HIV and the strengthening of Health Systems

[Guest guest]

HIV and the strengthening of Health Systems,

Dear FORUM,

The response to the HIV pandemic is exceptional in the history of

Medicine and Social sciences. HIV has brought the importance of

various oft-forgotten and sidelined issues to the fore-front of

health care especially in the developing world.

There are very few responses to a disease which address an array of

health and social issues like stigma, marginalization, human rights,

ethics, involvement of affected individuals in formulating the

response, economics of the disease, cost-effectiveness of the

response, politics, epidemiology, advocacy, gender issues,

management, biology of the virus, interactions in its host, as well

as a horde of other attendant consequences.

Hence, thanks to HIV, we have learnt a lot during the last twenty-

five years. As I am involved in strengthening health systems

especially the Government ones in our State,

I am interested in learning from the experiences of the Solution

Exchange Community on:

Areas of Health Care Systems that have been strengthened as a direct

result of the responding to HIV

Examples from the developing world of the areas in health care

delivery, where success or lessons learnt from HIV have been

transferred and applied

Impact of HIV epidemic response on the health care delivery in the

developed world and ways in which the developing countries can learn

from them

Looking forwards to your responses so as to develop better the Health

Care System.

Dr. Ajithkumar K.,

Medical College Chest Hospital,

Trichur, Kerala.

Dr. Ajithkumar K

E-MAIL: <ajisudha@...>

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Cross posted from Solution Exchange for AIDS Community in India

www.solutionexchang e-un.net.in

[Guest guest]

Dear Forum,

Re: /message/9073

The writing on the wall is writ large.The strengthening of the health systems is

not just an option but an absolute  must if we wish to provide the desired

vigour and support to  the concerted response to the HIV pandemic.

Condition of the blood banks and the STD clinics in most of the hospitals in our

country was in a miserable state of affairs.Thanks to the National AIDS Control

Programme(NACP) and its components of STD care and blood safety, the respective

service delivery systems have shown tremendous improvement in last two decades.

All this strengthening should have been ensured within the existing health care

infrastructure itself.

The parent departments of Pathology and Dermatology and Venereology  have

traditionally neglected these two subspecialities (Blood Banking and

Venereology).

As a former MD(Dermatology and Venereology) and MD(Pathology)student myself in

the premier institutions of the nation, I have come across the 'craze' of opting

for Histopathology and Dermatology in preference to Transfusion Medicine and

Venereology respectively as future pursuits/careers by the Post graduate

students,

more as a rule than an exception.

The 'bias' used to be carried over to the senior faculty members of the

department and administrators of the teaching hospitals. This was apparently

responsible for the neglect hitherto shown   to the blood banks and STI clinics.

The roll out of the ART centres, establishment of innovative Link ART centres

etc. have done wonders to the existing support to the present health systems.

The NACP-III, however,necessitates that in recognition to the need of full

convergence and mainstreaming within the health sector, the issue of health

Systems Strengthening(HSS)should be taken up in a structured and needs based

manner generating support from the NRHM and other resources as the outputs will

go a long way in generating a reinvigorated response to HIV which may not be

exclusively ensured just through the available support under the National AIDS

Control Programme(NACP).

Governance issues will decide the quality of healthcare in general and the

prevention,care,support and treatment of HIV/AIDS in

particular.

Let us ensure the same at the respective levels.

Best wishes,

Dr.Rajesh Gopal.

Dr. Rajesh  Gopal,MD

Joint  Director,

Gujarat State  AIDS  Control  Society (GSACS),

O/1 Block, New  Mental Hospital  Complex,

Meghaninagar,Ahmedabad, Gujarat. PIN 380016

Phone (O) 079-22680211--12--13,22685210 Fax 079-22680214

e-mail: <dr_rajeshg@...>

[Guest guest]

Dear Forum,

Re: /message/9073

 

The contribution of vertical programmes towards strengthening management

processes and establishment of quality concept and SOP has been phenomenal, but

is in isolation and in pockets. To have a real impact, Primary Health Care needs

to be strengthened up to grassroots level. 

Much more needs to be done to revive the primary health care system.

 

Grassroots staff feels constrained by lack of flexibility and unrealistic

timelines imposed by various programmes, which leads to work being done on

PAPER. The planning process needs to be consultative and mechanisms for getting

realistic feedback of key stakeholders, the frontline workers and medical

workers should be built in and developed.

 

Manpower support is a critical area where states have problem and vertical

programmes could take the lead. As workload is being added on the existing

health workers, there is need to have additional health workers at Sub center to

run the system efficiently.

 

Managerial processes need additional inputs- for instance, Programme Officers at

district are not holding independent charge of a programme, and they have to

look after OPD and night duties in addition to the public health work and are

not able to tour or do justice to any.

 

A public health cadre of managerial support needs to be created to strengthen

and monitor the work, conduct operational research into problems before lip

service to strengthen the system. States may not be having will or resources to

finance, the public health cadre- It is here that Vertical programmes can

leverage and create pressure or support to facilitate this crucial link

 

Moreover, no provision for operational research exists and needs to be strongly

advocated and included in national Programmes.

 

However, this may be initially seen as a threat by some of us, though it will

lead to tremendous gains in long term.

Dr RK Sood

FETP Scholar (NIE, Chennai)

drrksood@...

+91 9418064077, +91 9445157327