Presentation outline 1. Where are we and where do we want to go? - - PowerPoint PPT Presentation

Ending the AIDS epidemic as a public health threat by 2030:

sustainability and universal health

Amalia Del Riego

Unit Chief Health Services and Access

Health Systems and Services Department Pan American Heath Organization/World Health Organization

III Latin American and Caribbean Forum Road to Ending AIDS in LAC – Towards Sustainable Regional Fast Track Targets Port-au-Prince, 6 -8 November 2017

Presentation outline

• 1. Where are we and where do we want to go?

Sustainability or expanding access with sustainability?

• 2. Where are we coming from?: Evolution of the response

to HIV and health systems evolution, intersections.

• 3. Current sustainability challenges.
• 4. Addressing the challenges: universal health
• 5. Conclusions and key messages

2

Where are we?

3

1,181,000 2,100,000 45,000 20,000 40,000 60,000 80,000 100,000 120,000 140,000 500,000 1,000,000 1,500,000 2,000,000 2,500,000 2010 2011 2012 2013 2014 2015 2016 PLWH on treatment PLWH AIDS deaths New HIV infecCons

Source: UNAIDS Spectrum esCmates 2017

An esCmated 25% in LAC do not know their serostatus. Only 55% were receiving ART in 2015 The rate of reducCon of new infecCons slowed aTer 2010, and has been stagnant. Inequi'es persist: gay men, MSM,

transgender women and sex workers and

• ther key populaCons are

disproporConally affected.

S'gma and discrimina'on persist in society and health care se7ngs: in

2015 almost 1/3 of newly diagnosed HIV cases had highly compromised immune system.

Source: PAHO/WHO: HIA 2017

Timeline of health systems development

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1978 Alma Ata PHC 1989 Structural adjustment 2000 Core Health systems functions 2002 EPHF Stewardship 2005 PHC Renewal PAHO 2008 PHC Reforms WHO 2010 UHC WHO

2014

Basic pro-poor packages 1993

Timeline of the global response to HIV

1981 1987 GPA 1996 2003 WHO 2004 PEPFAR Scale-up 2000 2006 Towards Universal Access (goals) 2014

Ending the epidemic

2002

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Current sustainability challenges

5 10 15 20

2006 2007 2008 2009 2010 2012 2013 2014 2016

Million USD

HIV expenditure from interna'onal funds

Source: adapted from NASA 2016 Honduras

• 1. Financing

Drop in donor support + complex fiscal outlook

• 2. Service delivery and model of care

Fragmented stand-alone services

Source: h[p://www.medifit.co.za/mobile-clinics-gallery/

• 4. Intersectoral action

Isolated from the rest of the health system and dependent on donors

Source: NGO for AIDS awareness

• 3. Stewardship and governance

Fragmentation and weakening of national health authorities

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Regional Strategy for Universal access to health and universal health coverage Values: ü Right to Health ü Equity ü Solidarity

Universal access Absence of geographical, economic, sociocultural,

• rganizational, or gender barriers that prevent all

people from having equitable use of comprehensive health services and healthy living to allow their development and well-being Universal coverage Sufficient organizational mechanisms and financing to cover the entire population

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• 1. Expanding

equitable access to health services

• 2. Strengthening

stewardship and governance

• 3. Increasing and

improving financing, with equity and efficiency

• 4. Strengthening

intersectoral coordination to address SDH

Conclusions and key messages

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Changing context: (epidemiological, technological, political, financial..) require changing response Convergence:

evolution of the

response and changing health systems paradigm Challenges: broader than financial, there is the need for a comprehensive and

integrated approach

Universal health: Framework to address challenges in comprehensive and integrated manner

Universal health and ending AIDS by 2030: access and coverage for all

A moral imperaCve. An investment for healthy living, well-being and sustainable human development.

Leaving no one behind!

Values Right to Health ü Equity ü Solidarity