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Improving Resource-Use through the Integration of HIV/AIDS ServicesThe Context The countries of Central Asia inherited a comprehensive health care system from the former Soviet Union, although upon achieving independence, the financial sustainability of the system fell into question. The system is essentially vertical and integrated services are generally unavailable. HIV/AIDS prevention, care, support, and treatment programs have been recognized within the government as an important priority, and recently are funded with increasing resources, although mostly from external sources. Existing in the same environment as the rest of the health services, the development of HIV/AIDS services functions as another vertical system managed by and conducted at the republican and oblast-level AIDS centers. HIV/AIDS programs are distinctly separate from primary health care (PHC), and there is very little or no interaction between and across the various tiers and fragmented clinical services within the health care and SES systems to effectively address co-infections, opportunistic infections, and other conditions (e.g. HIV-TB, HIV-STI, HIV-related diarrhea). Overall, the health care system is highly complicated with too many vertical systems in place, and the functional roles and relationships of the key actors providing HIV/AIDS and relevant co-infection services are unclear. There is a lack of adequate understanding and information on the existing referral, patient-flow, and financing mechanisms across the above-mentioned key actors in the provision of these services. In addition to the general inconvenience that exists for patients in seeking a continuum of care for HIV/AIDS and related health services, the existence of numerous vertical and fragmented service-systems is a major deterrent to efficient and improved use of available health care resources. Although, in general, there are similarities across all of the CAR countries with regard to the above issues, variations in the current state of progress with the reforms of the health/SES systems and HIV/AIDS and TB programs in each of these countries may require country-specific structural models of integration to be developed and implemented. CAPACITY’s Approach CAPACITY’s approach to improving resource use for more efficient HIV/AIDS services will build on Strategy 3 above. While Strategy 3 will focus on the content of services o in order to improve quality and effectiveness, Strategy 4 will focus on the structure of care to improve efficiency of providing services. Of interest will be the cost of providing services (financing), the functionality of the systems involved to link various services (referrals), and the convenience for patients to improve access (patient-flow). To this aim, CAPACITY will work closely with its partners and stakeholders, including other USAID partners, in individual CAR countries to improve resource-use through the development, implementation, and testing of appropriate restructuring models that allow integration of HIV/AIDS services into PHC and other health systems, consistent with the ongoing and planned health sector reforms. CAPACITY will physically and functionally integrate the vertical structures into general health care delivery, particularly at the local and regional levels. A key focus will be on building systems for the integration of HIV/AIDS programs and relevant vertical programs with PHC. CAPACITY will also develop, implement, and test models on appropriate financing mechanisms (provider payment systems) to offer incentives to the providers in favor of efficient integration of HIV/AIDS services with PHC and other health systems. In addition, CAPACITY will work with government and other stakeholders to support the securing of needed regulatory and policy support for the above approaches on improved resource-use through integration and new financing mechanisms. Given the concentrated stage of the HIV epidemics in the region and the relatively small number of patients eligible for AIDS treatment, strategy 4 will not move forward with full steam until about midway through the project. After that point, model development will begin. Illustrative Interventions CAPACITY will conduct patient-flow analyses to assess and map the movement of patients across the various service-systems of health care delivery, including VCT, HIV/AIDS care, support, and treatment, STI and TB cases for detection and treatment, and patients with co-infection of HIV/AIDS and both TB and STIs. CAPACITY will also conduct fund and functional analyses to clearly define the institutional structure, functional roles and relationships, and existing financing mechanisms of the key actors in providing HIV/AIDS and other relevant prevention and care services (such as TB and STI). This will contribute to identification of appropriate integration and financing issues and strategies. Following the above mentioned assessments, CAPACITY will implement the following interventions in model areas. • Engage in policy dialogues to design models on efficient and effective structures and systems for integration of HIV/AIDS services into PHC and other general health care delivery, and appropriate financing approaches and provider payment systems for the integration. Anticipated Results • PHC providers, Centers for Healthy Lifestyles, and SES integrate HIV/AIDS care and prevention/treatment of relevant opportunistic infections. |
BulletinPartnerswww.rcaids.kz www.ncc.tj www.afew.org www.caap.info www.cdc.gov www.ddrprogram.org www.theglobalfund.org www.projecthope.org www.soros.org www.undp.org www.unicef.org www.unodc.org www.usaid.gov www.euro.who.int www.zplus.kz |
© 2010 Capacity Project
