Katz Itamar, Glandon Douglas, Wong Wendy, Kargbo Brima, Ombam Regina, Singh Shanti, Ramsammy Leslie, Tal-Dia Anta, Seck Ibrahima, Osika John S
Abt Associates, International Health Division, 4550 Montgomery Avenue, Bethesda, MD 20814, USA. E-mail:
Health Policy Plan. 2014 May;29(3):379-87. doi: 10.1093/heapol/czt024. Epub 2013 Apr 23.
In light of the decline in donor HIV funding, HIV programmes increasingly need to assess their available and potential resources and maximize their utilization. This article presents lessons learned related to how countries have addressed the sustainability of HIV programmes in a stakeholder-driven sustainability analysis.
During HIV/AIDS Programme Sustainability Analysis Tool (HAPSAT) applications in six countries (Benin, Guyana, Kenya, Lesotho, Sierra Leone and South Sudan), stakeholders identified key sustainability challenges for their HIV responses. Possible policy approaches were prepared, and those related to prioritization and resource mobilization are analysed in this article.
The need to prioritize evidence-based interventions and apply efficiency measures is being accepted by countries. Five of the six countries in this study requested that the HAPSAT team prepare 'prioritization' strategies. Countries recognize the need to prepare for an alternative to 'universal access by 2015', acknowledging that their capacity might be insufficient to reach such high-coverage levels by then. There is further acceptance of the importance of reaching the most-at-risk, marginalized populations, as seen, for example, in South Sudan and Sierra Leone. However, the pace at which resources are shifting towards these populations is slow. Finally, only two of the six countries, Kenya and Benin, chose to examine options for generating additional financial resources beyond donor funding. In Kenya, three non-donor sources were recommended, yet even if all were to be implemented, it would cover only 25% of the funding needed.
Countries are increasingly willing to address the challenges of HIV programme sustainability, yet in different ways and with varying urgency. To secure achievements made to date and maximize future impact, countries would benefit from strengthening their strategic plans, operational plans and funding proposals with concrete timelines and responsibilities for addressing sustainability issues.
鉴于对艾滋病防治的资助减少，艾滋病项目越来越需要评估其现有和潜在资源，并最大限度地加以利用。本文介绍了在利益相关方驱动的可持续性分析中，各国在应对艾滋病项目可持续性方面所汲取的经验教训。
在六个国家（贝宁、圭亚那、肯尼亚、莱索托、塞拉利昂和南苏丹）应用艾滋病项目可持续性分析工具（HAPSAT）期间，利益相关方确定了其艾滋病应对措施面临的关键可持续性挑战。制定了可能的政策方法，本文分析了与优先事项确定和资源调动相关的方法。
各国逐渐接受了基于证据的干预措施需优先实施并采用效率措施的观点。本研究中的六个国家中有五个要求HAPSAT团队制定“优先事项确定”战略。各国认识到需要为“到2015年普及治疗”的替代方案做准备，承认届时其能力可能不足以实现如此高的覆盖水平。各国进一步认识到覆盖最易感染、边缘化人群的重要性，例如在南苏丹和塞拉利昂就可见一斑。然而，资源转向这些人群的速度缓慢。最后，六个国家中只有肯尼亚和贝宁选择研究除捐助资金外获取更多财政资源的选项。在肯尼亚，推荐了三个非捐助资金来源，但即便全部实施，也只能满足所需资金的25%。
各国越来越愿意应对艾滋病项目可持续性挑战，但方式各异，紧迫性也不同。为巩固迄今取得的成果并使未来影响最大化，各国若能加强其战略计划、业务计划和资金提案，明确解决可持续性问题的具体时间表和责任，将受益匪浅。
