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The 10-year struggle to provide antiretroviral treatment to people with HIV in the developing world.
Lancet. 2006 Aug 5; 368(9534):541-546.In March, 2006, the WHO took stock of the 3 by 5 initiative, which had been formally launched with UNAIDS 2 years earlier. With 1.3 million people on antiretroviral treatment in developing countries by the end of 2005, the world had not reached the target of treating 3 million people living with HIV/AIDS. In terms of numbers, at least, some said that the campaign failed. But the initiative did show that with the right vision and a determined effort by all relevant parties, development achievements that seem unthinkable are indeed possible. The apparent failure to achieve what was always an aspirational goal should not overshadow the fact that the progress on access to antiretroviral treatment might have no precedent in global public health. For no other life-threatening disease has the world moved from the first scientific breakthroughs to a commitment to achieve universal access to treatment in less than a decade. But we should not forget that the number of new HIV infections still outpaces the expansion of access to treatment, and that progress remains slow in view of the millions still dying from AIDS every year. (excerpt)
JAMA. 2007 Feb 21; 29(7):744-746.HIV disease is essentially the black death of the 21st century, killing on a massive scale and threatening to cripple economies and topple governments. However, the continued spread of the HIV epidemic and the new availability of lifesaving antiretroviral drugs have triggered an extraordinary response by governments, international organizations, philanthropies, pharmaceutical companies, religious organizations, and individuals. Campaigning against HIV/AIDS has no precedent in the history of medicine. Smallpox was eliminated by a globally coordinated strategy that required a single patient encounter to deliver the vaccine. In contrast, the directly observed therapy strategy at the core of modern tuberculosis treatment necessitates daily patient contact over much of the treatment course and, therefore, a much larger health workforce. Treating AIDS requires the daily delivery of medications as well as the clinical management of patients-- for the rest of their lives. Antiretroviral medications can help control disease, but do not cure it. More problematic yet, stopping treatment once started promotes the emergence of resistant strains of the virus, making halfway programs hazardous to public health. The sheer volume of health workers needed to tackle HIV disease--and the health systems to support their work--is off the scale of any previous public health campaign. (excerpt)
Boston, Massachusetts, MSH, 2001. 26 p.This 2001 annual report summarizes the efforts of Management Sciences for Health (MSH) at the global, national, and local levels to fight HIV/AIDS and other preventable diseases. It is noted that MSH seeks to increase the effectiveness and sustainability of health services by improving management systems, promoting access to services, and influencing public policy. Its activities focus on educating those concerned in health care; applying practical management skills to public health problems in the public and private sectors; strengthening capabilities through collaborative work and training programs; and applying and replicating innovations in health management. Case studies from Malawi and Brazil are included.
Findings Infobriefs. 2007 May; (136): p.The specific objectives of this project - financed through an IDA credit of $28.7 million (2002-05) - were to : (i) provide resources that would enable the government to implement a balanced, diversified multi-sector response, engaging all relevant government sectors, non-governmental organizations (NGOs) and grassroots initiatives; (ii) to expand contributions made by the Ministry of Health ( MOH ) engage civil society in the fight against AIDS; and (iii) finance eligible activities conducted by civil society organizations, including NGOs, community-based organizations (CBOs), faith-based organizations (FBOs), trade and professional associations, associations of people living with HIV/AIDS (PLWHAs), districts, and line ministries to ensure a rapid multisector scaling-up of HIV prevention and care activities in all regions and at all administrative levels. (excerpt)
Lancet. 2007 Jul 28; 370(9584):311.In 1983, Michel Kazatchkine was a clinical immunologist at the Hôpital Broussais in Paris, France, when he was called to see a French couple with unexplained fever and severe immune deficiency who had been airlifted home from Africa. This man and woman were the first of many AIDS patients that Kazatchkine would take care of in the coming decades. There were no effective antiretroviral treatments available, and the couple lived only a few months on the ward before dying. "Those were difficult years with patients dying every day on the wards", Kazatchkine recalls. Much of his time, he says, was spent providing end-of-life care, consoling patients, "and holding their hands when they were dying". This year, after more than two decades of working in AIDS clinical care, research, and international programmes, Kazatchkine takes over the helm of the second largest funder of AIDS care: the Global Fund to Fight AIDS, Tuberculosis & Malaria. Anthony Fauci, Director of the US National Institute of Allergy andInfectious Disease, who says he has worked "up close and personal" with Kazatchkine since the early days of the epidemic, calls him "the perfect kind of person for the position". He's a scientist who understands the science; a clinician who understands clinical care; and an expert in AIDS who understands the epidemic, Fauci says. "He's also a fine 'people person': the kind of person who can build consensus, but also the kind of person who can take the lead." (excerpt)
AIDS is not a business: A study in global corporate responsibility -- securing access to low-cost HIV medications.
