Guidelines

1
Monitoring progress towards Universal Access
2010 in the health sector
Kevin M De Cock Ties Boerma
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Monitoring progress towards Universal Access by
2010

• UN General Assembly 60th session, June 2006
• Reiterates "commitment to pursuing all necessary
  efforts to scale-up towards the goal of
  universal access to comprehensive prevention,
  treatment, care and support by 2010"
• Calls for setting up and maintaining rigorous
  monitoring evaluation frameworks
• Lessons learned solid commitment to monitoring
  progress essential
• International initiatives Health for All by the
  Year 2000 Millennium Development Goals "3 by 5"
• Too much focus on indicators and reporting
  requirements
• Too little focus on investment in measurement and
  country health information systems

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WHO framework for monitoring the health sector
components of access

• Availability
• reachable and
• affordable services
• that meet a minimum
• standard

Coverage people using the intervention among
those who need it
Impact reduction in new infection rates and
improved survival of those infected
Health Interventions
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WHO framework for monitoring the health sector
priority interventions
Availability
Coverage
Impact
ART Treatment programs for people with advanced
infection
PMTCT Preventive therapy for pregnant women
Counseling testing TB patients, risk populations
Nosocomial infections Blood safety, universal
precautions
Most-at-Risk Populations Targeted interventions
Strategic Information Comprehensive HIV/AIDS
surveillance systems
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Indicators and Targets

• Indicators minimize the number of indicators to
  monitor progress
• Impact UNGASS and other goals (e.g. prevention
  HIV in infants)
• Coverage UNGASS and other goals (e.g. people on
  ART among those in need)
• Availability focus on basic indicators to
  measure progress and direct link with service
  provision (e.g. districts providing ART services)
• Measurement invest systematically in better
  measurement to obtain quality data
• Facility census, service recording and reporting,
  coverage surveys, vital registration
• What about setting targets?

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Global scale-up experienceTrends in the number
of people on ART 2004-2006
3 by 5 target
All low and middle income countries
Sub-Saharan Africa
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Global scale-up experienceTrends in the number
of people on ART 2004-2006

ART need 2006
3 by 5 target
All low and middle income countries
Sub-Saharan Africa
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Country experiences (1)Rapid increase in number
of ART sites, selected countries in Africa
2002-2006
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Country experiences (2)Expanding sites and site
volumes, Malawi
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Country experiences ART availability and
coverage trend, Thailand, 2003-2006
Number of people on ART
Number of ART sites
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ART coverage () trends in six African
countries, 2003-2006
Namibia Rwanda
South Africa Malawi
Tanzania Nigeria
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Targets and global standards

• Universal aim for 100, with global standards
  as benchmarks
• TB 70 case detection / 85 treatment success
  rate
• Immunization Reach Every District (RED) at
  least 80 DPT3 coverage in every district
  includes equity
• Targets Country-specific targets are important,
  supported by global standards for universal
  access
• Example 80 of districts have at least 2 ART
  facilities by 2008
• Variable time line adapted to country-specific
  constraints
• What are the constraints?

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Targets and TimelinesOvercoming country
constraints to reach minimum standards
Constraints
Minimum standard for UA
Contextual factors governance, physical
environment

Public policies Government bureaucracy,
infrastructure

Health sector policy and strategic management
level

Country rates of scale-up
Health service delivery infrastructure, staff,
drugs and supplies

Community and household demand for services,
barriers to use


Epidemiologic situation ability to reach the
people in need

2010
2005
2015
Constraints adapted from Hanson K et al. J Int
Dev 15, 2003 1-14
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WHO's commitment

• Take responsibility for monitoring progress in
  the health sector at the international level and
  set international standards for key
  interventions, in close collaboration with UNAIDS
  and other partners
• Provide guidance and assistance to countries to
  develop national targets and monitor progress
• Launch a first Update on progress in the health
  sector by World AIDS 2006 focusing on
• Availability, Coverage and Impact of the priority
  interventions
• Development of global standards for universal
  access
• Progress in the highest burden countries
• Provide annual Updates on progress in the health
  sector