Blog Posts by Jonathan Quick

Over 33 million people are currently living with HIV & AIDS throughout the world. Despite great strides in slowing the epidemic, there remains a stunning gap in prevention, care, and treatment efforts. This is especially true for most-at-risk-populations, which include commercial sex workers (CSWs) and their clients, injecting drug users (IDUs), men who have sex with men (MSM), and prisoners. People in these risk groups are so stigmatized and discriminated against in many countries that it becomes extremely difficult – sometimes impossible – to provide them with much-needed HIV prevention, care and treatment services. Even more, MARP behaviors often are illegal, which then compromises needed action and support from government authorities.

Denial of such basic human rights as access to prevention, care, and treatment for the most-at-risk-populations is unacceptable. It leaves those most in need underserved and severely marginalized. As World AIDS Day 2010 approaches with this year’s message of “Universal access and human rights,” I am reflecting on the specialized HIV interventions that MSH helps provide to most-at-risk populations.

Fragile states such as Afghanistan, the Democratic Republic of Congo, Haiti, Liberia, and Southern Sudan have among the worst health statistics – especially for women and children.  For political, economic, security and other reasons they can be extremely challenging work environments. Despite this, I have been deeply inspired to see what local health leaders have achieved when they have created strong partnerships among government, donors,  non-governmental organizations and where possible the private sector.  The charismatic former minister of health from Afghanistan, the  medical director of an urban clinic in northern Haiti, and the director of Torit hospital in Southern Sudan stand out as examples of local leadership in action under circumstances that would immobilize many of us.

In fragile states, constraints on governments often prevent them from simultaneously building their stewardship role and immediately expanding service delivery. Supporting the Ministry of Health to establish a basic package of health services, train local organizations to implement those services, and provide incentives (such as through performance-based financing) is critical to success. Additionally, the goal should be to move from many plans and actors across districts to one health plan with committed partners. 

At a time when many are looking for examples of lasting local success in international development and sustainable approaches to healthcare for low income populations, PROSALUD, Bolivia’s largest health nongovernmental organization (NGO), embodies this success.  PROSALUD just celebrated its 25th anniversary last week – and MSH was there to help celebrate. For over two decades, PROSALUD has contributed to the unmet health needs of low-income populations in Bolivia, working with the active participation of the communities it serves.

As we have heard, Haiti is the poorest country in Western Hemisphere and has some of the worst health statistics. Many things did not work well before the earthquake and the recovery effort has not progressed as many had hoped.

There is a perception among some, though, that nothing was working before the January 12th earthquake and that nothing has happened since.

Certainly in the health sector, and specifically in AIDS, this perception is simply wrong. The earthquake has been devastating for Haiti and its people, but in the health sector there were many good things going on before the earthquake and some real strengths to build upon. The government of Haiti, at both the national and department level, has been playing a strong leadership role.

MSH first began working in Haiti over 30 years ago. Over the last decade our nearly all-Haitian staff has worked intensively to develop leadership, management, planning, and service delivery skills within the Ministry of Health and Population, nationally and at the departmental and local levels. We also work to strengthen over two dozen service delivery NGOs.

Next month in Vienna, Austria, thousands of activists, community workers, donors, health leaders, and government officials will gather for the VVIII International AIDS Conference.  This year’s theme is Rights here, right now: a mandate on the importance of health as a human right for all.  While it is easy to talk about health as a human right, it is much more difficult to deliver to diverse communities in some of the poorest countries around the world. 

Last year when President Obama announced his Global Health Initiative (GHI), he spoke about meeting the health needs of the world by leveraging current resources and integrating programs for greater health impact. Integrating HIV & AIDS services with other health services such as reproductive health (including family planning), TB, malaria, or maternal and child health increases effectiveness and ultimately sustainability. 

In fragile states, constraints on governments often prevent them from simultaneously building their stewardship role and immediately expanding service delivery. National and local governments must ultimately lead the process and work together with NGOs and the private sector to successfully strengthen their own health systems.

In Haiti, a two-pronged approach was successfully developed and implemented prior to the earthquake by a four-way partnership between the Government of Haiti, the United States Government, a network of Haitian and international NGOs  (Santé pour le Développement et la Stabilité d’Haíïti) (SDSH), and Management Sciences for Health.

The two-pronged approach included:

Pages

Printer Friendly Version