Impact of HIV/AIDS on Health Systems

Overview

A pilot study, conducted during 2005, provided some initial insights through co-ordinated research in three countries: South Africa, Tanzania and Zambia. Its focus was on the system of management and administration of public health services, not directly on the operation of health care facilities. The empirical focus was on how the management system for delivering public health care actually functions in the context of an HIV/AIDS epidemic. The analytical focus was on the intended and unintended effects of national policies and plans, including how they are implemented at the local level, and how the capacity of the system plays a significant role in combating HIV/AIDS.

According to gaps and the key areas of interest arising from the 2005 pilot study, two broad focus areas were identified for the main phase research:

• Decentralisation: looking at how HIV/AIDS interventions affect a decentralised (or decentralising) health system.
• Partnerships (NGO/FBO, community, donor): looking at different models of partnership more generally for the health sector, and more specifically in relation to HIV/AIDS interventions.

Research Aims:

• To understand how the public health services in South Africa, Tanzania and Zambia are functioning in the context of HIV/AIDS.
• To understand how public health care delivery is managed in these countries.
• To understand how the administrative and management systems are changing.

Research Questions

In planning for the main phase research, key questions were identified for each of the proposed two focus areas (decentralisation and partnerships). In addition, four broad questions were posed; their purpose being to guide analysis of research results (on decentralisation and partnerships) towards achieving the vision and goal of the project as a whole.

Decentralisation: Specific Questions

• How do HIV/AIDS interventions affect a decentralised (or decentralising) health system? More specifically, how do they affect:
  • Decision making processes (give high profile nature of the HIV problem);
  • Prioritisation and deflection of resource allocation (financial, human); and
  • Coordination and implementation roles of different structures within health systems?
• Why does HIV/AIDS have these effects?
• What was intended and what was not?
• What was the justification/rationale for the intended effects?

Partnerships Specific Questions:

• What are the different models of health system partnership within and between countries, for HIV/AIDS and other interventions?
  • What are the different roles of the partners?
  • Who decides on these roles?
• How do HIV/AIDS interventions change existing partnerships and lead to creation of new partnerships?

Broad questions in relation to both focus areas:

• What are the consequences/ramifications (of intended and unintended effects of HIV/AIDS) for the capacity of the health system to deliver both general health care and HIV/AIDS health care?
• What are the consequences/ramifications (of intended and unintended effects) for the future development of health systems in eastern and southern Africa?
• What is the “optimal organisation” of health care in relation to HIV/AIDS? (relates to decentralisation)
• How might the different models of partnership affect their longer-term sustainability? (relates to partnerships)

Strategic Questions

Falls into Programme 1.

Question to be answered is around constructing sustainable responses

Expected Knock-On

With regards to knowledge advancement/capacity building by virtue of this project being collaborative we aspire to the notion of 'shared learning'. We believe that all countries involved in the research can learn from each other. We have begun this process in various ways, for example, we held a workshop in 2008 for our Tanzanian and Zambian colleagues training them to use Endnote and NVivo.

Furthermore, we held workshops on project management; Microsoft Access using the Health Systems database.

Project Impact

We envisage this project to be able to facilitate strategic planning and the revision of management and operational procedures within health systems of southern and eastern Africa, in a way that will benefit health care delivery operations.

Brief Description

The pilot study was completed in 2005. It has been a long road to the beginning of the main phase of this study which is in progress now. The fieldwork and analysis is expected to run through until the end of August 2009. Analysis and report writing (country as well as synthesis reports) is expected to be completed at the end of April 2010. Thereafter, dissemination is expected to take place in the three countries.

Collaborators

• Tanzania Lead Researcher: Dr Mughwira Mwangu Development Studies Department Muhimbili University of Health and Allied Sciences Dar es Salaam
• Zambia Lead Researcher: Caesar Cheelo Economics Department University of Zambia Lusaka

Key Phases

Outputs and Activities

• 3 country reports
• 1 synthesis report
• 1 policy brief
• Dissemination meetings at district, provincial and national levels in all three countries.
• Strategic meetings with stakeholders at all levels in all three countries.
• Journal articles
• HOUSEHOLD IMPACTS OF AIDS: Using a life course analysis to identify effective, poverty reducing interventions for prevention, treatment and care.  Click here for more information.