HIV programme sustainability in Southern and Eastern Africa and the changing role of external assistance for health
Dados Bibliográficos
High human immunodeficiency virus (HIV)–prevalence countries in Southern and Eastern Africa continue to receive substantial external assistance (EA) for HIV programming, yet countries are at risk of transitioning out of HIV aid without achieving epidemic control. We sought to address two questions: (1) to what extent has HIV EA in the region been programmed and delivered in a way that supports long-term sustainability and (2) how should development agencies change operational approaches to support long-term, sustainable HIV control? We conducted 20 semi-structured key informant interviews with global and country-level respondents coupled with an analysis of Global Fund budget data for Malawi, Uganda, and Zambia (from 2017 until the present). We assessed EA practice along six dimensions of sustainability, namely financial, epidemiological, programmatic, rights-based, structural and political sustainability. Our respondents described HIV systems’ vulnerability to donor departure, as well as how development partner priorities and practices have created challenges to promoting long-term HIV control. The challenges exacerbated by EA patterns include an emphasis on treatment over prevention, limiting effects on new infection rates; resistance to service integration driven in part by ‘winners’ under current EA patterns and challenges in ensuring coverage for marginalized populations; persistent structural barriers to effectively serving key populations and limited capacity among organizations best positioned to respond to community needs; and the need for advocacy given the erosion of political commitment by the long-term and substantive nature of HIV EA. Our recommendations include developing a robust investment case for primary prevention, providing operational support for integration processes, investing in local organizations and addressing issues of political will. While strategies must be locally crafted, our paper provides initial suggestions for how EA partners could change operational approaches to support long-term HIV control and the achievement of universal health coverage
Developing country · Economic growth · Economics · Environmental health · Human immunodeficiency virus (HIV) · Political science · Sustainability · Adolescent Sexual and Reproductive Health · HIV/AIDS Research and Interventions · Medicine · Poverty, Education, and Child Welfare · Virology
Financial sustainability of local NGOs funded by the Churches Health Association of Zambia in Zambia
Assessing the integration of social protection into infectious disease policies
The Lenacapavir effect
Qualitative Exploration of Healthcare Providers’ Perspectives on HIV Service Vulnerability During Funding Disruption in Nigeria
The successful scaling-up of antiretroviral therapy globally has many lessons for advancing universal health coverage
Sustainability science
Geographic prioritisation in Kenya and Uganda
Transitioning from donor aid for health
How donors support civil society as government accountability advocates
Exceptionalism at the End of Aids
What does sustainability mean in the HIV and Aids response
The impacts of donor transitions on health systems in middle-income countries
Rethinking external assistance for health
Understanding pathways for scaling up health services through the lens of complex adaptive systems
Applying lessons learned from the Usaid family planning graduation experience to the Gavi graduation process
Associations of Neighborhood Characteristics With the Location and Type of Food Stores
An Agenda for Research on the Sustainability of Public Health Programs
| Obras citantes distintas | 5 |
|---|---|
| Citações por ano | 5 |
| Intervalo de citações | 2025 - 2026 (2) |
| Velocidade de citação | current |
| Altamente citado | Não |
| Tipos de citação | Neutras: 5 |