AIDS: using results to speed up progress towards universal access
Dr Margaret Chan
Director-General of the World Health Organization
Honourable ministers, distinguished delegates, distinguished panel members, ladies and gentlemen,
In order to accelerate progress, the setting of national targets for universal access is one way to intensify country efforts. It stimulates a drive to aim high, building on success, and increases accountability. To date, 105 countries have set targets for universal access.
National targets help countries develop prioritized and costed strategies and this, in turn, stimulates the collection of evidence to inform the planning process. We cannot underestimate the importance of evidence for priority setting. Furthermore, national targets help mobilize resources through the Global Fund and other sources, thus supporting results-based accountability.
Experience shows that progress can indeed be very rapid. For example, Ethiopia, within the context of its Millennium AIDS Campaign, has successfully tripled its coverage of HIV testing and counseling in just one year.
In areas of notable progress, we can identify increased investment in AIDS programming, and declining costs of testing and treatment, as major contributing factors.
But, as we all know, the drive to accelerate progress is affected by many factors other than national plans, targets, drug prices, and grants. We need to look at some hard realities, and find ways to address them.
First and foremost, funding absolutely must be predictable and sustainable. Several reports indicate that countries are reluctant to scale up HIV programmes, especially to increase access to treatment, without the assurance of predictable, sustainable funding. This is important for development partners and the donor community in particular.
Stigma and discrimination are huge obstacles to access to all forms of prevention, treatment, care, and support. This is most especially true in countries where discrimination against people living with HIV or against groups at high risk is enshrined in national policies and regulations.
Accelerated progress further depends on broad investments in human resources and health infrastructures, including procurement systems and supply chains, and laboratory services.
As one obvious way forward, countries and their partners should seek better integration of HIV services into existing services for sexual and reproductive health, maternal and child health, and tuberculosis.
Knowing the precise drivers of the epidemic within different settings helps guide a targeted response, which must also give top priority to prevention. The notion of context-specific responses is equally important.
Evidence is mounting: treatment makes prevention more effective, and prevention makes treatment more affordable.
Finally, the urgent need for a coordinated, cohesive response to the epidemic has put the spotlight on the importance of country ownership. As efforts accelerate, the leadership role of national authorities must be safeguarded. This means a constant effort to align activities with national priorities and capacities.
We have made progress in this area, and must not slip on this important agenda, which has major implications for development.