Journal of Business Ethics. 2007 Jun; 73(1):65-75.At the end of the 1990s, Brazil was faced with a potentially explosive HIV/AIDS epidemic. Through an innovative and multifaceted campaign, and despite initial resistance from multinational pharmaceutical companies, the government of Brazil was able to negotiate price reductions for HIV medications and develop local production capacity, thereby averting a public health disaster. Using interview data and document analysis, the authors show that the exercise of corporate social responsibility can be viewed in practice as a dynamic negotiation and an interaction between multiple actors. Action undertaken in terms of voluntary CSR alone may be insufficient. This finding highlights the importance of a strong role for national governments and international organizations to pressure companies to perform better. (author's)
Following the funding for HIV / AIDS: a comparative analysis of the funding practices of PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda and Zambia.
[Washington, D.C.], Center for Global Development, HIV / AIDS Monitor, 2007 Oct 10.  p.Donor funding for HIV/AIDS has reached levels unprecedented in the history of global health: annual funding for AIDS in low- and middle-income countries increased 30-fold from 1996 to 2006, from US$ 300 million to US$ 8.9 billion. While funding remains far short of the estimated need, international donor commitments for HIV/AIDS are significant, and likely to be so, well into the future. The resources for AIDS are a topic of considerable interest and debate internationally, yet little is understood about how these resources are actually being spent, and whether they are being made available as efficiently and effectively as possible for the fight against AIDS. Through the lens of what is happening in several countries in sub-Saharan Africa, this paper examines the flow of resources from three of the world's largest AIDS donors: the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), and the World Bank's Multi-Country HIV/AIDS Program for Africa (MAP). Drawing on country-level research undertaken by collaborating local research organizations, we describe the levels and types of funding from these donors, and highlight the procedures through which funds are committed, released and accounted for in three countries in which all of the programs are active: Mozambique, Uganda, and Zambia. Through this close look at how money moves from donor to specific purposes, we describe bottlenecks and other difficulties in the disbursement of funds, document the way their disbursement systems attempt to build national capacity to fight AIDS, and identify specific ways in which the donor agencies could make the resources move more efficiently. (excerpt)
A trickle or a flood: Commitments and disbursement for HIV / AIDS from the Global Fund, PEPFAR, and the World Bank’s Multi-Country AIDS Program (MAP).
[Washington, D.C.], Center for Global Development, HIV / AIDS Monitor, 2007 Mar 5. 26 p.This paper provides an analytical framework for understanding funders' disbursement policies and practices while also offering an overview of the total volume of resources being committed and disbursed by each funder. The analysis is focused on the global-level, but does provide brief country case studies to help understand some of the implications of these large inflows of funding for HIV/AIDS at the country-level. (excerpt)
Coordination, management and utilization of foreign assistance for HIV / AIDS prevention in Vietnam. Assessment report.
