Health system strengthening as a key strategy to achieve universal access
A. Del Riego1, M. Pinto2, N. Jack1, O. Sued3, S. Caffe1, P. Edwards1, R. Mazin2, G. Hirnschall2
1Pan American Health Organization (PAHO), HIV Caribbean Office, Port of Spain, Trinidad and Tobago, 2Pan American Health Organization (PAHO), Washington, United States, 3Pan American Health Organization (PAHO), HIV Project, Washington, United States
Issues: Universal access to HIV prevention, care and treatment requires a strong health system with HIV Services decentralized and integrated into Primary Health Care, a capable workforce and the availability of evidence for decision-making and policy formulation. PAHO and key stakeholders developed a comprehensive methodology to evaluate the HIV response within the context of the Health System to inform reorganization and reorientation of health systems.
Description: By the end of 2009 national evaluations were completed in the Dominican Republic, Guatemala, Bahamas, Belize, Trinidad & Tobago and Paraguay. The evaluation methodology is based on WHO/PAHO health system building blocks and generates information regarding gaps and opportunities for integration of HIV and overall strengthening of the health system. Implementation relies on the leadership of the Ministry of health and active participation of the government and non-government stakeholders and development partners.
Lessons learned: The evaluation approach has proven to be a highly effective exercise to document country's progress towards universal access and objectively identify gaps and factors emanating from the wider health system that limit further expansion of HIV services. Key issues emerging from the six evaluations included persisting vertical models of service delivery, inefficient use of human resources, inability of health systems to identify innovative strategies to reach marginalized groups, and limited capacity to generate strategic information for policy and planning.
Next steps: Dissemination of the tool and capacity building for utilization in additional countries for ongoing health system strengthening and scaling up of the HIV response. Technical cooperation to countries for implementation of recommendations resulted from the evaluation.
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