A US-funded study has indicated that increased funding of HIV/Aids programmes in Rwanda has benefited other health programmes.The six-year long study, published in the May 2012 issue of the American Journal of Tropical Medicine and Hygiene, found that when rural health clinics expanded Aids services, these efforts had not undermined health funding for other diseases.Its lead author, Donald S. Shepard, a professor at Brandeis University’s Schneider Institute for Health Policy, said there was even evidence that clinics that have received funding for HIV/Aids services provide better care for all patients, including superior prevention services, than those clinics without Aids programmes.The team of researchers undertook the study in order to address a long-standing debate within the public health community on whether HIV/Aids funding had strengthened or diminished the capacity of health care systems of the recipient countries to manage other diseases.“This study shows that for most indicators examined, there were neither prominent diversion nor enhancement effects after AIDS services were inaugurated. The results are consistent with those fromstudies in several other countries in Africa,” said Shepard as he released the findings this week.The USAID-Rwanda HIV/Aids Technical Advisor Dr Nancy Fitch, said Rwanda was a unique country with a leadership that’s “focused strategically on capturing HIV funds to strengthen its health system.”“Rwanda had prior experience managing a donor invasion following the Genocide (against the Tutsi) and noted the lack of sustainability of those donor initiated activities. During the scale-up of HIV services, the Ministry of Health expressed their intention to maximally coordinate these funds to result in sustainable strengthening of its health system,” Fitch wrote on sciencecodex.com.She added; “Donor coordination was much more actively led in Rwanda than in many other countries. The Rwanda experience demonstrates that disease-specific programmes can provide sustainable capacity building to health systems when there is conscious intent to do so… Future studies in other countries would be very informative.” Speaking to The New Times yesterday, the Director General of Health Communication Centre, Arthur Asiimwe, explained that other health services are equally catered for by HIV funding because Rwanda has an integrated approach to funds disbursement.“We try to maximise all the available resources to ensure that we improve our service delivery across the board. For example, if a microscope is bought using the HIV funds, we place it in a clinic laboratory and it can be used for any other lab tests,” said Asiimwe. “This is the same case to funding for other diseases, when we receive funds for malaria to construct a ward, that facility may as well be used by other patients.”Debate in rife within the global health community about the impact of dedicated HIV/Aids funding on general public health services.Between 2002 and 2006, global funds directed to HIV/Aids programmes absorbed approximately one third of donor funding on health and population programmes.Critics of dedicated HIV/Aids spending argue that this has undermined the ability and commitment of governments to manage diseases such as malaria, measles and tuberculosis, and to tackle malnutrition and child immunisation.The researchers evaluated both the number of personnel assigned to HIV/Aids and non-HIV/ Aids services, as well as nine types of preventive and curative services provided, including vaccinations administered, number of visits for child growth monitoring, and number of hospital admissions.Previous studies, they write, mostly considered just the input of indications such as personnel.Reacting to the development, the Acting Executive Director of Health Development Initiative Rwanda, Cassien Havugimana, noted that the country has used funds it received from Global Fund to improve health services in general.“The number of health infrastructures increased as well as practitioners. In a situation where the facilities and practitioners have increased, it’s the patients that benefit; For example, most of the ambulances were purchased under the funding of Global Fund. These ambulances have not only benefited people living with HIV/Aids but all patients in general,” said Havugimana said.