Ha Noi, Vietnam, CCRD, 2006 Oct. 82 p. (CCRD Assesssment Report)International assistance for HIV / AIDS prevention and control in Vietnam has significantly contributed to combating this epidemic. However, while current resources have not yet fully met the needs, the management and utilization of resources still had many limitations which affect the effectiveness of foreign assistance and investments. The independent assessment was prepared for the Conference on “the Coordination of Foreign Assistance for HIV / AIDS Prevention and Control”. Analytical assessment and comments on the management and coordination of foreign aid were made on the basis of Government’s official procedures and regulations on those issues. This research was carried out in October, 2006.
Supporting community responses to malaria: A training manual to strengthen capacities of community based organizations in application processes of the Global Fund to Fight HIV / AIDS, Tuberculosis and Malaria.
Cologne, Germany, STOP MALARIA NOW!, 2009 Nov. 53 p.This training manual is a product of the STOP MALARIA NOW! advocacy campaign and aims to support community responses to malaria. In particular, this manual aims to improve knowledge and skills of Community Based Organizations (CBOs) in application processes of the Global Fund to Fight HIV / AIDS, Tuberculosis and Malaria. The contents are based on results of the needs assessment 'Capacity Needs of CBOs in Kenya in Terms of Application Processes of the Global Fund to Fight HIV /AIDS, Tuberculosis and Malaria (GFATM)', conducted in June and July 2009.
Supporting country-led initiatives to strengthen national health information systems in East Africa.
Washington, D.C., Futures Group, Health Policy Initiative, 2009 Oct.  p. (USAID Contract No. GPO-I-01-05-00040-00)In response to a growing recognition of the importance of reliable and timely health information systems (HIS) to support improved decisionmaking for public health action and health systems strengthening, USAID supported a regional forum in East Africa that focused on engaging HIS champions from key public sectors -- including health, finance, telecommunications, and vital statistics -- and supporting country ownership of HIS. Toward that end, delegations from six focus countries (Ethiopia, Kenya, Malawi, Rwanda, Tanzania, and Uganda, with Namibia and Sudan as observers) convened for a three-day workshop, "Country Ownership Strategies: Leadership Forum on Health Information Systems," in Addis Ababa from August 10-13, 2009. As part of the preparation and planning for this forum, the USAID |Health Policy Initiative, Task Order 1 designed and executed a semi-structured qualitative survey to capture the current state of HIS in each of the six focus countries. This report highlights the results of that survey and includes background materials that supported the survey process. Given the overall success of the first forum, USAID is exploring ways to replicate this activity in other regions and continue to provide country-specific technical and financial assistance for HIS strengthening..
Country-led monitoring and evaluation systems. Better evidence, better policies, better development results.
Geneva, Switzerland, UNICEF, Regional Office for CEE/CIS, 2009.  p.This collection of articles by UNICEF discusses how to improve evidence-based decision making in developing countries through the use of monitoring and evaluation systems. While information on programmatic best practices is available, knowledge bases in developing countries still have significant gaps. This book forges the link between learning about evidence-based policymaking and the contributions that country-led monitoring and evaluation systems can make in supporting good decision making.
