Promoting effective and inclusive governance for HIV and health

26 Oct - 10 Nov 2015
Go back to HIV, Health and Development Strategy of the United Nations Development Programme (2016-2021)

Democratic governance is “a process of creating and sustaining an environment for inclusive and responsive political processes and settlements.” The institutional and human capacities for governance determine the way in which the effectiveness of public policies and strategies are attained, especially in service delivery.

Experience to date with the Millennium Development Goals has shown that, in many cases, sustained progress towards the MDGs has been underpinned by good governance and women’s empowerment, and hampered by their absence.

Sustainable advances in health and development are dependent on progress in other areas of development. For example promoting human rights and strengthening laws that eliminate discrimination against people living with HIV and groups that are at highest risk of HIV, will ensure that these communities are not driven underground, but are able to access health care and other basic services.

Achieving universal access to ART and other essential medicines requires continued innovation in the development of new drugs and diagnostics. It is therefore imperative to ensure that within the context of the TRIPS Agreement, the policy incoherence between research/innovation, public health and human rights is remedied.

Low- and middle-income countries carry the burden of the world’s largest killers, non-communicable diseases (NCD). These could be prevented if policy makers and health systems responded effectively and equitably to the needs of people with NCDs.

Related resources:

 - Strategy Note on promoting effective and inclusive governance for HIV and health

 - Global Commission on HIV and the Law

 - Non-communicable diseases

 

Proposed guiding questions

  • How can we best promote resilient, legitimate and inclusive national and local institutions, as well as inclusive participation in public processes in the context of HIV and health? What will make institutions more effective in order to achieve equity, transparency and accountability in the context of HIV and health?
  • What contributions can UNDP make to strengthening inclusive and effective governance for HIV and health?
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Comments (17)

David Patterson

UNDP can make make a huge contribution to other global health challenges by modelling how a human rights-based approach can be applied to health issues, based on the experience of working with communities as partners in the response to HIV. The human rights-based approach is certainly about protecting and promoting the rights of key populations. But it is also about a way of working to address health and other social development challenges. The UN system has been challenged to take a human rights-based approach to development assistance since the mid-90s. The principles include universality and inalienability; indivisibility; interdependence and inter-relatedness; non-discrimination and equality; participation and inclusion; accountability and the rule of law (see hrbaportal.org). David Patterson

Emmanuel Akoyibo

The best  way to promote an inclusive and effective governance for HIV and Health is through increasing community education enabling individual to know about risk factors which are related to HIV and other health issues. Education is a powerful tool UNDP can use to archieve the target. Volunteers that have passion to educate people  within each community should be employed. The education can be done in languages the people understand. 

Children in various communities should be trained as peer educators and each of them would have it as an assignment to teach their friends and family in their communities about risk factors and ways of prevention .There should be a policy to have compulsory HIV and Health education at all levels of our education system: Primary, Secondary and Tertiary education and students should be well thought.

The media should also play much role in spreading the word.

 

Saripalli Suryanarayana • from India

The key to success in any field is out side people direct  participation in daily affairs for some time or say 3 to 6 years.External funds for creating key infrastructure and transport systems is essential.Encouraging PPP,with investments in first 3 to 5 years and then generating income slowly in next 10 to 15 years is another way to get the entrepreneur supported by facilitated finances.

The key is education,gender equality starting with primary eduaction.Use of resources.etc.

Ignatious (not verified)

I do believe the key to building the inclusive and effective governance for HIV and Health is exactly that, inclusion. Inclusion of every affected group in every decision that is made and that affects them not only as beneficiaries, but as partners and also as the very decision makers too. Speaking from a young persons perspective it's a sad reality to see that young people world over account for almost 55% of the global population face more than 60% of the HIV disease burden but especially in issues of HIV and Health are either under represented or unrepresented at all in in decision making which affects at the end of the day which ultimately affects uptake of interventions aiming to end HIV and in health matters. I do believe this is a key component is seeing these global targets being reached, casing point being the amazing strides that have been made in women empowerment and the sucesses thereof. Try it and commit to it with the youth and see if these targets that we so desire can also be reached. 

