The Impact of HIV and AIDS Funding and Programming on Health System Strengthening in Malawi

Abstract

[Extract] In 2001, the United Nations declared HIV and AIDS an international crisis (United Nations, 2001). The HIV epidemic hit African countries that were already facing a multitude of problems including weak governance, conflicts and natural disasters.

That same year, the World Health Organization's Commission on Macroeconomics and Health and the UN’s Commission on HIV/AIDS and Governance in Africa concluded that the lack of political will to sufficiently increase spending on health at sub-national, national and international levels was perhaps the most critical barrier to improving health in low-income countries (Sachs, 2001; The Commission on HIV/AIDS and Governance in Africa, 2001). It was clear, however, that removing financial constraints alone would not be sufficient to improve health outcomes and that progress also hinged on the ability of countries to increase the capacity of their health sectors. In particular, the human resource shortage in Africa, which was exacerbated by the effects of AIDS, constituted a barrier to universal and sustainable access to health services. Other weaknesses in the health system, such as poor infrastructure, the absence of sustainable supply systems, fragmented health information systems and weak governance structures, also needed to be addressed with short-, medium- and long-term perspectives.