Scaling-Up Health Systems

Health systems all over Latin America and the Caribbean are suffering the consequences of a lack of organization and planning for the increase in the demand for—and use of— services. The advent of a new infectious disease undermines already limited capacity to ensure access to quality care for everyone according to established standards. Few governments in the region have managed to implement the necessary policies and expend resources for a comprehensive response to HIV/AIDS. The HIV/AIDS pandemic is occurring at a time when most countries throughout the region are reducing social spending, thus damaging already resource-constrained health facilities and health systems by limiting funding. The current barriers to effective AIDS treatment programs are analogous in many ways to the conditions of the MDR-TB epidemic, so that the management of MDR-TB treatment programs through the mechanism of the Green Light Committee (GLC) can offer practical lessons for the challenge of delivering HIV/AIDS treatment to poor communities worldwide. Beyond parallel concerns of cost, objections center on the problem of inadequate local infrastructure and management capacities. Given infrastructure weakness and institutional inefficiency, it could be argued that even if drugs for HIV were available at no cost, the systems for delivering them to those in need might still not be there. Situations like this reflect real gaps in poor countries’ health care delivery apparatus. Yet, their existence is not an excuse for inertia and resignation and nontraditional infrastructure and institutional capacity are present, and proven mechanisms for scaling up delivery exist.