Ninoslav Mladenovic • HIV AIDS Officer at UNDP

When talking about how to achieve universal access to ART and other essential medicines, I would like to reflect upon few points on what is required to sustain continued innovation in the development of new drugs and diagnostics

First and foremost, UNDP should carefully consider developments in trade likely to impact cost and access to essential medicines. Research and development has yielded state of the art medical products and devices that many people still do not benefit from, as access remains limited. The economic downturn has led to increasing pressure to make treatment more cost-effective while maintaining high levels of quality of care and improving levels of access. There is an urgent need to improve the affordability and sustainability of equitable and universal access by reducing the costs of medicines. To take advantage of this opportunity, while maintaining adequate and rational investment in research and development, cooperation with and leadership from civil society, governments and industry on a number of issues concerning intellectual property is needed.

WHO pre-qualified generic versions of medicines for HIV and TB treatment, as well as medicines approved by the United States Food and Drug Administration and the European Medicines Agency, are bioequivalent to the originator medicines and have the same therapeutic effect. Competition among the generics market has resulted in a reduction in prices of medicines and improved access to affordable antiretroviral medicines around the world. Patents, and the extensions thereof, are protecting monopolies and preventing the entrance of generics to pharmaceutical markets. Imbalanced trade negotiations are pressuring countries to adopt provisions limiting generic competition in various ways. Test data exclusivity provisions are of particular concern, since they prohibit use of the originator’s data for registration of generic equivalents, promote wasteful spending, delays, and the unethical practice re-researching medicines already proven safe and effective. Quite often generic competitors do not have incentives to enter smaller markets, due to the prohibitive costs associated with test data exclusivity regimes.

Besides, test data exclusivity and excessive enforcement requirements, as well as patent extensions and supplementary protection certificates, limit the opportunity for countries to use the TRIPS flexibilities. Data exclusivity prevents competitors from obtaining registration on a product, prohibiting a generic supplier from relying on efficacy and safety data submitted by an originator medicine to register a generic product. The alternative would be for generic manufacturers to repeat clinical trials of medicines to prove their safety and efficacy. However, data exclusivity is not always subject to the flexibilities and exceptions that have been established for patents. The provisions on data exclusivity overlap with and complement patent protection and may extend beyond it. Furthermore, data exclusivity will apply to all medicines, regardless if they are patented or not. This creates a very strong kind of monopoly, which is ‘TRIPS-plus’, as TRIPS does not require WTO member states to integrate data exclusivity into its national laws.

To counter these problems, UNDP could contribute towards lowering medicine prices through e.g. supporting measures aimed at increasing competition, as well as supporting other means of reducing prices, such as differential pricing schemes that would offer lower prices on originators’ medicines to countries in need, yet supporting other methods to increase access to treatment, such as voluntary licensing through pooling of pharmaceutical patents.

Secondly, how medicines are priced and procured is a key driver of medicine expenditures. Public procurement and national regulatory framework play a significant role in the economy of each country and is a powerful tool for the state authorities to encourage economic development. Notwithstanding the fact that many national frameworks have improved significantly in recent years, there are still a number of challenges such as lack of enforcement of rules and standards, inefficiencies in resource allocation and in the distribution chain, and occasional conflicts between public health and industrial policy objectives. In the future, the upward pressure on medicine expenditures may be further aggravated by population aging, increases in health system utilization, and the development of new, potentially more expensive, medicines. To this end, UNDP could support governments in upholding their commitments to increase affordability and provide universal access, thus support cooperation between pharmaceutical companies and civil society in ensuring affordable, sustainable, equitable, and universal access to HIV prevention, treatment and care.  

