Trends in HIV/AIDS Programs and Child Mortality

Trends in HIV/AIDS Programs and Life Expectancy

Impact at Bubonong Primary hospital (Secure the Future, BMS) HIV/AIDS mortality reduced from 25% to 13% from 2004 to 2006 Reduction in hospital bed occupancy by HIV/AIDS patients from 93% to 52% from 2004 to 2006

Impact in Uganda In rural setting in Eastern Uganda with ART and clean water program delivered through lay HCW: -95% reduction in HIV/AIDS mortality -81% reduction in non-HIV infant mortality -93% reduction in orphanhood Mermin et al, Lancet 2008

The Power of Partnerships: Building Capacity PEPFAR estimates its investment in network development, human resources and local organizational capacity development and training in FY 2007 is roughly $640 million. PEPFAR partnered with 2,217 local organizations in FY 2007— up from 1,588 in 2004 — and 87 percent of partners were local. In FYs 2006 and 2007, PEPFAR provided approximately $321 million to support training activities. In FY 2008, PEPFAR plans to provide an additional $309 million for training activities. A preliminary evaluation by the Rwandan Ministry of Health found that 40 percent of PEPFAR resources in the country were devoted to general health systems

The Power of Partnerships: Building Capacity PEPFAR partnered with the WHO and UNAIDS to develop and launch the first ever normative guidelines for task shifting to assist countries to rapidly expand the health workforce In April 2008, the US and the UK announced a partnership between PEPFAR and DFID and the Ministries of Health in Ethiopia, Kenya, Mozambique and Zambia, to increase the number of health workers to provide essential services, including HIV/AIDS care and interventions to reduce maternal mortality. In FY 2008, PEPFAR plans to support 2.7 million training encounters and salaries for over 110,000 health care workers. In FY 2009, countries may use $6 million or 3% of the total PEPFAR country budget to support long term pre-service training for new health professionals.

The Power of Partnerships: Strengthening Systems In a study of 33 PEPFAR-supported sites providing antiretroviral treatment and associated care in 4 countries, PEPFAR supported 92% of the systems strengthening investments at a typical facility. Source: PEPFAR Fourth Annual Report to Congress, 2008.

PEPFAR Support Provided through the Public Sector Partner Public-Private Government Private NGO Africa Centre X Africare American Internal Health Alliance (AIHA) Absolute Return for Kids (ARK) Aurum Health Institute BroadReach HealthCare CAPRISA (University of KwaZulu-Natal) Columbia University Catholic Relief Services (CRS) Eastern Cape Regional Training Centre (ECRTC) Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) Foundation for Professional Development (FPD) HIVCare Medical Research Council (MRC) Phidisa/SA Military Health Services Perinatal HIV Research Unit (PHRU) Reproductive Health Research Unit (RHRU) Right to Care Rational Pharmaceutical Management (RPM Plus) Solidarity Center Quality Assurance Project (QAP) Integrated Primary Healthcare Project (IPHC)

Leveraging HIV Improvements for General Health A study by Family Health International at 30 primary health centers in Rwanda examined 22 non-HIV health indicators before and after the introduction of basic HIV care. Only 1 indicator declined, while 15 improved. Non-HIV Health Indicators Before intro of basic HIV Care After intro of basic HIV Care p value Independent effects New family planning users 9 13 .012 HIV exp (p <.001) Returning family planning users 91 141 .002 Total family planning users 100 155 .001 1st trimester ANC visit 5 10 HIV exp (p=.010) 2nd trimester ANC visit 36 52 <.001 (p=.004) ANC Coverage rate (all 4 visits) 3.0% 4.7% .016 HIV exp (p=.020) Syphilis screening 1 79 HIV (<.001)

Leveraging HIV Improvements for General Health In the 7 sites included in the FHI Rwanda study that had been offering ART for more than 2 months, the average number of new hospitalizations decreased by 20.9 percent. Source: PEPFAR Fourth Annual Report to Congress, 2008.

PEPFAR Support for Renovation of Existing PHCs Before HIV renovation work, October 2006 After HIV renovation work, April 2007 Rutobwe Primary Health Center Lab *Photo courtesy of FHI

PEPFAR Support for Renovation of Existing PHCs Before HIV renovation work, October 2006 After Renovations, May 2007 Mukoma Health Center Patient Waiting Area *Photo courtesy of FHI

PEPFAR Also Supports Construction of New Facilities Mwananyamla Hospital Care and Treatment Center - Tanzania *Photo courtesy of Still Life Project

Building Capacity: Focus on Workforce Contributing to the overall workforce In Kenya, PEPFAR supports the government’s Emergency Hiring Plan to train and deploy retired physicians, nurses and other health care workers for the private sector; 830 were deployed in 2007 In Zambia, the rural retention scheme provides incentives such as hardship allowance, housing, transportation and educational stipends for children of physicians serving in rural areas In Namibia and Mozambique, through contracting mechanisms supported by PEPFAR, newly qualified health care workers are hired on a short-term basis to work for the Ministry of Health until the government can bring them into the public system In Tanzania, PEPFAR is piloting a “retired but not yet tired’ program to bring retired health care workers back into the health workforce.

Building Capacity Focus on the Workforce Support for new cadres of health care workers In South Africa, PEPFAR is supporting policy change, curriculum development and training of a new cadre of clinical officers. In Nigeria is piloting a program to train nurses to provide ART and PMTCT in the home. In Ethiopia, PEPFAR supports the government’s program to train 30,000 new community health workers and 5,000 clinical officers to work in rural villages; 18,000 CHW have been trained and deployed so far. In Vietnam, new cadres of health workers, addiction specialists and case managers have been trained, with PEPFAR, support to counsel and support current and former injecting drug users to stop drug use.

SCMS regional distribution centers help pool procurement Leveraging HIV Improvements for General Health SCMS regional distribution centers help pool procurement

PEPFAR Supports Mapping to Monitor ART Coverage

PEPFAR Partnership with the President’s Malaria Initiative and the Private Sector In Zambia, by leveraging PEPFAR’s existing HIV/AIDS distribution infrastructure, PMI will deliver more than 500,000 bed nets at a 75 percent savings Working country by country with PMI to leverage and expand malaria services Same approach with new NTD Presidential Initiative

The Power of Partnerships: Building Capacity PEPFAR is working to insert language in its contracts and grant agreements with large, international partners requiring them to turn over programs to local partners, further strengthening indigenous capacity. Through Partnership Compacts, which will be the main vehicle for support in the next phase of PEPFAR, the U.S. Government will work with host governments, civil society, and other international partners to strengthen health system capacity and implement policy changes, such as task shifting, that can rapidly expand the health workforce.