Taking the E out of PEPFAR: Commemorating World AIDS Day 2013

Amanda PuckettPEPFAR. To me, these six letters symbolize one of the most significant global health commitments in history. The US President’s Emergency Plan for AIDS Relief (PEPFAR) is the largest response by one country to a single health epidemic. Over the past eight years at IntraHealth International, I have supported a range of PEPFAR-funded country programs that have led to improving the lives of millions. And I have observed the United States’ cornerstone HIV/AIDS global development program transform from an emergency response to one that encompasses proven prevention and treatment programs, harnesses technology and innovation, and supports ownership at the country level. So as we commemorate World AIDS Day, I want to reflect on the progress we’ve made and contemplate that “E” in PEPFAR.

Then and now

Ten years ago when PEPFAR was created, $15 million was committed to fighting the HIV/AIDS epidemic through HIV/AIDS prevention, care, and treatment. In 2008, the reauthorization further strengthened this fiscal commitment nearly three-fold to $48 million, and included funding for tuberculosis and malaria. The reauthorization also expanded PEPFAR’s goals to support country sustainability of HIV/AIDS programs, investments in innovation and research, integration of HIV/AIDS programs with broader global health goals, and health systems strengthening. The reauthorization went as far as to include a target of training and retaining at least 140,000 new health care professionals and paraprofessionals.

What have we seen from these noteworthy investments? According to a recent UNAIDS report, there were an estimated 3.4 million new adult and child HIV infections in 2001. In 2012, this figure dropped by 33% with a significant reduction in new infections among children. In the same time frame, AIDS-related deaths dropped from 1.9 million per year to 1.6 million. Improvements in antiretroviral therapy efficacy, increased access to treatment, and greater prevention efforts, such as prevention of mother-to-child transmission (PMTCT), have contributed to the shift.

PEPFAR stacks the blocks

With the reauthorization, PEPFAR now addresses each of the six health systems strengthening building blocks defined by the World Health Organization, focusing resources on strengthening national systems so that countries can mount their own, effective responses to providing HIV/AIDS and other health services. This work includes supporting strong governance for leadership of health systems, developing public-private partnerships to increase HIV/AIDS awareness, and working with countries to track national expenditure on HIV/AIDS and identify opportunities to improve the flow of fiscal resources.

These PEPFAR activities strike a chord with me because not only do they provide countries with tools to combat the HIV/AIDS pandemic, they enable and equip countries to better address future pandemics as well as put them on the path to achieving universal health coverage.

Making a difference in Nigeria

Human resources for health (HRH) is one of the six building blocks and a key component of PEPFAR. Nowhere is the need for HRH more prominent than in sub-Saharan Africa. The countries in this area have the highest HIV/AIDS prevalence and the most severe shortages of health workers. In Nigeria, for instance, an estimated 3.14 million people are living with HIV—the third highest HIV prevalence rate in the world. Though Nigeria has one of the largest quantities of HRH in Africa, there are insufficient numbers of health workers to deliver services to the large population. One particular challenge is the scarce production of health workers and the inadequate distribution of the health workforce, with health workforce shortages the most severe in the rural and northern parts of the country. CapacityPlus is working in Nigeria to address these challenges and advance PEPFAR’s goals, particularly by contributing to the reauthorization’s target of training at least 140,000 new health workers.

In 2013, with funds from PEPFAR, CapacityPlus supported scholarships for 1,345 midwives and 711 community health workers, all who were in their last year of training and identified as “at risk” for dropping out of their respective programs. Financial difficulties are cited as one of the most prominent reasons for student attrition and poor health worker production. As the program manager for CapacityPlus’s Nigeria program, I have observed the excitement this activity has brought to my colleagues, the Federal Ministry of Health of Nigeria, and staff at Schools of Midwifery and Schools of Health Technology throughout the country. More important has been the impact on the recipients of the scholarships—the future health workers who will be providing HIV/AIDS services like prevention education, counseling, and PMTCT, as well as primary health care, malaria and TB treatment, safe delivery, and other services. The support is not only keeping these students in school but motivating them to pursue their dreams. 

One example is Christina Igwe, a student at the School of Midwifery, Ogaja, in Cross River State. Christina was scheduled to complete her training in March, but had to withdraw from her training program because she had to use her school fees to pay for her mother’s burial ceremony. Out of options, she applied for and received the scholarship and is set to graduate in March 2014. “The scholarship will help me achieve my goal in life,” she says. “I am really thankful to CapacityPlus.”

This message from Christina motivates and inspires me to continue championing health workers and supporting PEPFAR programs. This year as we put on our red ribbons to commemorate World AIDS Day, I encourage you to reflect on how far we have come with PEPFAR’s support over the past 10 years. Not only are we contributing to the reduction of new infections and supporting millions with advanced ARV treatment, we are thinking bigger and supporting health workers all over the world in providing HIV/AIDS prevention, treatment, and care services. With these successes we have truly shifted from an emergency response to one that is much broader and sustainable. 

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Photo by Carol Bales