Finally, as far as the need to ensure policy coherence between research/innovation, public health and human rights (within the context of the TRIPS Agreement), UNDP could support exploration of alternatives to the current model for promoting innovation, which links the costs of research and development with the cost of producing essential medical products, as  innovation is  rewarded with patents which give pharmaceutical companies market exclusivity enabling them to charge monopoly prices for their products. There is ongoing debate in the international community about the appropriateness of this linkage. Prior to the 1970s, most countries excluded medicines and food (and processes of producing them) from patentability to avoid creating barriers to these essential public goods. Since 1995, the TRIPS agreement made the current model in which innovation is rewarded by patents global. In the current model, tension exists between economic exploitation of the reward for innovation and the need to provide affordable universal and equitable access to high quality medicines and medical products.

To sum up, enabling legal, policy and regulatory environments for HIV and health (in line with the public health objectives of the TRIPS agreement), shall remain imperative priority for UNDP.

 

 

 

Saeid FERDOWSI • Programme Specialist at UNDP

Dear colleagues,

Over the past decade, UNDP has worked with the Global Fund in many countries helping national counterparts to apply for, receive, and duly manage GF grants. The partnership, while having assisted programme countries to effectively manage their GF grants, has also created a wealth of capacity within UNDP at all levels. Within COs, dedicated units have been created to translate the GF grants into UNDP projects and implement the projects.

On the other hand, the Global Fund is changing as the disease landscape is changing. For one thing, the names of the three diseases have been taken out from the logo of the GF – it is now only called “The Global Fund” indicating that its scope and mandate may extend over a new array of (non-communicable) diseases diseases).

Also, as countries are doing better in their fight against communicable illnesses, the share of NCDs in total mortality and morbidity increases, especially in medium income countries; hence the drivers of NCDs becoming a more important development obstacle in such countries.

With the above in mind and in the face of likely decreases in the level of GF funding, every effort should be made to retain and strengthen the capacities that we have already developed at country level. This can only be done through expanding the scope of our health related assistance. “Health&Development” should be made a pillar of UNDP’s structure in country offices and duly integrated into the UNDAFs. To that end, division of labour with WHO, based on the principle of “common, but differentiated responsibilities” would be of prime importance. 

Douglas WEBB • Health and Innovative Financing, UNDP at UNDP from United States Moderator

Colleagues, thank you for your insightful and very helpful comments. We will give them careful attention. For now, I see some themes emerging:

    • Supporting governments (and potentially industry – see below) to better align economic incentives with health, development and human rights (which themselves have economic benefits/dimensions), including by facilitating strengthened collaboration across sectors;
    • The need for UNDP to leverage existing partnerships and capacities to tackle emerging health and development priorities, including NCDs;
    • The importance of including youth in the decision-making process, harnessing their ability to help generate and implement novel approaches; and 
    • Scaling up CSO involvement and supporting community education and civic engagement, which would strengthen a rights-based approach, enable people to make healthier choices, and shape an electorate that is more empowered to hold governments accountable.

 

The engagement of national governments (and the UN system) with industry is a topic that has cut across some comments. I encourage more discussion on this point. Is industry part of the problem or part of the solution? Can we leverage business to help build public sector capacities/efficiencies, for example in data management or workplace wellbing programmes? Is a pro-equity business model possible or are countervailing profit motives too entrenched?

I look forward to your thoughts, and thanks again for your comments thus far. Doug

Eco Global • from Panama

Si la población está educada los ciudadanos podrán convertirse en eslabones claves para la respuesta resiliente y efectiva  en los procesos de partición pública frente a el contexto del  VIH y la salud en general. Ofrecer las herramientas para acceder a la información necesarias a tiempo y con la amplia distribución necesaria  para que de manera democrática, participativa e incluyente los servicios de salud lleguen a la población PEMAR.

