The debate within the global health community about the impact of dedicated HIV/Aids funding on general public health services has been taken a step further with a study showing that funding dedicated to HIV/Aids does not undermine health funding for other diseases.
A six-year long study in Rwanda published in the May 2012 issue of the American Journal of Tropical Medicine and Hygiene, found that when rural health clinics expanded Aids services, these efforts had no adverse effects on other types of health care.
The study's lead author, Donald S. Shepard - a professor at Brandeis University's Schneider Institute for Health Policy - added that there was "even evidence that clinics that have received funding for HIV/Aids services provide better care for all patients, including superior prevention services, than do clinics without Aids programmes."
The team undertook the study in order to address a long-standing debate within the public health community on whether HIV/Aids funding had strengthened or diminished the capacity of health care systems of the recipient countries to manage other diseases.
Between 2002 and 2006, global funds directed to HIV/Aids programmes absorbed approximately one third of donor funding on health and population programmes.
Critics of dedicated HIV/Aids spending argue that this has undermined the ability and commitment of governments to manage diseases such as malaria, measles and tuberculosis, and to tackle malnutrition and child immunisation.
By contrast, those who support dedicated HIV/Aids funding argue that the sharp increase in spending on such programmes benefits the broader public health system - bringing improvements in such areas as laboratories, disease surveillance, human resources, and information systems. These, they say, generate broad benefits across the health care system.
The study compared 25 rural health centres in Rwanda that had begun offering antiretroviral therapy (ART) between 2002 and 2006, and another similar 25 centres that had not introduced such services.
In 1996, the HIV infection rate in Rwanda was 6.9 percent among the rural population. In 2010, HIV prevalence stood at 2.3 percent among rural populations with more than 95 percent of all Rwandans having access to antiretroviral treatment. [ http://www.usaid.gov/our_work/global_health/aids/Countries/africa/rwanda.pdf ]
"Rwanda's progress against HIV/AIDS has not come at the expense of addressing other health needs," said Shepard. He added that while there was not a large difference between those health centres offering ART and those that did not, it was possible that "Aids funding may be having a spill-over effect in terms of improving overall quality of care".
The decision in Rwanda to integrate HIV/Aids services with general health services, together with generous donor support, "may have contributed to widespread service improvements," says Shepard. He added that an example of this was the provision of Aids services together with a variety of other family health care interventions. This combination meant that clinics that offered Aids treatment could have more encounters with children who might otherwise miss their vaccinations.
The study argues that the findings from Rwanda are born out in other countries such as Ethiopia, where even though there was an influx of funding for HIV/Aids which might have encouraged health professionals to move from the public sector to donor-funded programmes, there was no evidence that this had had a negative effect on the health system overall.
The evidence from Ethiopia showed that "mortality decreased, coverage of immunization increased and antenatal care coverage increased over the four-year period of HIV expansion."