The Impact of HIV/AIDS on the Health System and Child Health*

This chapter reviews the impact of HIV/AIDS on the health sector and on the health status of children in 40 developing countries with medium-high HIV prevalence rates. The study finds that HIV/AIDS has (i) generated a substantial increase in the overall burden of disease, (ii) crowded out the health resources assigned to the care of traditional sicknesses, (iii) directed most of the additional demand for care at the secondary and tertiary levels thus causing a congestion at these levels while weakening primary health care, including the programs targeted at children and mothers, (iv) caused a substantial increase in health expenditure that was financed by the households in poor countries and by the public sector in the middle income ones and (v) eroded the delivery capacity of the whole health sector due to mounting infection rates among the staff and falling expenditure on fixed investment and maintenance. As for the impact on U5MR, the evidence shows that countries with high HIV prevalence rates, a high coverage of child health services and low U5MR in the pre-AIDS era, there was a marked reversal of the declining trend in child mortality. In contrast, in countries with low-medium HIV prevalence, low pre AIDS coverage of health services for children and high pre-AIDS U5MR, the surge in AIDS-related child mortality was more than offset by a decline in child mortality due to an expanded coverage of basic child health interventions. Finally, the chapter illustrates the merits and limitations of the policy and programme responses introduced so far to fight the new pandemics. It concludes that the current efforts on prevention ought to be intensified and the severe problems encountered in this area rectified. At the same time, the future of child mortality will depend also on: a renewed strengthening of PHC as the main vehicle for the treatment of all child diseases, both AIDS and non-AIDS related; a rapid expansion of PMTCT programs; and a gradual expansion of the treatment of mothers and other adults with generic antiretroviral drugs according to simplified protocols. The chapter also provides, on the basis of a simple mathematical model, a few suggestions on the choice of the optimal mix between prevention and treatment policies under different assumptions concerning their relative costs and efficiency.