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Monitoring UA 2010 in health sector1 |
Monitoring progress towards Universal Access 2010
in the health sector
Monitoring progress towards Universal Access 2010
in the health sector
Kevin M De CockTies Boerma
Monitoring UA 2010 in health sector2 |
Monitoring progress towards Universal Access by 2010
Monitoring progress towards Universal Access by 2010
UN General Assembly 60th session, June 2006– Reiterates "commitment to pursuing all necessary efforts to scale-up … towards the
goal of universal access to comprehensive prevention, treatment, care and support by 2010"
– Calls for setting up and maintaining rigorous monitoring & evaluation frameworks
Lessons learned: solid commitment to monitoring progress essential– International initiatives: Health for All by the Year 2000; Millennium
Development Goals; "3 by 5"– Too much focus on indicators and reporting requirements– Too little focus on investment in measurement and country health information
systems
Monitoring UA 2010 in health sector3 |
WHO framework for monitoring the health sector: components of access
WHO framework for monitoring the health sector: components of access
Availabilityreachable and
affordable services
that meet a minimum
standard
Coverage people using the
intervention among those who need it
Impact reduction in new
infection rates and
improved survival of
those infected
Health Interventions
Monitoring UA 2010 in health sector4 |
WHO framework for monitoring the health sector: priority interventions
WHO framework for monitoring the health sector: priority interventions
Availability Coverage Impact
ART Treatment programsfor people with advanced infection
PMTCT Preventive therapyfor pregnant women
Counseling & testingTB patients, risk populations
Nosocomial infectionsBlood safety, universal precautions
Most-at-Risk PopulationsTargeted interventions
Strategic Information: Comprehensive HIV/AIDS surveillance systems
Monitoring UA 2010 in health sector5 |
Indicators and TargetsIndicators and Targets
Indicators: minimize the number of indicators to monitor progress– Impact: UNGASS and other goals (e.g. prevention HIV in infants)– Coverage: UNGASS and other goals (e.g. people on ART among those in
need)– Availability: focus on basic indicators to measure progress and direct link
with service provision (e.g. districts providing ART services)
Measurement: invest systematically in better measurement to obtain quality data
– Facility census, service recording and reporting, coverage surveys, vital registration
What about setting targets?
Monitoring UA 2010 in health sector6 |
Global scale-up experience
Trends in the number of people on ART 2004-2006 Global scale-up experience
Trends in the number of people on ART 2004-2006
0
1000
2000
3000
End2003
End2004
End2005
End2006
All low and middle income countries
Sub-Saharan Africa
3 by 5 target
Monitoring UA 2010 in health sector7 |
Global scale-up experience
Trends in the number of people on ART 2004-2006 Global scale-up experience
Trends in the number of people on ART 2004-2006
0
1000
2000
3000
4000
5000
6000
7000
End2003
End2004
End2005
End2006
*
All low and middle income countries
Sub-Saharan Africa
3 by 5 target
ART need 2006
Monitoring UA 2010 in health sector8 |
Country experiences (1)Rapid increase in number of ART sites, selected countries in Africa 2002-2006
Country experiences (1)Rapid increase in number of ART sites, selected countries in Africa 2002-2006
0
20
40
60
80
100
120
140
160
180
2003 2004 2005 2006
Malawi
Uganda
Rwanda
Zambia
Monitoring UA 2010 in health sector9 |
Country experiences (2)Expanding sites and site volumes, Malawi
Country experiences (2)Expanding sites and site volumes, Malawi
Monitoring UA 2010 in health sector10 |
Country experiences ART availability and coverage trend, Thailand, 2003-2006
Country experiences ART availability and coverage trend, Thailand, 2003-2006
112
462
908
0
100
200
300
400
500
600
700
800
900
1000
Jan-03 Jul-03 Jan-04 Jul-04 Jan-05 Jul-05 Jan-06
0
10000
20000
30000
40000
50000
60000
70000
80000
Number of ART sites
Number of peopleon ART
Monitoring UA 2010 in health sector11 |
ART coverage (%) trends in six African countries, 2003-2006
ART coverage (%) trends in six African countries, 2003-2006
0
10
20
30
40
50
60
2004 2005 2006
NamibiaRwanda
South AfricaMalawi
TanzaniaNigeria
Monitoring UA 2010 in health sector12 |
Targets and global standardsTargets and global standards
Universal – aim for 100%, with global standards as benchmarks
– TB: 70% case detection / 85% treatment success rate– Immunization: Reach Every District (RED) = at least 80% DPT3
coverage in every district; includes equity
Targets: Country-specific targets are important, supported by global standards for universal access
– Example: 80% of districts have at least 2 ART facilities by 2008
Variable time line adapted to country-specific constraints– What are the constraints?
Monitoring UA 2010 in health sector13 |
Targets and TimelinesOvercoming country constraints to reach minimum standards
Targets and TimelinesOvercoming country constraints to reach minimum standards
*Constraints: adapted from Hanson K et al. J Int Dev 15, 2003: 1-14
Epidemiologic situation ability to reach the people in need
Community and householddemand for services, barriers to use
Health sectorpolicy and strategic management level
Public policies Government bureaucracy, infrastructure
Health service delivery infrastructure, staff, drugs and supplies
Contextual factorsgovernance, physical environment
*2005 2010 2015
Country rates of scale-up
Minimum standard for UAConstraints
Monitoring UA 2010 in health sector14 |
WHO's commitmentWHO's commitment
Take responsibility for monitoring progress in the health sector at the international level and set international standards for key interventions, in close collaboration with UNAIDS and other partners
Provide guidance and assistance to countries to develop national targets and monitor progress
Launch a first Update on progress in the health sector by World AIDS 2006 focusing on
– Availability, Coverage and Impact of the priority interventions– Development of global standards for universal access– Progress in the highest burden countries
Provide annual Updates on progress in the health sector