Population ageing and development: social, health and gender issues. Report of an Expert Group Meeting, Population Ageing and Development: Social, Health and Gender Issues with a Focus on the Poor in Old Age, 29-31 October 2001, Valletta, Malta. [Envejecimiento de la población y desarrollo: aspectos sociales, de salud y de género. Informe de la reunión del Grupo de Expertos sobre Envejecimiento y Desarrollo: aspectos sociales, de salud y de género centrado en los pobres en la vejez, 29-31 de octubre de 2001, Valletta, Malta]
New York, New York, UNFPA, 2002 Apr. x, 93 p. (Population and Development Strategies Series No. 3)Professor Fenech welcomed participants of the Expert Group Meeting on Population Ageing and Development, convened in Malta by the United Nations Population Fund in collaboration with the UN Programme on Ageing, HelpAge International and the AARR He stated that INIA was proud to host the event. "This three-day international expert group meeting is particularly timely and important, for during these three days, we will explore the approaches and programmes that are meaningful and necessary to address the needs of the older poor and frail, especially those living in developing countries. It is hoped that at the end of the meeting there will be a set of recommendations which could be presented at the Second World Assembly on Ageing in Madrid in April next year. I am confident that we are going to have a most productive and fruitful meeting". (excerpt)
Geneva, Switzerland, WHO, 2004 Apr 15. 15 p. (A57/13)By resolution WHA55.19, the Health Assembly requested the Director-General “to develop a strategy for accelerating progress towards attainment of international development goals and targets related to reproductive health … .” A progress report setting out the key elements of the strategy and summarizing the Executive Board’s comments thereon was reviewed and noted by the Fifty-sixth World Health Assembly. In order to ensure maximum involvement of Member States and other interested parties in the development of the strategy, four regional consultations were held: for the South-East Asia and Western Pacific Regions jointly (Colombo, 2-4 June 2003), for the European Region (Copenhagen, 5-7 June 2003), the Region of the Americas (Washington, DC, 11-13 June 2003), and jointly for the African and Eastern Mediterranean Regions (Harare, 7-9 July 2003). The aim of these meetings was two-fold: to review country-level experiences and lessons learnt in implementing reproductive health strategies, policies and programmes; and to review, and make recommendations on, the draft global reproductive health strategy. WHO subsequently convened a meeting of experts (Geneva, 18 and 19 September 2003) to provide final input into the draft strategy. The resulting text is annexed. The draft strategy was considered by the Board at its 113th session in January 2004. The Board adopted resolution EB113.R11, which contained a further resolution recommending the Fifty-seventh World Health Assembly, inter alia, to endorse the strategy. (excerpt)
Woking, England, Plan, 2004 Oct. 52 p. (Working Paper Series)Safe water and environmental sanitation services (by which we mean solid and liquid waste facilities, vector and pest control as well as food hygiene) are vital for people's dignity and health, and are especially important in ensuring the healthy development of children. The lack of such facilities is responsible for over two million child deaths each year. This working paper aims to support Plan staff by looking at the whole issue of water and environmental sanitation and enable the organisation as a whole to direct resources in an integrated and cost-effective way. By doing so, we will be able to play a crucial role in achieving the Millennium Development Goals and in the 'International Decade for Action, Water for Life (2005-15)'. There is a clear link between poverty, poor water quality and a lack of environmental sanitation facilities. This working paper aims to position Plan's approach to water and environmental sanitation within the context of the broader international development goals andwithin Plan's own commitment to child centred community development. From this standpoint, it then looks in more detail at the main challenges linked to water and environmental sanitation and in each case details how Plan staff can put our approach into practice and the main issues to bear in mind while doing so. Further important issues to consider are also included. (excerpt)
[Unpublished] 1992. 12,  p.Nongovernmental organizations (NGOs) have been shown to play an essential and often unique role in HIV/AIDS prevention, care, and community support. However, the capacity of developing country NGOs to initiate, improve or expand HIV/AIDS activities depends on their access to appropriate financial, technical, and managerial resources. In response to the need for increased and improved support to developing country NGOs working on HIV/AIDS, a donor sub-group was formed that included agencies from Germany, the US, the European Union, WHO/GPA, and the Rockefeller Foundation. These donor sub-groups organized the NGO Support Programme to improve the access of indigenous NGOs to appropriate financial, technical, and managerial assistance. This document outlines the overall goals and objectives of the program, as well as the specific tasks for the start-up period. Among the start-up tasks are the development of appropriate and effective systems and guidelines for providing support to developing country NGOs.
