Delivery Prevention in Decentralization Health System with Regards to HIV Prevention in Brazil - Research Paper Example

of Learning: Policy Memo Re: Delivery Prevention in Decentralization Health System WithRegards to HIV Prevention in Brazil Date: March 7, 2013 Background The first Aids cases in Brazil were identified in 1982 in Sao Paulo and these cases were witnessed among gay men. In the 1980’s, the SUS was at its infancy thus did not operate nationally. This resulted to a limited surveillance infrastructure that made it almost impossible to track arising HIV cases. By 1989, the new AIDs cases were approximated to have tripled from the earlier figure of 2,600 to 9,000. By the year 1990, Aids cases had been diagnosed in heterosexuals, haemophiliacs, newborns and blood transfusion receipts. At the beginning of the 1990’s, the AIDs epidemic was increasing in such a rate that it was compared to that of South Africa. This followed the cumulative AIDs cases that had doubled to 51,000 from 25,000 by the year 1992 (Simao 3). The main mode of transmission was identified as being sexual intercourse which contributed to more than 97 percent of the total cases. The age group that was mostly affected was the ages between 25 and 35. The male IDU as well as the MSM populations were identified as the ones to be at most risk with the incidence rates being placed at 15 times more than the nation’s general population. At the same time, the infection rates were also observed to be sky rocketing and this was mostly observed among poor people and women in small towns. This alarming situation left the AIDs officials to refer to the AIDS trends in Brazil as being ruralisation, pauperization and feminization. Measures had to be put in place to combat the disease progress in Brazil. The earliest and most aggressive response were witnessed in the cooperation between civil society and government and grounded with respect to human rights. This made the issue being viewed as being an international success. It will be remembered that Brazil became the first developing country in 1996 to come out publicly and offer financed antiretroviral treatment to its citizens living with HIV/AIDs. By the year 2000, the HIV epidemic in Brazil had stabilized and the figures were compared to those in Western Europe and the United States with the highest rates of infection being witnessed among the high-risk groups like sex workers, gay men and injection drug users (Simao 7). However, the country still faced a number of challenges as in 2009, new AIDs cases were seen to increases among gay men, poor women and young people in smaller cities where civil society advocacy and health system were weakest. In addition to this, infection rates were observed to increase in towns and cities were the HIV/AIDs programs were neglected as a result of the transfer of the administrative and financial power from the city government and federal state level. Following this situation, the decentralization process was enacted and six years following the inaction, the results still remained mixed. Most stakeholders including the National Department of STD, Viral Hepatitis and AIDs believed that the efforts of sustaining HIV prevention measures across Brazil still needed strengthening both the municipal and state capacity in order to effectively deliver AIDs treatment and prevention services through the country’s decentralized public health system (Simao 9). Considering the expensiveness witnessed in Brazil, the Department is targeting to have its technical support and funding to go to those places that most need them. Issue The effort of delivering prevention in relation to a health system that is decentralized in not about money but to have the measures put in place being considered at a different perspective. The agenda needs to be moved at both the local and state levels so as to achieve a better planning. The strengthening and fostering this desired structure is a process that will take a long time. Options Possible options towards achieving a decentralized system towards HIV prevention in Brazil include; PAMs action and goal plans can be made the main program management tool. PAMs is out to address individuals as well as community needs while at the same time including the national guidelines that are related to prevention, surveillance, human rights and treatment NAP has come out strongly since 2004 implementing the process of decentralization. This implementation has however done in an uneven manner with some cities and states observed to be embracing additional autonomy as others remained struggling. The other option is strengthening both the municipal and state programs that require the NAP to have more control over the priority delivery and settings. Coming up with meetings and workshops on decentralization planning process with several stakeholders like government officials and NGO leaders Recommendation As the National Department has been more progressive as compared to many cities and states in relation to working with populations that were marginalized, HIV prevention agenda should be pushed to support and protect the citizens who are at the highest infection risks while at the same time considering the autonomy of the local government. The National Department should come out strongly offering technical assistance as well as take action in areas that have failed to implement the policy of decentralization now that most of the NGO’s that were behind the services provision are collapsing (Simao 8). The reduction of HIV transmission between mother-to child as well as guaranteeing timely access to treatment, testing and care depends mostly on the primary health care system strength hence the health system should work on the vast inequalities across the nation. Rational From 2004, the National Department has been monitoring the decentralization policy implementation via a reporting system that is web based and one that was made available to the public. The goals of the monitoring the system include; coming up with sufficient data that is meant to inform the PAM planning process as well as key program decisions, to make sure that there is transparency in the utilization of financial resources as well as health management ability to make use of available resources in the implementation of the local response, to monitor the implementation of the agreement that took place between the SUS at the state, municipal and national levels with respect to condoms availability and STDs drugs. The above measures will for sure ensure that the preventive measures of HIV/AIDs remained decentralized and this will better help in the treatment and prevention of HIV/AIDs in Brazil (Simao 9). Work Cited Galvao Simao. “HIV/AIDS in Brazil: Delivering Prevention in a Decentralized Health System”. Cases in Global Health Delivery. New York: Brigham and Women’s Hospital, 2011. Print Read More