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Dr Isabella Aboderin Oxford Institute of Ageing University Of Oxford

Health Systems, HIV/AIDS and the Development Agenda in sub-Saharan Africa : Implications for Ageing Populations. Dr Isabella Aboderin Oxford Institute of Ageing University Of Oxford. Outline of Presentation. Background : HIV/AIDS and older persons in sub-Saharan Africa (SSA)

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Dr Isabella Aboderin Oxford Institute of Ageing University Of Oxford

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  1. Health Systems, HIV/AIDS and the Development Agenda in sub-Saharan Africa: Implications for Ageing Populations Dr Isabella Aboderin Oxford Institute of Ageing University Of Oxford

  2. Outline of Presentation • Background: HIV/AIDS and older persons in sub-Saharan Africa (SSA) • Health systems: Central role in mediating or underpinning impacts of HIV/AIDS on older people • Pathways • Recommendations

  3. Background: HIV/AIDS and older people in SSA • SSA is the epicenter of the worldwide HIV/AIDS crisis. Home to 63% of all adults and children with HIV globally. (24.7 million in 2006) • AIDS disproportionately kills adults in the ‘prime’ of their lives. Key Impacts: • Societal level: loss of human capital, labour productivity erodes capacity for economic growth • Family level: affects well-being and life chances of all generations

  4. Background: HIV/AIDS and older people in SSA • Rising international focus on impacts of HIV/AIDS on older persons (e.g. Valetta Declaration,Research Network on HIV/AIDS and the Elderly) Focus on: • Older persons as carers of sick, orphaned or vulnerable kin (especially children and grandchildren) • Loss of intergenerational support from younger generation kin • Older people themselves infected with HIV/suffering from AIDS

  5. Health systems: central role • These impacts hinge on (are underpinned or mediated by) the present functioning of health systems • Also giving rise to additional indirect impacts of the HIV/AIDS epidemic on older persons • Impacts linked to three key features of health systems: • Limited resource capacity • Core agendas and priorities for deploying health resources • Specific foci of HIV/AIDS related health programmes

  6. Health systems: limited resource capacity • Health care delivery dysfunctional in most SSA countries following years of debilitating under-investment (in large part due to World Bank/IMF structural adjustment programmes) • Expressed in dismal survival indicators: • Life expectancy at birth in 2005 was 46.7 years—lower than in 1975 • 1 in 10 babies die before the age of 1 year; almost 2 in 10 die before the age of 5 years(UNDP, 2006; WHO, 2006)

  7. Health systems: limited resource capacity • Central problem: extreme lack of financial and human resources

  8. Health systems: lacking financial resources • Per capita government expenditure on health ($) per year • At least $34 needed to achieve essential public heath interventions Source: WHO, 2006

  9. Health systems: lacking human resources • Human resource ‚crisis‘ – severe shortage of physicians and nurses (brain drain, rising demand) Source: WHO 2006

  10. Health systems: lacking financial and human resources • In worst hit countries, resource constraints exacerbated by HIV/AIDS: •  numbers seeking HIV-related care adding pressure on services • HIV/AIDS treatment more costly than treatment for other diseases • AIDS illness and death among health workers (e.g. Botswana lost 17% of health staff to AIDS between 1999-2005) • Stress and low morale  migration of health workers to OECD, Middle East, other SSA countries with lower HIV/AIDS prevalence

  11. Health systems: core agendas • In recent years emergence of key international agendas to enhance health and/or health systems in SSA: • UN Millennium Development Goals (2000) • Abuja Declaration of Leaders of African Countries (2001) • 2002 NEPAD Health Strategy (2002) • Commission for Africa Recommendations (2005) • Pledges for increased health spending: African countries 15% of annual countries; Donor nations 0.7% of GNP (largely not yet met)

  12. Core priorities • Crucially, agendas also set the priorities for deploying the resources that are available • Highest Priority: Fight against HIV/AIDS, Tb and other infectious diseases (MDG 6) • Economic Rationale: Tackling HIV/AIDS, Tb  enhanced human capital, labour productivity, educational attainment  to lead to economic growth (WHO, 2006, ILO, 2006)

  13. Specific foci of HIV/AIDS related health programmes Set by: • UN Declaration of Commitment on HIV/AIDS & the MDGs (2001) Top four programme priorities: • Prevent HIV infection esp. among the young (15-24 yrs) • Stop mother to child transmission • Provide treatment to all those infected • Provide care to all whose lives are devastated by AIDS, esp. orphans

  14. HIV/AIDS programmatic foci in practice • Expansion of Anti-Retroviral Treatment (ARV) (reduces complications, prolongs life, stops mother-child transmission) • Voluntary Counselling and Testing (VCT) • Support to families affected by AIDS, esp.orphans (e.g. Child support grants, Community Home-Based Care initiatives) • Explicit and implicit focus on children and reproductive ages (15-49 yrs)

  15. Health systems impacts: pathways • We can identify four key pathways through which these key features of health systems mediate or cause the impacts of HIV/AIDS on older people • Impacts on present and future cohorts of older people

  16. Impacts 1: Neglect of HIV/AIDS among current cohorts of older people

  17. Impacts 2. Creating extra care burdens for current cohorts of older people

  18. Impacts 3. ‚Crowding out‘ service provision for age-related non-communicable disease (NCD) among current cohorts of older people

  19. Impacts 4:Crowding out service provision for prevention of NCDs among future cohorts of older people

  20. Life course and risk of CHD, stroke and diabetes FetalLife Infancy &Childhood Adolescence Adult Life SEP,established adult behavioural/biological risk factors SEP, diet obesity lack of PA smoking high SEP; birth weight, maternal nutrition status Development of NCD SEP, diet, obesity, lack of PA, diseases, growth rate Accumulated Risk (Range) low Age PA: physical activitySEP: socio-economic position Source:Aboderin, Kalache et al., 2002

  21. Recommendations • Efforts to address the impacts of HIV/AIDS on present and future cohorts of older people must focus on enhancing health systems • Efforts need to hinge on: B

  22. Recommendations • Expansion of current HIV/AIDS programmatic foci to include: • HIV/AIDS detection and treatment among age groups 50+ • Adequate support (education, material, practical) to home-based care for AIDS sufferers

  23. Recommendations • Expansion of core priorities beyond MDG 6 (5,4) to include affordable measures to address NCDs : • Primordial prevention: reduce exposure to risk-inducing environments (e.g. control sale/marketing of tobacco, alcohol, unhealthy foods) • Primary Prevention (among children, youth, adults) (health promotion to encourage healthy lifestyles, possibly integrated with HIV/AIDS programmes) • Management/secondary prevention of NCDs among older adults (Examples of successful low-cost programmes exist (WHO, 2006))

  24. Thank you

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