In: All of us. Births and a better life: population, development and environment in a globalized world. Selections from the pages of the Earth Times, edited by Jack Freeman and Pranay Gupte. New York, New York, Earth Times Books, 1999. 142-4.In the villages of Nepal, women have organized themselves and begun saving schemes through Amma Tolis (Mothers Groups). Over the past four years, the women in Amma Tolis built 250 resting places along the route that women travel; helped build two primary school buildings; conducted literacy classes for women; broadened village trails for easy access to villages; and helped maintain springs and wells for water supply. The labor was provided by the women themselves. Some of their activities received assistance from UNICEF, the UN Development Program, the UN Population Fund, and the local government. Eventually, Amma Tolis was able to render loans from the saving schemes to start income-generating activities. Development projects like these, which involve village participation, accomplish three important things: 1) they develop capacity at the grassroots level; 2) they provide and generate capital; and 3) they develop skills.
[Hove, United Kingdom], International HIV / AIDS Alliance, 2012 Jun.  p.Our vision is a world in which people do not die of aids. For us, this means a world in which communities: have brought HIV under control by preventing its transmission; enjoy better health; and can fully exercise their human rights. Our mission is to support community action to prevent HIV infection, meet the challenges of AIDS, and build healthier communities.We take great pride investing in a community-based response that understands what works in a local context, and that is strengthened by learning from a global partnership of national organisations. In 2011 this approach enabled us to reach 2.8 million people.
Development in Practice. 2012 Apr; 22(2):202-215.Empowerment has become a mainstream concept in international development but lacks clear definition, which can undermine development initiatives aimed at strengthening empowerment as a route to poverty reduction. In the present article, written narratives from 49 international development organisations identify how empowerment is defined and operationalised in community initiatives. Results show a conceptual framework of empowerment comprising six mechanisms that foster empowerment (knowledge; agency; opportunity; capacity-building; resources; and sustainability), five domains of empowerment (health; economic; political; resource; and spiritual), and three levels (individual; community; and organisational). A key finding is the interdependence between components, indicating important programmatic implications for development initiatives.
Contemporary Politics. 2012 Jun; 18(2):186-199.Capacity-building has become a mainstay of many AIDS and public health programmes. This article examines its impact on civil society organisations and claims-making around citizenship, as these have been articulated through heterogeneous policy networks doing HIV prevention work. Drawing on a growing literature on the Foucauldian notions of biopower and governmentality, the genealogy of capacity-building as a globalised technology of governmentality is traced, examining its uses both at the international level and in Brazil. Brazilian civil society organisations have undoubtedly been transformed by their participation in networks carrying out capacity-building projects. While recognising these effects, the conflicts and productive tensions inherent to such networks are highlighted.
Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center, MEASURE Evaluation, 2017 Jan. 18 p. (Working Paper WP-17-171; USAID Cooperative Agreement No. AID-OAA-L-14-00004)In 2011, the U.S. Agency for International Development (USAID) published its Evaluation Policy. The policy emphasizes the need to conduct more evaluations of its programs to ensure greater accountability and learning, and it outlines best practices and requirements for conducting evaluations. Since releasing the policy, USAID has commissioned an increasing number of evaluations of its programs. The importance of evaluations for international public health programs has been long recognized, with demand for such evaluations coming from both internal and external sources. Donors or those external to program implementation seek evidence of accomplishments and accountability for resources spent, whereas those involved in program implementation seek evidence to inform and improve program design. Within USAID, the need for more evaluations was driven by the understanding that evaluations provide information and analysis that prevent mistakes from being repeated and increase the likelihood of greater yield from future investments. Finally, there is overall recognition that evaluations should be of high quality and driven by demand, and that results should be communicated to relevant stakeholders. Despite the increased demand for evaluations, there is limited evaluation capacity in many countries where international development programs are implemented. Before strategies to strengthen evaluation capacity can be implemented, it is important first to assess existing evaluation capacity and develop action plans accordingly. We conducted a review of existing assessment tools and guidance documents related to assessing organizations’ capacity to carry out evaluations of international public health programs in order to determine the adequacy of those materials. Here, we summarize the key findings of our review of the literature and provide recommendations for the development of future tools and guidance documents.
