Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #120212

Kenneth Gimbel-Sherr, MPH¹, Sarah Gimbel-Sherr, RN, MA¹, Mark A. Micek, MD, MPH², James T. Pfeiffer, PhD, MPH³, and Stephen Gloyd, MD, MPH⁴. (1) Epidemiology, University of Washington, 178 27th Avenue, Seattle, WA 98122, 206 427 6946, ksherr@u.washington.edu, (2) International Health Program, Department of Health Services, University of Washington, Box 354809, University of Washington, Seattle, WA 98195, (3) Department of Health Services, University of Washington, HAI, 1107 NE 45th St, Suite 427, Seattle, WA 98105, (4) Health Services/International Health, University of Washington, 1959 NE Pacific Street, H-660 P.O. Box 357660, Seattle, WA 98195-7660

Background: The expansion of HIV treatment offers new opportunities to support primary health care systems, though it raises questions about the role of international NGOs with little expertise in health systems development. The NGO approach creates tension and often has deleterious effects within the public sector. The Ministry of Health (MOH) in Mozambique developed a national plan to guide HIV treatment scale-up which has helped contain these effects.

Methods: Comparing the experience of four models of NGO participation in the ARV expansion program highlights the benefits and risks of the NGO model. Analysis focuses on how aid to NGOs has helped in the initial phase of ARV scale-up, the deleterious effects of this aid on the public sector (including human resource distortions, sustainability, efficiency and issues around coordination), as well as new modalities of cooperation and financing led by the MOH to maximize their efforts.

Lessons Learned: International NGOs can help catalyze public sector ARV expansion initiatives, though with important collateral effects that sometimes weaken primary health care systems. Relatively higher salaries attract key human resources away from the MOH; donor reporting requirements and parallel distribution and information systems create duplication; and different training, community and treatment approaches hinder local and national coordination. A national ARV expansion plan establishes a strong public sector role which helps minimize the potential unintentional negative consequences of NGO involvement.

Recommendations: New models for supporting public sector and NGO/public sector coordination are emerging that can build strong, sustainable health systems and. reinforce a positive role for NGOs in the process.

Learning Objectives:

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.