Access to HIV/AIDS Access to HIV/AIDS Support for NursesSupport for Nurses

Identifying Actions to TakeIdentifying Actions to Take

A Strengthening A Strengthening Health Systems Health Systems

ApproachApproach

Deloris Russell, Canadian Nurses Assoc.Deloris Russell, Canadian Nurses Assoc.

August 7, 2008August 7, 2008

Context: MagnitudeContext: Magnitude

Country Population (million) HIV Prev. No. Persons

Living with HIV

Swaziland 1.0 33.4

220,000

Botswana 1.8 24.1

270,000

Lesotho 1.8 23.2

270,000

Zimbabwe 13.0 20.1

1,700,000

Namibia 2.0 19.6

230,000

South Africa 47.4 18.8

5,500,000

Zambia 11.7 17.0

1,100,000

Mozambique 19.8 16.1

1,800,000

Malawi 12.9 14.1

940,000

Central African Republic 4.0 10.7

250,000

Context: Financial BaseContext: Financial Base

CountryCountry Per Capita Per Capita Health ExpHealth Exp

GDP Per GDP Per CapitaCapita

SwazilandSwaziland 367 367 4,824 4,824

BotswanaBotswana 504 504 12,387 12,387

LesothoLesotho 139 139 3,335 3,335

ZimbabweZimbabwe 98 98 2,038 2,038

NamibiaNamibia 407 407 7,586 7,586

South AfricaSouth Africa 748 748 11,100 11,100

ZambiaZambia 63 63 1,023 1,023

MozambiqueMozambique 42 42 1,242 1,242

MalawiMalawi 58 58 667 667

Central African Central African RepublicRepublic

54 54 1,224 1,224

Context: HIV Service NeedsContext: HIV Service Needs

CountryCountry Contraceptive Contraceptive PrevalencePrevalence

Receiving Receiving ARTART PMTCTPMTCT

SwazilandSwaziland 48%48% 31.0%31.0% 11.9%11.9%

BotswanaBotswana 48%48% 85.0%85.0% --

LesothoLesotho 37%37% 14.0%14.0% 5.1%5.1%

ZimbabweZimbabwe 54%54% 8.0%8.0% 4.4%4.4%

NamibiaNamibia 44%44% 35.0%35.0% 25.0%25.0%

South AfricaSouth Africa 60%60% 21.0%21.0% 14.6%14.6%

ZambiaZambia 34%34% 27.0%27.0% 4.0%4.0%

MozambiqueMozambique 17%17% 3.4%3.4% 3.4%3.4%

MalawiMalawi 33%33% 20.0%20.0% 2.3%2.3%

Central African RepublicCentral African Republic 28%28% 16.4%16.4% 16.4%16.4%

Context: Health MDGContext: Health MDGCountryCountry Under 5 Under 5

Mortality Mortality RateRate

Maternal Maternal Mortality Mortality

RateRate

% % Population Population

Under-Under-nourishednourished

% Children % Children under under

weight for weight for ageage

South AfricaSouth Africa 6868 400400 <2.5<2.5 1212

BotswanaBotswana 120120 380380 3232 1313

NamibiaNamibia 6262 210210 2424 2424

LesothoLesotho 132132 960960 1313 2020

SwazilandSwaziland 160160 390390 2222 1010

ZimbabweZimbabwe 132132 880880 4747 1717

MalawiMalawi 125125 11001100 3535 2222

ZambiaZambia 182182 830830 4646 2020

Central African Central African RepublicRepublic

193193 980980 4444 2424

MozambiqueMozambique 145145 520520 4444 2424

Gov. Spending (% of GDP)Gov. Spending (% of GDP)

CountryCountry Health Health Education Education Military Military Debt Debt Services Services

