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 (7)

Saripalli Suryanarayana • Engineer at "Senior Professional Engineer 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. 

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. 

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 • Engineer at "Senior Professional Engineer 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.