIV-specific funds and programmes on non-HIV-related health services and health systems in genera has been debated extensively. Drawing on evidence from Malawi and Ethiopia, this article analyses the effects of ART scale-up interventions on human resources policies, service delivery and general health outcomes, and explores how synergies can be maximized. METHODS: Data from Malawi and Ethiopia were compiled between 2004 and 2009 and between 2005 and 2009, respectively. We developed a conceptual health systems framework for the analysis. We used the major changes in human resources policies as an entry point to explore the wider health systems changes. RESULTS: In both countries, the need for an HIV response triggered an overhaul of human resources policies. As a result, the health workforce at health facility and community level was reinforced. The impact of this human resources trend was felt beyond the scale up of ART services; it also contributed to an overall increase in functional health facilities providing curative, mother and child health, and ART services. In addition to a significant increase in ART coverage, we observed a remarkable rise in user rates of non-HIV health services and an improvement in overall health outcomes. CONCLUSIONS: Interventions aimed at the expansion of ART services and improvement of long-term retention of patients in ART care can have positive spill-over effects on the health system. The responses of Malawi and Ethiopia to their human resources crises was exceptional in many respects, and some of the lessons learnt can be useful in other contexts. The case studies show the feasibility of obtaining improved health outcomes beyond HIV through scaled-up ART interventions when these are part of a long-term, system-wide health plan supported by all decision makers and funders. The International AIDS Society 2011-07-06 /pmc/articles/PMC3194148/ /pubmed/21967809 http://dx.doi.org/10.1186/1758-2652-14-S1-S3 Text en Copyright ©2011 Rasschaert et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Rasschaert, Freya Pirard, Marjan Philips, Mit P Atun, Rifat Wouters, Edwin Assefa, Yibeltal Criel, Bart Schouten, Erik J Van Damme, Wim Positive spill-over effects of ART scale up on wider health systems development: evidence from Ethiopia and Malawi |
title | Positive spill-over effects of ART scale up on wider health systems development: evidence from Ethiopia and Malawi |
title_full | Positive spill-over effects of ART scale up on wider health systems development: evidence from Ethiopia and Malawi |
title_fullStr | Positive spill-over effects of ART scale up on wider health systems development: evidence from Ethiopia and Malawi |
title_full_unstemmed | Positive spill-over effects of ART scale up on wider health systems development: evidence from Ethiopia and Malawi |
title_short | Positive spill-over effects of ART scale up on wider health systems development: evidence from Ethiopia and Malawi |
title_sort | positive spill-over effects of art scale up on wider health systems development: evidence from ethiopia and malawi |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3194148/ https://www.ncbi.nlm.nih.gov/pubmed/21967809 http://dx.doi.org/10.1186/1758-2652-14-S1-S3 |
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