South AfricaSouth Africa 3.53.5 5.45.4 1.51.5 2.02.0

BotswanaBotswana 4.04.0 10.710.7 3.03.0 0.50.5

NamibiaNamibia 4.74.7 6.96.9 3.23.2 n/an/a

LesothoLesotho 5.55.5 13.413.4 2.32.3 3.73.7

SwazilandSwaziland 4.04.0 6.26.2 1.81.8 1.61.6

ZimbabweZimbabwe 3.53.5 4.64.6 2.32.3 6.76.7

MalawiMalawi 9.69.6 5.85.8 0.70.7 4.64.6

ZambiaZambia 3.43.4 2.02.0 2.32.3 3.33.3

Central African RepublicCentral African Republic 1.51.5 **2.2**2.2 1.11.1 0.40.4

MozambiqueMozambique 2.72.7 4.34.3 2.32.3 1.71.7

2006 DAC Contributions2006 DAC Contributions

US $ US $ BillionBillion

Country Contribution 2006Country Contribution 2006

20-2420-24 United StatesUnited States

15-1915-19 NilNil

10-1410-14 UK, Japan, France, GermanyUK, Japan, France, Germany

5 – 95 – 9 NetherlandsNetherlands

0 – 40 – 4 Sweden, Spain, Canada, Italy, Norway, Denmark, Australia, Sweden, Spain, Canada, Italy, Norway, Denmark, Australia, Belgium, Switzerland, Austria, Ireland, Finland, Greece, Belgium, Switzerland, Austria, Ireland, Finland, Greece, Portugal, Luxembourg, New ZealandPortugal, Luxembourg, New Zealand

107.42 M.107.42 M. Total DAC ContributionsTotal DAC Contributions

Top 10 ODA Recipient Countries

United State Eur. Union United King. Canada Japan

Iraq Turkey Nigeria Iraq Iraq

Afghan. Morocco Iraq Cameroon China

Sudan Sudan India Afghan. Indonesia

Columbia Egypt Afghan. Haiti Nigeria

Egypt Serbia Tanzania Indonesia Philippines

Ethiopia AfghanSudan Ethiopia Viet Nam

Congo DR Palestinian Bangladesh Bangladesh India

Nigeria Congo DR Pakistan Ghana Thailand

Pakistan India Ghana Mozambique Zambia

Jordan Ethiopia Malawi Sudan Sri Lanka

Percentage Expenditures on Education, Health & Population

0

2

4

6

8

10

12

14

16

18

20

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No

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Un

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Kin

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Can

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Eu

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Context SummaryContext Summary1.1. Top HIV prevalence countries Top HIV prevalence countries

o Low income countries = low tax base.Low income countries = low tax base.• Tax base low to meet pandemic needs.Tax base low to meet pandemic needs.• Individual income frequently lowIndividual income frequently low• High range of needed services High range of needed services • High HIV prevalence = high prevention and health High HIV prevalence = high prevention and health

care costscare costs

2.2. ODA FundingODA Funding• High HIV prevalence countries not top ODA recipients.High HIV prevalence countries not top ODA recipients.• Health, Education & Population variedHealth, Education & Population varied

3.3. HIC/MIC = higher tax base > more resources. HIC/MIC = higher tax base > more resources. Strengthening LIC health systems = Transfer of resources Strengthening LIC health systems = Transfer of resources (human and financial) from HIC. (human and financial) from HIC.

NursingNursing Response of Support Response of Support

Population health requires strong health Population health requires strong health system.system.

Long-term sustainability of health Long-term sustainability of health system (public or private) requires system (public or private) requires quality input.quality input.

Nurses are majority health care Nurses are majority health care providers.providers.

Gender issue ? “Vacuum of silence” on Gender issue ? “Vacuum of silence” on global health issues.global health issues.

