Mind the design

The double burden of HIV and TB is a huge problem in two regions – Africa and central Europe, especially Ukraine and Russia.

In the case of Africa, we know the answer lies in an absolute shortage of resources for health. But what about Ukraine and Russia?

“It is certainly not shortage of health infrastructure and human resources (in central Europe). It is because of the weaknesses in the way health systems are designed,” observed Rifat Atun, cluster director at the Global Fund for AIDS TB and Malaria (GFTAM), who gave the Health Policy and Planning annual lecture at the symposium on Wednesday.

GFATM's Rifat Atun says systems design is crucial. Credit: GFATM

There are structural and financial weaknesses in these two countries, as well as weaknesses in their use of human resources.

“Systems design is critical in improving the outcome,” he told delegates.

Atun cited examples of studies that show that hospital admissions for TB treatment in Russia have nothing to do with the epidemiology of the disease, but the country’s health systems funds in a given financial year. As the financial year comes to a close in January,  hospitals admit fewer TB patients in December.

Health systems worldwide is at cross roads today, says Atun. One the one hand, there are substantial gains in financing for health, but on the other hand, the health outcomes are not progressing.

These conflicting indicators come against a backdrop of a changing economic environment;  broadening of the global health agenda; problems in sustaining long-term health systems, especially to manage HIV, malaria and TB in the long term; and donors’ increasing focus on the value for money, he says. Adding to these problems is the increasing complexity of health interventions that are being rolled out.

The biggest challenge of all is the weak evidence base. Experts do not know what works in practice, why it works and how.

T. V. Padma, South Asia Regional Coordinator, SciDev.Net

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