HIV and health systems   Download (pdf 229 KB)

Faith in the System: The impact of local HIV responses on strengthening health systems in Malawi and Chad

There has been an ongoing debate as to whether the significant investment in HIV and AIDS programmes has diverted funding from other areas of health programmes, and whether such direct (vertical) HIV funding has an impact on the strengthening or weakening of health systems. The debate raises the question of whether funding vertical HIV and AIDS programming or integrated horizontal approaches is more appropriate.  The focus of this research is the role of faith-based organisations - which to date have been largely unacknowledged in the discourse on HIV funding and health systems strengthening - to see if and how local faith-based responses to HIV strengthen health systems. Commissioned by Tearfund, the research aims to contribute to the growing literature on health systems strengthening by adding the experiences of faithbased responses.

Foi dans le système   Download (pdf 262 KB)

Impact des réponses locales au VIH sur le renforcement des systèmes de santé au Malawi et au Tchad

Un débat permanent cherche à déterminer si l'investissement important dans les programmes VIH et sida a détourné le financement qui aurait pu aller vers d'autres domaines des programmes de santé, et si un tel financement VIH direct (vertical) a un impact sur le renforcement ou l'affaiblissement des systèmes de santé. Le débat soulève la question: entre le financement de programmes verticaux VIH et sida et celui d'approches horizontales intégrées, lequel est le plus approprié.  Cette recherche est centrée sur le rôle des organisations confessionnelles, qui à ce jour a été largement méconnu dans le discours sur le financement VIH et le renforcement des systèmes de santé, pour examiner si et comment les réponses locales confessionnelles au VIH renforcent les systèmes de santé. La recherche, commanditée par Tearfund, vise à apporter une contribution à la littérature croissante sur le renforcement des systèmes de santé, en y ajoutant les expériences des réponses confessionnelles.

Key findings

The findings in this report emerge from a qualitative research process with a range of stakeholders in two African countries: Chad and Malawi. The research focuses on Tearfund partner organisations, Christian organisations and national- and local-level stakeholders. The participating individuals and organisations were identified as having a key role in the HIV response and/or health systems strengthening. Local community members who participate in projects of the Tearfund partner organisations in each country were also consulted.

Faith-based responses to HIV can help strengthen health systems, because:

• interfaith HIV awareness programmes and services can be delivered that cut across the traditional barriers between different religions and make HIV services available to all
• HIV services can extend the reach and coverage of health systems by carrying out local education and awareness raising, and referring people to existing clinic programmes
• faith-based organisations can provide HIV services in difficult-to-reach rural areas where there is weak health infrastructure
• faith-based organisations can influence and empower religious leaders to discuss HIV and AIDS in the communities where they are based and thereby support the local health service responses
• HIV services can relieve pressure on health systems by carrying out home-based care and palliative care and by delivering medicines.

There are barriers to overcome if the full potential of faith-based organisations to contribute to health systems strengthening is to be realised.

• A lack of coordination at the local and national levels means that government health facilities and faithbased responses are sometimes unaware of each other's work. This can result in ineffective or no referral systems, and the possibility of services being duplicated unnecessarily.
• Faith-based organisations need to ensure good practice and improve monitoring and evaluation of their programmes to measure the impact and draw out the learning.
• Attitudes towards people living with HIV and AIDS by some religious leaders and a reluctance by some to promote comprehensive services (including condoms or antiretroviral therapy) can create challenges for health workers implementing HIV and AIDS programmes.