Nurses Addressing Global HealthNurses Addressing Global Health

Organizational DevelopmentOrganizational Development• Building strong nursing associations. Building strong nursing associations. • Building strong nurses unionsBuilding strong nurses unions

EducationEducation• Strengthening Faculties of Nursing Strengthening Faculties of Nursing • Providing scholarships and Providing scholarships and

educationeducation• ResearchResearch• Implementing best practicesImplementing best practices

Leadership & DialogueLeadership & Dialogue• International Council of NursesInternational Council of Nurses• World Health OrganizationWorld Health Organization• World Health AssemblyWorld Health Assembly• United NationsUnited Nations• International Labour OrganizationInternational Labour Organization

Case Study: Canadian Nurses Case Study: Canadian Nurses AssociationAssociation

Federation of 11 provincial and territorial nursing associations and colleges

Represents 133,700 registered nurses and nurse practitioners. History:

Policy Leadership, Educating members Advocacy w/ Government Program Leadership, Volunteerism, Achieved results

Goal: Advance international health policy and development in Canada and abroad to support global health and equity

CNA Position - Global Health & Equity

Social Justice ApproachSocial Justice Approach

““Canadian health professionals, including registered nurses, Canadian health professionals, including registered nurses,

have the have the right and responsibilityright and responsibility

to to raise awarenessraise awareness of the root cases of the root cases of inequity in global of inequity in global healthhealth

and to participate in and to participate in finding solutionsfinding solutions. .

Collaboration, cooperation and communication Collaboration, cooperation and communication among all among all health professionalhealth professional are key to are key to advancing an agenda to advancing an agenda to improve global health and equityimprove global health and equity.”.”

Position Statement, Global Health and Equity Canadian Nurses AssociationPosition Statement, Global Health and Equity Canadian Nurses Association

CNA International Development ProgramCNA International Development Program

30 year history30 year history Partnership approach Partnership approach CIDA Funding:CIDA Funding:

• On-going program funding to strengthen nursing associations On-going program funding to strengthen nursing associations (US$ 1million). Funds 8 NNA / 1 regional HIV network.(US$ 1million). Funds 8 NNA / 1 regional HIV network.

• Bilateral HIV & Nursing Support project.Bilateral HIV & Nursing Support project.• Research grant reduce needle stick injury.Research grant reduce needle stick injury.• Bilateral project strengthening regulations.Bilateral project strengthening regulations.

Federation of Unions contribution to strengthen union.Federation of Unions contribution to strengthen union. On-going Membership EducationOn-going Membership Education

Nursing Organizations Can:Nursing Organizations Can: Educate membershipEducate membership

• Global health issuesGlobal health issues• Promote involvement at local, national and Promote involvement at local, national and

international levelinternational level Organizations can:Organizations can:

• Implement partnership programs/projectsImplement partnership programs/projects• Partnership in research for best practicesPartnership in research for best practices• Advise government to meet global health needs.Advise government to meet global health needs.• Provide support and mentorshipProvide support and mentorship• Undertake projects in partnershipUndertake projects in partnership• Mobilize financial support Mobilize financial support

Multi-Sector Approach to HIV & Health Systems Multi-Sector Approach to HIV & Health Systems StrengtheningStrengthening

Physicians

Persons Living with Persons Living with HIVHIV

Faith Based

Organizations

Musi

cian

s

Musi

cian

s

Community OrganizationsLabour

Labour

Economists

Historians

Historians

Social Workers

Social Workers

Sports Persons

Government: Local, Government: Local, National, National,

InternationalInternationalBusiness

Business

Universities

Universities

Community Community CaregiversCaregivers

Ending the Vacuum of SilenceEnding the Vacuum of Silence

Physicians

PersonsPersons Living with HIV Living with HIV

Faith Based

Organizations

Musi

cian

s

Musi

cian

s

Community Organizations Labour

Labour

Economists

Historians

Historians

Social Workers

Social Workers

Sports PersonsGovernment: Local, Government: Local, National, National,

InternationalInternational

Business

Business

Universities

Universities

NursesNurses

Community Community CaregiversCaregivers

Thank YouThank You

Data Sources:Organization for Economic Cooperation and Development:

2006 Expenditures Report. 2007UNAIDS Report 2008CNA Backgrounder: Social Determinants of Health and

Nursing.