 Debo coincidir en que apoyar a los gobiernos  para nivelar los incentivos económicos con la salud, el desarrollo y los derechos humanos incluso facilitando el fortalecimiento de la colaboración entre los distintos sectores debe ser ejercicio coordinado entre  el PNUD gobiernos locales y otras agencias de cooperación internacional vículadas con la salud global y fortaleciendo las alianzas y las capacidades existentes de los grupos vulnerables pero organizados para hacer frente a las nuevas prioridades de salud y desarrollo, incluyendo las enfermedades no transmisibles.

La población de los jóvenes es importante para ser incluida en este proceso de toma de decisiones, aprovechando  su capacidad de respuesta y de generar  y aplicar enfoques innovadores a través de su participación en organizaciones de la sociedad civil, de la comunidad y con compromiso ciudadano, lo que fortalecería el proceso de la gobernabilidad abierta basado en el conocimiento de los derechos, que permitan a las personas poder tomar decisiones más saludables e influir en las decisiones que los gobernantes toman frente a temas tan sensibles como el del VIH.

Brice Millogo • Conseiller VIH at UNDP
  1. Promotion d’une gouvernance efficace et inclusive  

    1. Appui à la coordination de la réponse nationale en mettant l’accent sur le maintien de son caractère multisectoriel et  multidisciplinaire

  • Il est important d’avoir une très bonne synergie entre les différents acteurs (Gouvernement, société civile, secteur privé…) afin de prendre en compte l’avantage comparatif des différents acteurs et également assurer une meilleure mobilisation des ressources internes. Il est primordial de construire des institutions de gouvernance inclusives et participatives dans lesquelles toutes les sensibilités et couches sociales sont effectivement impliquées et représentées et où elles expriment leurs préoccupations et besoins qui sont pris en compte et traduits dans les stratégies et interventions.

  • Prendre en compte une révision de l’organisation de la réponse pour aller d’une vision verticaliste à une vision plus « intégrative » de la réponse nationale. Cela nécessite de revoir l’approche de la réponse au VIH en l’intégration de manière plus globale à la problématique de la réponse des questions globales de santé en prenant en compte toutes les dimensions, de celle relatives à l’approche des droits humains. De ce fait la réflexion pour la révision du rôle de certains secteurs de développement dans la réponse pour davantage prendre en compte les autres dimensions de la réponse peu couverte (genre et droits humains, renforcement socioéconomique, implication des structures décentralisées, focalisation sur les personnes les plus vulnérables….). De même l’intégration du VIH dans certaines grandes stratégie nationales telles que l’Assurance Maladie Universelle, le développement des activités de micro finance, la conduite de grands programmes de développements devrait être envisagée

  • Aider les pays à procéder à l’évaluation des programmes nationaux de riposte au VIH et d’offre de service de santé afin de s’assurer de « l’inclusivité » de la réponse mais aussi de renforcer et vulgariser les modèles pertinents existants ;

  • Appuyer davantage les structures de coordination nationale de la réponse au VIH et des services de santé dans les stratégies d’intégration des populations clés et/ou vulnérables afin d’arriver à meilleure expression de leurs besoins dans les services offerts. L’idée c’est d’évaluer avec les populations clés et/ou vulnérables les normes et protocoles d’offre de services de santé afin d’identifier les goulots d’étranglements et éventuellement de procéder aux ajustements nécessaires, étant entendu que l’offre de services doit refléter les attentes des éventuels usager

    2.2 Appui au renforcement de la réponse à l’échelle décentralisée notamment les « villes »

  • Les acteurs Municipaux jouent de plus en plus un rôle important dans l’élaboration, la conduite et le suivi des programmes de développement à l’intention de populations qui les ont élues. De ce fait leur interaction avec les populations est plus étroite rendant ainsi la collaboration avec ces acteurs indispensables si l’on souhaite développer des programmes qui contribuent efficacement à changer les vies des populations. De ce fait la prise en compte de ces acteurs dans le développement des programmes et le renforcement de leurs capacités devrait être une stratégie à renforcer

