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SCALING up HEALTH SYSTEMS to RESPOND to the CHALLENGE of HIV/AIDS in LATIN AMERICA and the CARIBBEAN ACKNOWLEDGMENTSFOREWORD V

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SCALING up HEALTH SYSTEMS to RESPOND to the CHALLENGE of HIV/AIDS in LATIN AMERICA and the CARIBBEAN ACKNOWLEDGMENTSFOREWORD V Scaling Up Health Systems to Respond to the Challenge of Special Editions HIV/AIDS in Latin America 8 and the Caribbean Washington, D.C. June 2003 This publication was produced by the Pan American Health Organization. Partial financing was received by the United States Agency for International Development’s Regional Office for Sustainable Development within the Bureau for Latin America and the Caribbean under the terms of Grant number LAC-00-97-007-00. Regular funds of PAHO/WHO were also used. The opinions expressed in this document are those of PAHO/WHO and do not necessarily reflect those of USAID. This document can be revised, reproduced and translated, in part or in its entirety, only when the source is referenced and when it is not used towards commercial ends. TABLE OF FCOREWORDONTENTS iii Table of Contents Acknowledgments ...........................................................................................................v Foreword ...................................................................................................................... vii Part I: Current and Future Responses of Health Sector Reform to HIV/AIDS in Latin America and the Caribbean ..................................................................... 1 Introduction ....................................................................................................................3 Chapter 1: Magnitude of the HIV/AIDS Pandemic and Patterns of Transmission in Latin America and the Caribbean ............................................................................................. 7 Chapter 2: Evolution of Health Systems’ Functions ........................................................ 11 Chapter 3: Aligning the Steering Role Function of Health Authorities.............................. 13 Chapter 4: Addressing the Challenges posed by HIV/AIDS to the Financing of Health Systems and Services ..................................................................................... 19 Chapter 5: Provision of Health Services ........................................................................ 25 Chapter 6: Health Systems and Services Research of HIV/AIDS Comprehensive Programs......................................................................... 43 Chapter 7: Synergy in the Responses and Resources to Confront the HIV/AIDS Pandemic ............................................................................. 45 References.................................................................................................................... 53 Part II: LAC HSR Initiative Regional Forum 2002: The Challenge of the HIV/AIDS Pandemic for the Reform and Strengthening of Health Systems and Services in LAC ............................................................................................. 63 1. Purpose of the Meeting ........................................................................................................ 65 2. Outcomes and Results .........................................................................................................65 3. Keynote Address .................................................................................................................... 66 4. Abstracts of Panel Presentations ........................................................................................ 70 5. Summary of Discussions from the Working Groups ..................................................... 79 6. Concluding Remarks ............................................................................................................. 81 Annex 1: Meeting Agenda.........................................................................................................83 Annex 2: List of Participants .................................................................................................... 87 iv SCALING UP HEALTH SYSTEMS TO RESPOND TO THE CHALLENGE OF HIV/AIDS IN LATIN AMERICA AND THE CARIBBEAN ACKNOWLEDGMENTSFOREWORD v Acknowledgments EDITORIAL TEAM Arachu Castro1, 2 Paul Farmer1, 2 Jim Yong Kim1, 2 Eduardo Levcovitz3 Daniel López-Acuña3 Joia Mukherjee1, 2 Patricia Schroeder3 Edwina Yen3 CONTRIBUTORS Stephen J. Corber4 José Ramiro Cruz3 Carrie Farmer1 James Fitzgerald3 Karem Harth1 José M. Hermida4 Rafael Mazin4 Hernán Rosenberg3 Fernando Zacarías4 USAID LAC and Global Bureau The authors acknowledge the contributions made by all the participants who attended the Latin America and the Caribbean Health Sector Reform Initiative Regional Forum 2002, held in Ocho Rios, St. Ann, Jamaica. The authors also acknowledge the comments made by USAID staff and consultants who reviewed the Background Document, as well as Debbie Sabin for her editorial revisions. 