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OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Health Systems, HIV/AIDS and the Development Agenda in sub-Saharan Africa: Implications for Ageing.

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Presentation on theme: "OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Health Systems, HIV/AIDS and the Development Agenda in sub-Saharan Africa: Implications for Ageing."— Presentation transcript:

1 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Health Systems, HIV/AIDS and the Development Agenda in sub-Saharan Africa: Implications for Ageing Populations Dr Isabella Aboderin Oxford Institute of Ageing University Of Oxford

2 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Outline of Presentation Background: HIV/AIDS and older persons in sub-Saharan Africa (SSA) Health systems: Central role in mediating or underpinning impacts of HIV/AIDS on older people Pathways Recommendations

3 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Background: HIV/AIDS and older people in SSA SSA is the epicenter of the worldwide HIV/AIDS crisis. Home to 63% of all adults and children with HIV globally. (24.7 million in 2006) AIDS disproportionately kills adults in the prime of their lives. Key Impacts: Societal level: loss of human capital, labour productivity erodes capacity for economic growth Family level: affects well-being and life chances of all generations

4 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Background: HIV/AIDS and older people in SSA Rising international focus on impacts of HIV/AIDS on older persons (e.g. Valetta Declaration,Research Network on HIV/AIDS and the Elderly) Focus on: Older persons as carers of sick, orphaned or vulnerable kin (especially children and grandchildren) Loss of intergenerational support from younger generation kin Older people themselves infected with HIV/suffering from AIDS

5 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Health systems: central role These impacts hinge on (are underpinned or mediated by) the present functioning of health systems Also giving rise to additional indirect impacts of the HIV/AIDS epidemic on older persons Impacts linked to three key features of health systems: –Limited resource capacity –Core agendas and priorities for deploying health resources –Specific foci of HIV/AIDS related health programmes

6 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Health systems: limited resource capacity Health care delivery dysfunctional in most SSA countries following years of debilitating under-investment (in large part due to World Bank/IMF structural adjustment programmes) Expressed in dismal survival indicators: Life expectancy at birth in 2005 was 46.7 yearslower than in 1975 1 in 10 babies die before the age of 1 year; almost 2 in 10 die before the age of 5 years (UNDP, 2006; WHO, 2006)

7 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Health systems: limited resource capacity Central problem: extreme lack of financial and human resources

8 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Health systems: lacking financial resources Per capita government expenditure on health ($) per year At least $34 needed to achieve essential public heath interventions Nigeria6 Ghana5 Kenya8 Zimbabwe14 Uganda5 Belgium1,880 UK2,081 US2,548 Source: WHO, 2006

9 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Health systems: lacking human resources Human resource crisis – severe shortage of physicians and nurses (brain drain, rising demand) Doctors (per 1,000)Nurses (per 1,000) Nigeria0.281.7 Ghana0.150.9 Kenya0.141.14 Uganda0.080.61 Belgium4.495.83 UK2.3012.12 US2.569.37 Source: WHO 2006

10 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Health systems: lacking financial and human resources In worst hit countries, resource constraints exacerbated by HIV/AIDS: numbers seeking HIV-related care adding pressure on services HIV/AIDS treatment more costly than treatment for other diseases AIDS illness and death among health workers (e.g. Botswana lost 17% of health staff to AIDS between 1999-2005) Stress and low morale migration of health workers to OECD, Middle East, other SSA countries with lower HIV/AIDS prevalence

11 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Health systems: core agendas In recent years emergence of key international agendas to enhance health and/or health systems in SSA: –UN Millennium Development Goals (2000) –Abuja Declaration of Leaders of African Countries (2001) –2002 NEPAD Health Strategy (2002) –Commission for Africa Recommendations (2005) Pledges for increased health spending: African countries 15% of annual countries; Donor nations 0.7% of GNP (largely not yet met)

12 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Core priorities Crucially, agendas also set the priorities for deploying the resources that are available Highest Priority: Fight against HIV/AIDS, Tb and other infectious diseases (MDG 6) Economic Rationale: Tackling HIV/AIDS, Tb enhanced human capital, labour productivity, educational attainment to lead to economic growth (WHO, 2006, ILO, 2006)

13 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Specific foci of HIV/AIDS related health programmes Set by: UN Declaration of Commitment on HIV/AIDS & the MDGs (2001) Top four programme priorities: 1.Prevent HIV infection esp. among the young (15-24 yrs) 2.Stop mother to child transmission 3.Provide treatment to all those infected 4.Provide care to all whose lives are devastated by AIDS, esp. orphans

14 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing HIV/AIDS programmatic foci in practice 1.Expansion of Anti-Retroviral Treatment (ARV) (reduces complications, prolongs life, stops mother-child transmission) 2.Voluntary Counselling and Testing (VCT) 3.Support to families affected by AIDS, esp.orphans (e.g. Child support grants, Community Home-Based Care initiatives) Explicit and implicit focus on children and reproductive ages (15- 49 yrs)

15 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Health systems impacts: pathways We can identify four key pathways through which these key features of health systems mediate or cause the impacts of HIV/AIDS on older people Impacts on present and future cohorts of older people

16 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Impacts 1: Neglect of HIV/AIDS among current cohorts of older people

17 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Impacts 2. Creating extra care burdens for current cohorts of older people

18 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing I mpacts 3. Crowding out service provision for age-related non- communicable disease (NCD) among current cohorts of older people

19 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Impacts 4: Crowding out service provision for prevention of NCDs among future cohorts of older people

20 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Age Source:Aboderin, Kalache et al., 2002 PA: physical activity SEP: socio-economic position Accumulated Risk (Range) Development of NCD Fetal Life Adult Life Adolescence Infancy & Childhood SEP, diet, obesity, lack of PA, diseases, growth rate SEP, diet obesity lack of PA smoking SEP,established adult behavioural/biological risk factors SEP; birth weight, maternal nutrition status high low Life course and risk of CHD, stroke and diabetes

21 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Recommendations Efforts to address the impacts of HIV/AIDS on present and future cohorts of older people must focus on enhancing health systems Efforts need to hinge on: B

22 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Recommendations 1.Expansion of current HIV/AIDS programmatic foci to include: HIV/AIDS detection and treatment among age groups 50+ Adequate support (education, material, practical) to home-based care for AIDS sufferers

23 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Recommendations 2.Expansion of core priorities beyond MDG 6 (5,4) to include affordable measures to address NCDs : Primordial prevention: reduce exposure to risk-inducing environments (e.g. control sale/marketing of tobacco, alcohol, unhealthy foods) Primary Prevention (among children, youth, adults) (health promotion to encourage healthy lifestyles, possibly integrated with HIV/AIDS programmes) Management/secondary prevention of NCDs among older adults (Examples of successful low-cost programmes exist (WHO, 2006))

24 OXFORD INSTITUTE OF AGEING Oxford Institute of Ageing Thank you


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