The March issue of BMJ-STI is devoted to the topic of HIV and health systems, which was edited by Alan Whiteside, Gary Brook, Till Bärnighausen, John Imrie and William Wong. By all accounts, the global response to the epidemic is entering into a new phase. The funding landscape is changing, the sense of urgency has changed, and yet there is still a lot to be done. The articles in this issue are all devoted to challenges facing the global response from the perspective of heath systems as it enters into this new phase of the response.
Among the collection of papers, is an article I wrote on this topic which investigates the implications of what I can “donor fatigue” for HIV and the implications this might have on health systems and treatment programs. I argue that if funding remains relatively flat, which I believe it will for a while, then donor sponsored programs will have to focus more on getting more “bang for the buck” by making efficiency improvements. My argument, however, is that most of the gains that people think of when they think of efficiency gains, namely productive efficiencies, will not alone be enough. While most everyone can agree to make productive efficiency improvements (i.e. waste less), more challenging efficiency considerations must also be made, which may mean making tradeoffs between the types of HIV activities supported (e.g. prevention vs. treatment), to which populations, and in which ways. Those types of tradeoffs are less easy to make, but may be more important in the long run.
Lots of other interesting papers here too, including one by Allison Goldberg, Ashley Fox, Radhika Gore, and Till Bärnighausen on measures of political support for HIV programs and a series of articles that look at clinical models. I encourage you to have a look.Share on Facebook