    1. Appui aux acteurs de la société civile (y compris les structures intervenant en matière de droits de l’homme)

  • La société civile est le plus souvent à la pointe des changements importants et à l’avancée qualitative des programmes de développement. Il est important de les maintenir et de renforcer le partenariat avec elle tout en œuvrant à développer de stratégies pour renforcer la collaboration avec les autres composantes notamment le secteur public dans la mise en œuvre des programmes soutenus. A ce niveau un intérêt pourrait être apporté sur l’accompagnement des acteurs intervenant en direction des populations clés en vue de contribuer à renforcer leurs capacités non seulement pour les interventions terrains mais également pour leur participation aux structures de gouvernance de la réponse nationale

    1. Collaboration avec les instituts de recherche

  • L’organisation d’une réponse efficace de la réponse notamment en direction des populations clés se heurte actuellement à certaines contraintes telles que l’indisponibilité de données précises sur la situation de l’épidémie au sein de certains groupes particulièrement affectés. L’appui au développement de collaboration entre le secteur de la recherche et les acteurs du secteur public et de la société civile pourrait beaucoup aider pour faire face à ces contraintes.     

Ernest Rukangira (not verified)

HIV/AIDs programme design should avoid top-down approaches formulated by NGOs and international Donors. People affected by HIV/AIDs should be consulted in the design of the services and projects intended to help them. Any governance structure should take into account this requirement. Without participation and consultations, governance is meaningless. Institutions should be created based on the inputs provided by the people who will be served by these institutions, especially young people. This what I call HIV/AIDS Democracy. Asking the people  affected how they want to be helped, what are their needs, how  and when they want to take  anti-retroviral drugs.  How this could affected their sexual life and relationships. How effective  are the drugs administered to them. All this should be done in a confidential way. Governance systems should include the follow-up and monitoring of  the effectiveness  and outcomes of services including drugs provided to HIV/AIDs patients.

The role of  CBOs which are in immediate contact which people affected by HIV/AIDs must be included in any governance stricture about HIV/AIDS. National HIV/AIDs Committees should be established  and involve the Ministries in charge of  Health, Education, Agriculture, Food, Nutrition and Civil Society Organisations. These committees may also include representatives of  local UNDP, WHO, FAO, UNESCO. These committees should also define the targets, resources and outcomes in relation to HIV/AIDs services. 

Rodrigo Schoeller de Moraes

Esteemed colleagues

I believe that the three topics proposed on the Discussions (26 Oct – 10 Nov 2015) are entwined. They interconnect with themselves specially regarding the necessity/feeling of belonging (1 topic); to the cooperation networks implementation methods (2 topic); to proportional impacts on the three dimensions of sustainability (economic, social, environmental) (3 topic).

This is due to the need for a multidisciplinary and intersectorial approach so as to obtain integral healthcare and proposals effectiveness regarding HIV.

Furthermore, it seems indispensable to foster planning and management actions (on behalf of those who act and/or intervene on the covered systems), to practice the proposals, adapting them to local reality.

Regarding UNDP, we believe that the program may promote this convergence, notably with the Sustainable Development Goals (SDGs) and HABITAT III directives in sight.

I emphasize that development (within any scope, e.g. Goal 3: Healthcare), so as to generate effectiveness, sustainability and peace (internal and external) must qualify as Harmonic Sustainable Development (HSD).

In this context, we submit the same suggestion for the three proposed topics at Discussions (26 Oct – 10 Nov).

These suggestions are aligned with the document: Systemic Planning and Management Action SDG and Habitat III 09-11-15 (attached and in http://pgsistemicos.blogspot.com.br/2015/09/apresentacao-criterios-e-ma… - English version below - Please use the Slide Show mode for PowerPoint slides) and with our manifestations on other discussion environment, as follow:

 

Participation in the Urban Dialogues of Habitat III (https://www.habitat3.org/the-new-urban-agenda/summaries):

 

Esteemed Colleagues:

 

In the Urban Dialogues we realize that there is a convergence with regard to WHAT TO DO.

