The Bellagio Report: Leveraging HIV Scale-up to Strengthen Health Systems in Africa

In recent years, an unprecedented infusion of resources has brought life-saving HIV services to millions of people. While the urgent need to respond to the HIV epidemic has attracted widespread support, this unprecedented expansion of disease-specific health services has also fueled a lively debate regarding the impact of such initiatives on fragile health systems. Although early studies have yielded some descriptive information, relevant data on this question are scarce.

In September 2008, the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University's Mailman School of Public Health convened a high-level meeting in Bellagio, Italy. With the support of the Rockefeller Foundation, leaders from international agencies, donors, implementing partners, and recipient governments, met to identify gaps
in knowledge about the impact of HIV scale-up on health systems, recommend priority research questions, and suggest potential research methodology. Enclosed is the report from that conference, “Leveraging HIV Scale-up to Strengthen Health Systems in Africa.”

The Bellagio group recommended the following research focus areas:

• Human Resources – identifying trends in the supply of key cadres of health care workers who are linked to HIV scale-up and assessing the degree to which HIV scale-up affects health care access, quality, and outcomes in diverse health areas;

• Financing and Payments – determining national characteristics that predict the ability to use donor support most effectively for national program management, implementation, and health outcomes;

• Infrastructure – assessing clinic-level and district-level trends as HIV services are brought to scale, such morbidity and mortality, patient waiting times, and utilizations of services for other diseases and maternal and child health;

• Monitoring and Evaluation and Health Information Systems – documenting best practices in data management practices and assessing the degree to which HIV funding is spurring improvements in health information systems for other diseases;

• Patient and Provider Behaviors – evaluating models of HIV-related peer or community support organizations to determine their influences on other chronic diseases.

Research has already begun on several of the areas above. Funding must be secured for others. Findings from these studies will inform policymakers, ICAP, and other organizations in shaping the future of global health programs.