Do HIV Interventions have a Positive Impact on Other Health Programs?

One of the most interesting sessions I’ve attended was “Impact of HIV programs on other health services and population health.” Whether stand-alone HIV programs contribute to enhancing the performance of non-HIV services and, ultimately, to the improvement of broad health indicators remains one of the most debated (and debatable) issues.

The panelists presented different studies. In one, health indicator trends were assessed in PEPFAR-supported African countries versus other countries. In another, research compared outputs of public health activities between facilities providing HIV services and those that do not provide them.

In short, the results presented were inconclusive; they did not display convincing evidence of beneficial effects or added values generating from HIV programs and spillover to other health services. Some of the findings were not consistent or were even contradicting. The presenters acknowledged limitations in their study design and possible confounding factors that could have affected the final results. Surprisingly, they appeared content with some intermediate results and the statistical significance occasionally detected in their analysis.

It is probably premature to give definitive answers as to whether vertical interventions produce any “positive externality” on the health sector as a whole. There are obvious overlaps where this can easily and frequently happen. But more rigorous studies need to be conducted to extricate and interpret the complex relations between diverse interventions performed in different areas.

It is rare for HIV-related programs like NUMAT to collect this kind of information. Commonly, PEPFAR-funded programs are required to collect and submit numerical outputs: number of patients treated, number of clients reached, number of health workers trained. etc with very little consideration on rates and coverage of target population. As a result, monitoring & evaluation staff are too occupied (and preoccupied) submitting the required deliverables. However, our programs should nonetheless endeavor to gather as much data on other aspects of care as possible and to find time for elaborating and analyzing more health information. This could produce two essential results. First, by doing so we should be able to look at the broader picture of our intervention as far as health care services are concerned. Secondly, we could be more informed and authoritative in documenting our findings, supporting our views, and contributing to the design of future programs.

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