We believe it is very important to establish HOW TO DO. In other words, how to implement in practice the proposed.

To this aim, the methodology/action of Systemic Planning and Management (SPM) was created. We believe that it can contribute in some way.

As mentioned in the previous manifestation, this method allows, from the focus priority chosen and emphasizing the family context, vision, and resource integration, multidisciplinary and cross-disciplinary (and between institutions). Focus priority can be established, for example, in the Sustainable Development Goals (SDGs), in the thematic topics for the New Urban Agenda (social cohesion and equity, urban frameworks, spatial development, urban economy and urban ecology and environment), and, more specifically, in a flooding, in the construction of a hydroelectric plant, in the health of vulnerable populations, (indigenous population, homeless people, people affected by ecological catastrophes), in the improvement in the quality of life of the population of certain slum and etc. Thus, one can establish what to do, and who, where and when / why and how to map and integrate all these components. Therefore, it is important to be perceived a common mission, to be implemented with the assistance of the physiological, psychological (safety, belonging and self-esteem) and self-fulfillment, generating commensurate impacts on the three pillars of sustainability (economic, social - health, education, citizenship and security - and the environment) and through cooperation networks. Thus, public effects are produced by adding value to sustainable activities.

       This common mission, envisioned as public purpose, requires and favours the formation of cooperation networks for systemic action, allowing the integration of the three sectors (public, private and civil society) and the whole community. This context favors democracy, participatory and representative, providing Harmonic and Sustainable Development (HDS), the consciousness of unity and survival of all living beings.

Increasingly, it requires the cooperation of every part. However, sometimes, when making planning and management of public policy, some people forget the importance of integration, too, with the Justice System. In case of ineffectiveness of public policy (often due to a linear actuation - not realizing the interconnections), the Justice System undoubtedly will intervene, directly affecting the course of development that we want (something that can be evidenced by example, the "judicialization of health"). So the System of Justice should participate in the cooperation network.

The Systemic Planning and Management action has achieved many positive results. Therefore, we are building, with the National Confederation of Municipalities, the document: Systemic Planning and Management action focusing on Sustainable Development Goals (SDGs) and HABITAT III. HOW implement the SDGs in the local community and in the context of the HABITAT III. Moreover, Starting on September 30, 2015, we will be promoting the implementation of the action of Systemic Planning and Management (SPM) in all municipalities of Brazil, with the National Confederation of Municipalities.

We believe that this document (Systemic Planning and Management action focusing on Sustainable Development Goals and HABITAT III) can contribute to implementation of SDGs and for the preparation of New Urban agenda. The document will be available at the following address: pgsistemicos.blogspot.com.br and rodrigoschoeller.blogspot.com.br, in early September (including an English version). OBSERVATION: Currently the name of this document is: Presentation Criteria and Convergence Matrix for the Systemic Planning and Management Action (SPM) focusing on the Sustainable Development Goals (SDGs) and Habitat III: HOW TO cooperate on implementing and adapting  the SDGs and Habitat III directives to local reality. (updated version on 11-09-15) (versions in Portuguese and English available at: http://pgsistemicos.blogspot.com.br/2015/09/apresentacao-criterios-e-ma…  and attached).

 

       Further information can be obtained in the following materials - at the same address and:

 

1- What development do we want? - (an English version can be found on the link)

quedesenvolvimentoqueremos.webnode.com/news/que-desenvolvimento-queremos-/

2- Lecture Values, Systemic Planning, and Management and Public Ministry (English version)

 

http://rodrigoschoeller.blogspot.com.br/2010/10/pgs-lecture-values-syst…

 

     +3 - La Gestion and PGS (Spanish version)

 

http://rodrigoschoeller.blogspot.com.br/2010/10/pgs-la-gestion-e-pgs_26…

 

+4- Primer Systemic Planning and Management Action focusing on Health, 2015 version (in Portuguese). Further information (including guidelines for implementation) are on the Primer for PGS Action focusing on health:

 

http://pgsistemicos.blogspot.com.br/2015/08/acao-de-planejamento-e-de-g…

 

I hope that the documents, which are public domain, can contribute in some way.

