Care and support for people living with HIV/AIDS

Care and support for people living with HIV/AIDSwould not be affordable. For example, based on 1997 prices, the provision of triplecombination therapy to all people with HIV in sub-Saharan Africa could consumebetween 9% and 67% of total GDP.As these examples make clear, the ability to secure financing for health care, particularlyfor advanced care options such as antiretroviral therapy, is very limited indeveloping countries. Determining the best buy within the prevailing resource constraints– a recurring challenge for health system decision-makers – must go handin hand with efforts to make health service delivery more efficient and to mobilizeadditional resources for the sector.One of the critical factors for service delivery is the availability of people to deliverservices. As mentioned earlier, AIDS increases the demand on the health sector (seepage 31), and at the same time reduces the human resources available to it by causingillness and death in the sector’s workforce. With fewer health care providersavailable to carry an ever-increasing workload, it is easy to understand why theremaining staff may experience burn-out, which results in a lower quality of serviceand further attrition in the workforce. It is urgent for governments to establish humanresource policies aimed at mitigating these impacts on the health sector (see pages94-96). The desirable response would be to increase the number of health careworkers so as to maintain the sector’s ability to deliver services. This requires decisionsabout the kinds and numbers of health care workers that will be needed, anda clear idea of how the cost of the mitigation efforts will be shouldered.Care and support packagesThe kind of care and support “package” made available to people living with HIV orAIDS will thus depend on the ability to mobilize human, infrastructure and financialresources. Where the ability to mobilize resources is extremely limited (such as inmost of rural sub-Saharan Africa) or somewhat limited (as in northern Thailand), thepackage will necessarily be more limited than where resource availability is relativelyunrestricted.Examples of what the essential, intermediate and advanced packages could compriseare given in the Table 1, page 98.It is important to emphasize that progress in improving health service delivery neednot be strictly linear. For example, planners may discover an opportunity forexpanding access to treatment for multiresistant tuberculosis (an option in theadvanced package) in a region where people with HIV are receiving mainly the intermediatepackage. If so, they should not hesitate to push ahead with this option, inparticular when the prospect for improving delivery of some of the less advancedoptions is poor.In these examples of care and support packages, no consideration is given toimproving health service delivery through greater efficiency and coverage.97