1 Partners In Health 2 Program in Infectious Disease and Social Change, Department of Social Medicine, Harvard Medical School 3 Division of Health Systems and Services Development, Pan American Health Organization 4 Division of Disease Control and Prevention, Pan American Health Organization vi SCALING UP HEALTH SYSTEMS TO RESPOND TO THE CHALLENGE OF HIV/AIDS IN LATIN AMERICA AND THE CARIBBEAN FOREWORD vii Foreword The HIV/AIDS pandemic is occurring at a time of great health system change in Latin America and the Caribbean. Over the past decade, many countries in the region have undergone significant health sector reforms, often as a part of broader, economically-driven state reforms. The reforms have focused on decentralization and separation of functions and have attempted to improve economic efficiency. At times, these changes have led to fragmentation within the health sector. The advent of HIV/AIDS brings a new challenge to health systems. Prevention of and care for HIV/AIDS require a comprehensive and integrated response involving many aspects of health systems, including public health responsibilities, financing, social protection in health and service provision. In an era of separation of functions, providing adequate health services for those infected with the disease has already proven a major challenge to the health systems of many countries in the region. The Latin America and Caribbean Regional Health Sector Reform Initiative, developed by the Pan American Health Organization (PAHO) and the United States Agency for International Development (USAID), seeks to promote more equitable and effective delivery of health services by supporting regional activities. It uses a participatory approach, working in partnership with key decision-makers in the region to build capacity to assess health sector problems and to design, implement and monitor reforms. The implementing partners are PAHO and USAID-funded programs—Partners for Health Reformplus (PHRplus) and Management & Leadership (M & L) Program. With these matters in mind, the Latin America and Caribbean Regional Health Sector Reform Initiative (LAC HSR), along with its partners, decided to hold a Regional Forum on the topic. The Forum, entitled «The Challenge of the HIV/AIDS Pandemic for the Reform and Strengthening of Health Systems and Services in Latin America and the Caribbean», took place in February 2002 in Ocho Rios, Jamaica. The scope and purpose document, sent in advance of the meeting to those invited, is included in the present document. As a pioneering effort, the meeting brought together two fields: specialists in the prevention and care of HIV/AIDS and other infectious diseases, and decision-makers who work with health systems, services and health sector reform. Throughout the three-day meeting, these two groups shared their expertise and worked toward an understanding of the steps that must be taken to effectively combat the HIV/AIDS pandemic in the region. Descriptions of each presentation follow this introduction, and the agenda and list of participants are included in the annex. viii SCALING UP HEALTH SYSTEMS TO RESPOND TO THE CHALLENGE OF HIV/AIDS IN LATIN AMERICA AND THE CARIBBEAN In preparation for the meeting, advisors from PAHO and Partners In Health, a NGO affiliated with the Program in Infectious Disease and Social Change at Harvard Medical School’s Department of Social Medicine, worked together to create a background paper that would serve as a starting point for the discussion. After reviewing comments from Forum sponsors and participants, we developed a revised version of that paper, also included in this document. It is important to note that the background paper was a first attempt to bring together the issues associated with HIV/AIDS and health sector reform. As such, it was not possible to include all perspectives on these issues, nor should it be considered a comprehensive assessment of health systems, financing, insurance, or HIV/AIDS care. It is especially important to note that the document does not discuss fully the substantial resources (financial and other) needed to implement an effective and comprehensive HIV/AIDS program. For most countries in the region, resources are limited; research and documentation on how best to secure additional resources and/or prioritize available resources ought to be addressed in the immediate future. One promising prospect on this front is the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was founded in January 2002 to attract, manage and disburse additional funds to counter these diseases. The Global Fund opens a window of opportunity for enhancing comprehensive HIV/AIDS care in Latin America and the Caribbean. The Regional Forum was the beginning of the discussions and debates that will take place as Latin America and the Caribbean
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