Report on the Global HIV/AIDS epidemic

Care and support for people living with HIV/AIDS
would not be affordable. For example, based on 1997 prices, the provision of triple
combination therapy to all people with HIV in sub-Saharan Africa could consume
between 9% and 67% of total GDP.
As these examples make clear, the ability to secure financing for health care, particularly for advanced care options such as antiretroviral therapy, is very limited in
developing countries. Determining the best buy within the prevailing resource constraints - a recurring challenge for health system decision-makers - must go hand
in hand with efforts to make health service delivery more efficient and to mobilize
additional resources for the sector.
One of the critical factors for service delivery is the availability of people to deliver
services. As mentioned earlier, AIDS increases the demand on the health sector (see
page 31), and at the same time reduces the human resources available to it by causing illness and death in the sector's workforce. With fewer health care providers
available to carry an ever-increasing workload, it is easy to understand why the
remaining staff may experience burn-out, which results in a lower quality of service
and further attrition in the workforce. It is urgent for governments to establish human
resource policies aimed at mitigating these impacts on the health sector (see pages
94-96). The desirable response would be to increase the number of health care
workers so as to maintain the sector's ability to deliver services. This requires decisions about the kinds and numbers of health care workers that will be needed, and
a clear idea of how the cost of the mitigation efforts will be shouldered.
Care and support packages
The kind of care and support "package" made available to people living with HIV or
AIDS will thus depend on the ability to mobilize human, infrastructure and financial
resources. Where the ability to mobilize resources is extremely limited (such as in
most of rural sub-Saharan Africa) or somewhat limited (as in northern Thailand), the
package will necessarily be more limited than where resource availability is relatively
unrestricted.
Examples of what the essential, intermediate and advanced packages could comprise are given in the Table 1, page 98.
It is important to emphasize that progress in improving health service delivery need
not be strictly linear. For example, planners may discover an opportunity for
expanding access to treatment for multiresistant tuberculosis (an option in the
advanced package) in a region where people with HIV are receiving mainly the intermediate package. If so, they should not hesitate to push ahead with this option, in
particular when the prospect for improving delivery of some of the less advanced
options is poor.
In these examples of care and support packages, no consideration is given to
improving health service delivery through greater efficiency and coverage.

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