HIV & MNCH: Can we do one without the other? Key Issues & Emerging Evidence

Presentation for the XVIII International AIDS Conference-AIDS 2010Rights Here, Right Now

July 18, 2010

Ann Starrs, PresidentFamily Care International

Presentation Outline

• Brief background on MDGs 4, 5 & 6• Program linkages: target populations,

common needs, comprehensive services• Policy harmonization: focus on health

systems nationally and globally• Funding integration: moving toward a

common platform?

The health MDGs are integrally linked

• Inadequate progress on MDGs 4, 5 & 6 (5 furthest off track)

• HIV, TB, malaria are significant factors for maternal and child mortality

• Weak health systems limit potential for progress

• Funding is inadequate to meet health system and program needs

Background/Context

Maternal and child mortality worldwide

Source: Countdown to 2015, from WHO, UNICEF, UNFPA, World Bank

MDG4: Trends in child mortality, 1990-2015

On track

Insufficient progressNo progress /reversal

No data

Low maternal death ratio

Medium maternal death ratio

High maternal death ratio

Very high maternal death ratio

No data

MDG5: 2005 MMR estimates

Background/Context

Global HIV prevalence, 2007

Source: UNAIDS, 2008 Report on the global AIDS epidemic

Background/Context

MDG6: Sub-Saharan Africa hardest hit, also central Europe

SRH/MCH-HIV program linkages

• Major overlap in core target populations• Diseases/health problems often

concurrent or linked• Basic services provided through same/

similar channels• Common health system needs• Similar underlying gender/cultural/social

factors

Program Linkages

Target populations –the overlap

Women of Reproductive Age

1.8 billion

Children <5 642 million

PregnantWomen

210m/yr

HIV+39 million

Newborns136 million

High Risk Groups

(MSM, IDU, CSW)

Program Linkages

Sources: UN Population Division, USAID and UNFPA

Interconnected problems & interventions

SRH/MCH

Sexuality education

Family planning/ safe abortion

Antenatal care

Skilled care at childbirth

Postnatal care, incl. immunization and

Family planning

HIV

Risk reduction, esp. among young people

Prevention of HIV, STIs

Voluntary counseling & testing

PMTCT (ARV prophylaxis)

Ongoing PMTCT, b’feeding counseling, ART for mother

Program Linkages

Health systems strengthening needs

SRH/MCH HIV/AIDS

Health workforce

Infrastructure

Commodities

Management/supervision

Health education/ community engagement

Health information system

Program/Policy Integration

Benefits of program/policy integration: principles

• Improved access and increased utilization of services

• Reduction of stigma and discrimination• Better protection of individuals’ rights• Improved quality of care• Greater program effectiveness/efficiency• Better utilization of health workforce

Program/Policy Linkages

Source: IPPF et al, “SRH and HIV Linkages: Evidence Reviews and Recommendations”

Focus on ‘health’ MDGs as a wholeWithin global mechanisms:• High Level Task Force for Innovative

International Financing for Health Systems• Secretary General’s Joint Action Plan for

Women’s & Children’s Health

Among major funding sources:• Health systems Platform (GAVI, GFATM, WB)• Global Fund Decision Point on MCH• USG’s Global Health Initiative, MASSIVEGOOD,

G8/Muskoka Initiative

Policy/Funding Integration

Annual funding shortfalls for the health MDGs, 2011-2015

Source: UN Secretary General’s Joint Plan of Action for Women’s and Children’s Health

Policy/Funding Integration

Effective funding mechanismsfor SRH/MCH-HIV

• Be responsive to country needs/plans, fill gaps• Reward performance/results• Minimize administrative burdens• Allow for multi-sectoral participation• Take a rights-based approach• Promote/facilitate integrated approaches• Strengthen health system capacity to provide high

impact, high quality care

Policy/Funding Integration

Possible discussion questions• Do we have enough evidence on

programmatic benefits of integrated approaches? Where/when does integration not work?

• What is the role of funding mechanisms? Is integrated funding necessary for integrated programming?

• Can the SRH/MCH and HIV communities come together effectively?

Come talk about the UNSG’s Joint Action Plan

Breakfast panel

When: Wednesday, July 21, 2010

7:30am – 9:00am

Where: Restaurant Waggon 31, near the Wheel

Panelists from: UNAIDS, UNFPA,

Civil Society