 

Rodrigo Schoeller de Moraes,

Public Prosecutor,

Manager Strategic Projects of the Public Prosecutors Office/Public Ministry. 

 

E-mail: rsmoraes@mprs.mp.br

     and rsmoraes@mp.rs.gov.br

www.rodrigoschoeller.blogspot.com.br

 

Phones:         

                + 55 51 9628-4254      

                + 55 51 3295-1050    

 

Anna CHERNYSHOVA • Programme Specialist at UNDP

In the last 10 years since UNDP became Principal Recipient for the Global Fund's grants we have been mostly implemeting the service delivery or treatment objectives of the grants. Unfortunately, in the majority of cases, the governance component is not well articulated or is simply missing as everyone focuses on the number of people reached with prevention services or with treatment. This eventually leads to the programmes with massive budgets that don't generate change or impact and the moment the funding ceases the situation gets back to the almost pre-grant conditions. Possible solutions - inclusion of HIV governance component into every GF grant implemented by UNDP or by other PRs to ensure that the systemic change happens alongside the outputs. The option might sound attractive however in the majority of countries especially where UNDP is not a PR, there is no longer an HIV focal point in the countries so the front line cadre of people who were trained and sensitised is now gone. The question is - who will implement the HIV governance agenda?  

Fathin Faridah • from Indonesia

Dear All,Southeast Asia region will soon enter the era of free markets per December 31, 2015, so it is necessary to press the government in ASEAN countries to include in the agenda of health points towards the ASEAN Economic Community, especially regarding HIV and ratification of the FCTC.UNDP can work together to NGOs or governments in ASEAN countries to undertake specific discussion related to HIV, NCD (obligation for the ratification of the FCTC, including the agreement on sanctions) and other health problems. The need for the formation of the committee as a forum that will continuously promote, provide socialization / campaign, as well as donors for the treatment of HIV cases in the region

Rachel Albone (not verified)

I welcome the priority of Strengthening governance to address NCDs and tobacco control in the UNDP strategy note. The note recognises the increasing prevalence of NCDs and their link to poverty and contribution to economic losses. For people living with HIV in older age there is a crucial dynamic to be addressed as HIV, ageing and NCDs come together resulting in multi-morbidity and complex health challenges. People aged 60 and over account for 75 per cent of deaths from NCDs in LMICs.

 

NCDs include a range of chronic conditions, including cancer, diabetes, cardiovascular disease, hypertension, as well as Alzheimer's and other dementias. A number of these conditions have an explicit link to HIV with their increasing prevalence in people living with HIV in older age and links to long term ART use. There is a lack of understanding of these linkages and how best to manage them. This must be addressed as a priority for global health and HIV efforts. 

Saripalli Suryanarayana • from India

Rachel had taken the note of complex ages of persons with NCD.This has some thing to do with upscaling the health protection to the vulnerable.

Priya Kanayson (not verified)

The NCD Alliance welcomes Action Area 2, and supports the three priorities elaborated in the draft strategy note, particularly Priority 2.2: Strengthening governance to address NCDs and tobacco control. Inclusion of NCDs in the Sustainable Development Goals is a landmark achievement, as NCDs are now recognized as a global burden that must be addressed in order to achieve the goals set forth in the 2030 Agenda for Sustainable Development. As NCDs are included in the 2030 Agenda, governments and donors can no longer ignore this health and development priority, and must allocate sufficient resources to mitigate the burden of disease.  Similarly, integrating NCDs as part of the HIV, Health & Development Group’s Strategy moving forward will ensure NCDs are an integral component of UNDP’s work in the post-2015 era.

