Why do health systems matter? Exploring links between health systems and HIV response: a case study from Russia.

نویسندگان

  • Elena Tkatchenko-Schmidt
  • Rifat Atun
  • Martin Wall
  • Patrick Tobi
  • Jürgen Schmidt
  • Adrian Renton
چکیده

INTRODUCTION Studies on the relevance of stronger health systems to the success of vertical programmes has focused mainly on developing countries with fragile infrastructures and limited human resources. Research in middle-income, and particularly post-Soviet, settings has been scarce. This article examines the relationships between health system characteristics and the HIV response in Russia, the country which towards the end of the Soviet period had the world's highest ratios of doctors and hospital beds to population and yet struggled to address the growing threat of HIV/AIDS. METHODS The study is based on semi-structured qualitative interviews with policy-makers and senior health care managers in two Russian regions, and a review of published and unpublished sources on health systems and HIV in Russia. FINDINGS We identified a number of factors associated with the system's failure to address the epidemic. We argue that these factors are not unique to HIV/AIDS. The features of the wider health system within which the HIV response was set up influenced the structure and capacities of the programme, particularly its regulatory and clinical orientation; the discrepancy between formal commitments and implementation; the focus on screening services; and problems with scaling up interventions targeting high-risk groups. DISCUSSION The system-programme interplay is as important in middle-income countries as in poorer settings. An advanced health care infrastructure cannot protect health systems from potential failures in the delivery of vertical programmes. The HIV response cannot be effective, efficient and responsive to the needs of the population if the broader health system does not adhere to the same principles. Strengthening HIV responses in post-Soviet societies will require improvements in their wider health systems, namely advocacy of prevention for high-risk populations, reallocation of resources from curative towards preventive services, building decision-making capacities at the local level, and developing better working environments for health care staff.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Governance of HIV/AIDS: Implications for Health Sector Response

This paper reviews the essence of effective governance and importance of a multi-sectoral approach in generating health systems response to HIV/AIDS. This comprehensive approach highlights the importance of integrating reproductive sexual health programs and HIV prevention services, including peer education, life skills, and Voluntary Counseling and Testing (VCT), for Prevention of Mother–to-Ch...

متن کامل

BRIC Health Systems and Big Pharma: A Challenge for Health Policy and Management

BRIC nations – Brazil, Russia, India, and China – represent 40% of the world’s population, including a growing aging population and middle class with an increasing prevalence of chronic disease. Their healthcare systems increasingly rely on prescription drugs, but they differ from most other healthcare systems because healthcare expenditures in BRIC nations have exhibited the highest revenue gr...

متن کامل

All It Takes for Corruption in Health Systems to Triumph, Is Good People Who Do Nothing; Comment on “We Need to Talk About Corruption in Health Systems”

Numerous investigations demonstrate that the problem of corruption in the health sector is enormous and has grave negative consequences for patients. Nevertheless, the problem of corruption in health systems is far from eminent in the international health policy debate. Hutchinson, Balabanova, and McKee have identifed in their Editorial five reasons why the health policy community has been relu...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Health policy and planning

دوره 25 4  شماره 

صفحات  -

تاریخ انتشار 2010