[Brighton, England], University of Sussex, Institute of Development Studies, 2000 Nov. 30 p. (IDS Working Paper 121)This study examines the reasons for the rise in Zambian under-five mortality during the 1990s, paying particular attention to the relevance and effectiveness of health sector reform strategies and their impact on ordinary Zambians. In the 1980s, economic crisis and structural adjustment led to reduced public health spending in real terms so that by the early 1990s, Zambia's health care delivery system was characterised by a low-supply, low utilisation paradigm, typical of most of SSA. Health reform was designed to improve these trends by the integration and decentralisation of services, district capacity building and addressing issues of sustainability and financing. While large investments were made by the donors in the development of financial and health information systems, they did not actually improve the delivery of basic services. On the contrary, reform measures taken by government and donors appear to have further reduced access especially among the vulnerable populations through the implementation of user charges, and failed attempts to decentralise and integrate services. Although a variety of shocks are contributing to the rise in under-five mortality, particularly the HIV epidemic, there is strong evidence that a key factor explaining the rise over the last 20 years is that vulnerable populations have not received adequate protection from restructuring operations. Government and donors had little or no motivation to see that the poor had access to effective health care, were protected from the worst drought in 50 years, food subsidy withdrawal, falling living standards and rising prices. Poverty interest groups have never participated in the policy process and agencies which ought to have represented the poor have been a disappointment. As a consequence, health restructuring as social policy has been far removed from the reality of ordinary Zambians. An alternative set of reform strategies might have provided better protection for the poor by incorporating a livelihoods perspective, by being more flexible, attentive and responsive to changing needs in a turbulent environment. (author's)
Bulletin of the World Health Organization. 2006 Jul; 84(7):506.June 2006 marks the 25th anniversary of a report of five cases of Pneumocystis carinii (now jirovecii) pneumonia in men who have sex with men, heralding the acquired immunodeficiency syndrome (AIDS). Over 65 million infections with the causative agent, human immunodeficiency virus (HIV), have now caused at least 25 million deaths. Following recognition at the XI International Conference on AIDS in 1996, that combination antiretroviral therapy (ART) dramatically improves survival, various initiatives have helped to bring treatment to people with HIV/AIDS in developing countries. Although the target of treating 3 m people by the end of 2005 (WHO's "3 by 5" initiative) was not reached, about 1.3 m people now receive ART in low- and middle-income countries. Major lessons from the initiative include the utility of country-owned targets in mobilizing efforts and promoting accountability, the need for extensive partnerships to scale up activities, the importance of identifying and resolving health systems constraints, the challenges of ensuring equity, and the synergy between treatment initiatives and a simultaneous scaling-up of HIV prevention. (excerpt)
Resourcing global health: a conference of the Global Network of WHO for Nursing and Midwifery Development, Glasgow, Scotland, June 2006.
Midwifery. 2006 Sep; 22(3):200-203.With the focus of the World Health Report 2006 Working for health together firmly on the issue of human resources in health, the subject is officially placed among those at the top of the international agenda. The debates at this conference, held June 7--9 and hosted by the WHO Collaborating Centre (WHOCC) for Nursing & Midwifery Education, Research & Practice, based in Glasgow Caledonian University's School of Nursing, Midwifery and Community Health, were therefore highly topical and drew significant speakers from both the host country Scotland and 20-plus other nations. The conference was held in conjunction with the Royal College of Midwives (RCM) and the Royal College of Nursing (RCN). (excerpt)
SCN News. 2006; (33):39-42.The 1996 Manila meeting and subsequent meeting in Cape Town in 1999 stimulated capacity development activities within UNU and IUNS. IN 2000, several African regional capacity task forces held initial planning meetings to develop an overall action plan. The plan was accepted during the SCN meeting in April 2001 in Nairobi. Most of the activities outlined in the action plan were implemented in 2002. This paper reviews progress of these activities, directly or indirectly through the work of Food & Nutrition Programme of the United Nations University (UNU-FNP). (excerpt)