 As part of the Inter-Agency Task Force on the Prevention and Control of NCDs, UNDP is well placed to assist governments as they adapt the global goals into national development plans. Promoting a whole-of-government response and helping governments integrate NCD prevention and treatment policies into their national plans will not only result in more effective government, but also healthier populations.

 Successful action on NCDs involves a multisectoral approach, including partners and stakeholders outside the traditional health sector. This includes responsible inclusion of the private sector, and we continue to watch the development of the WHO Framework for engagement with non-State actors.

 Investment case frameworks are powerful instruments for facilitating focused and strategic use of scarce resources. Such frameworks exist for HIV/AIDs and women and children’s health, but not for NCDs. Although economic analysis exists for NCDs, a robust case to incentivize investment is lacking. UNDP, as part of its work, could promote and support the research and development of such an investment framework. 

rhon reynolds (not verified)

More than two billion people in middle-income countries (MICs) lack access to essential medicines. Medicines are expensive, and consume 25 to 65 percent of the total private and public spending on health, and 60 to 90 percent of household expenditure in MICs.1 In the public sector, there is poor availability of medicines and patients are forced to purchase medicines from the private market. The Global Burden of Diseases 2010 study shows that MICs rather than experiencing a classic ‘epidemiological transition’ in which infectious diseases dissipate and non-communicable diseases (NCD) emerge, are facing a ‘dual burden’ in which infectious diseases are still prevalent, especially HIV, viral hepatitis and tuberculosis, while NCD rates are rising. Access to affordable medicines is therefore of central importance in ensuring universal access to health care in these countries.

Middle-income countries (MICs) are facing a crisis of containing costs for treating people living with HIV. These countries carry a high burden of HIV, and transmission of the virus is often concentrated amongst key populations: people who inject drug (PWID), men who have sex with men (MSM), sex workers (SW), transgender (TG), prisoners and migrants. The highest numbers and the highest prevalence of PWID with HIV are in East and Southeast Asia (17 percent), Eastern Europe (27 percent), and Latin America (29 percent). HIV prevalence is on average 13 times higher among MSM compared to the general population. In most parts of the world, sex workers experience higher prevalence of HIV than the general population. Access to treatment can be a challenge for key populations given the structural barriers such as laws and legislation that criminalize their behavior, stigma and discrimination, and lack of general acceptance in society. But even when such barriers are overcome, medicines including ARVs may not be available (‘stocked out’), largely because of the high costs as well as poor procurement and distribution system. The high cost of medicines are often the reasons governments claimed to have prevented them from including or limiting access to treatment as part of the public health insurance or social security system. Moreover, a country’s ability to pay is not always commensurate to willingness to pay especially when it involves key populations.

Treatment for people living with HIV is life-long, and long-term survival depends on continuous access to newer and more potent ARVs, including more robust first-line drug combinations with fewer side effects. For key populations living with HIV, a simpler, less toxic treatment and with less potential for drug-drug interactions (such as with female hormones or injecting drugs) would encourage greater uptake and result in improved adherence. As HIV is constantly mutating, resistance will eventually develop. People living with HIV in MICs need access to affordable second-line and third-line regimens. Access to medicines for people living with HIV is not only limited to ARVs but may also include treatment that is affordable for other illnesses including HIV co-infections such as hepatitis C, drug resistant tuberculosis, sexually transmitted diseases, cancer drugs including vaccines for human papillomavirus, and basic antibiotics to fight off other infections. Therefore, as people living with HIV are aging they need access to affordable medicines to manage their own non-HIV related chronic diseases similar to the rest of the population.

The right to medicines is an integral part of the right to health. While the global community has repeatedly made commitments to secure affordable medicines for all, this promise runs counter to the prevailing economic and trade interests that view medicines as investments and commodities from which to extract maximum profit. In this next decade, governments will need to decide whether essential life-saving medicines for HIV, TB and malaria as well as for NCDs and infectious diseases are for protecting the profits of corporations or for protecting persons’ health.