On 1 December the international community celebrates World AIDS Day, which this year is ambitiously themed ‘Getting to Zero. Zero New HIV Infections. Zero Discrimination and Zero AIDS Related Deaths.’

Recently, we have indeed seen very promising developments in prevention and treatment. For instance, treating people with anti-retrovirals can reduce the risk of onward transmission to a partner by as much as 96%.

However, preventing new infections, including mother-to-child transmission, and providing HIV treatment to all those who need it is next to impossible without a well-functioning health system. Anti-retroviral treatment requires that the patient be regularly monitored and supported in adhering to the regime, which requires that he or she has access to a health facility. Similarly, where the quality and accessibility of health services is poor, many HIV positive pregnant women do not access antenatal care, resulting in unnecessary transmission of HIV from an infected mother to her baby.

In the new book I have edited together with my LSHTM colleagues Prof. Anne Mills and Prof. Martin McKee ‘Good health at low cost’ 25 years on (downloadable for free) we offer clues to help policy-makers in low and middle income countries build stronger health systems that can effectively tackle their HIV/AIDS epidemics (among other diseases).

In the book, we raise the question of why some low and middle income countries achieve good health while others fail. Five countries that have seen remarkable improvements in the health of their populations are the focus of the book: Bangladesh, Ethiopia, Kyrgyzstan, Tamil Nadu and Thailand.

Thailand in particular leads the way, having achieved the health MDGs in early 2000s and now working towards the more ambitious ‘MDG Plus’. Over a period of 40 years, the country has implemented successive pro-rural, pro-poor five-year national health plans that transcended political divides. Support from government leaders and the public health sector helped consistently strengthen the health system over generations. In particular, the focus was on improving child and maternal health, with the provision of services by the public sector (primary health centres). Long-term government policies were critical to expanding district health systems. In 2002 Thailand introduced universal healthcare covering the entire population.

As a result, when the AIDS pandemic hit 30 years ago, the Thai health system was in relatively good shape to respond to the emergency. Between 1975 and 2005 life expectancy increased, with female outpacing male due to the impact of AIDS. Studies showed that HIV was the leading cause of disability-adjusted life years lost both for men and women.

Subsequently, successful prevention and treatment turned a generalised epidemic into a concentrated epidemic among specific groups and have brought the number of new infections down dramatically from a peak in 1990. Particular successes have been noted in mother-to-child transmission, which has been integrated into general antenatal care. Nurses in district hospitals are trained to provide HIV counselling in pregnancy, offering advice about prevention and mother-to child transmission.

Although each country has a different story to tell, we were able to identify some common characteristics of a well-functioning health system, able to tackle the epidemic of AIDS. These included: leadership by individuals with a commitment to health gain; capacity within the individuals and institutions necessary to design and implement health reform; continuity to provide the stability that is required for reforms to succeed; the ability to seize windows of opportunity; and the ability to take context into account in order to develop appropriate and relevant policies.

Our research has shown that piecemeal interventions, however sound by themselves, cannot improve health without long-term commitment and attention to health system building. Despite the new advances, ending the HIV/AIDS epidemic is crucially dependent on functioning health systems.

Health systems represent the cornerstone in achieving universal access targets for HIV treatment and prevention. The lessons in our book go some way in helping policy-makers understand the key pillars required in transforming health systems and with it health care.

Contributed by Dina Balabanova, Senior Lecturer in Health Systems/Policy, London School of Hygiene and Tropical Medicine

The beginning of a new academic year and the UN Development Information Day on 24 October offer a good opportunity to talk about development education – what we mean under this term, what value it carries, how it has evolved over the years, and, finally, what it means in the second decade of the 21st century.

 

A quarter-century ago, the Horn of Africa was hit by a famine that killed somewhere between 400,000 and 1 million people and secured the region the unfair reputation as a place of hunger and misery. When famine hit the Horn again this year, analysts and journalists asked the not unreasonable question – will this one be as bad as the 1984-85 famine? For several reasons, this famine could be much worse than that one.

I have just returned from a stimulating fortnight at Akagera National park, Rwanda, where I ran a One Health workshop, held under a professional training initiative which the Royal Veterinary College (RVC) has been responsible for implementing in Africa through the African Union IBAR on behalf of RESPOND, as part of the global Emerging Pandemic Threats programme of the USAID.

One of the most difficult issues in global health is how to increase access to medicines, vaccines and technologies. But achieving access is not everything – once access is obtained, the challenge is how to sustain it. These issues are the focus of research we are conducting in collaboration between the Chatham House Centre on Global Health Security and the London School Hygiene & Tropical Medicine.

Improving access to vaccines in developing countries is essential for achieving the Millennium Development Goal of reducing the number of deaths among children under five. The GAVI Alliance (Global Alliance on Vaccines and Immunisation), a global partnership of governments, donors, global institutions and the private sector, plays a key role in co-ordinating these efforts. The Alliance sets global priorities in immunisation, co-ordinates efforts to raise and distribute funds, and seeks to use its influence to lower vaccine prices.

The recent emergence of a new and virulent strain of food-borne pathogen, E. coli 104, and its impact across Europe, reflects a longstanding failure to integrate health and agricultural policy.

Over recent decades, national and international agricultural policy has encouraged intensification of food production and globalization of food chains. For human diseases in the food chain, this will mean more rapid and widespread outbreaks, delays in identifying their source and greater economic impacts of consequent responses.

Welcome to the blog of the London International Development Centre (LIDC)!

LIDC facilitates interdisciplinary research and training to tackle complex problems in international development. We work with social and natural scientists from across the University of London’s six Bloomsbury Colleges: Birkbeck, Institute of Education, London School of Hygiene and Tropical Medicine, Royal Veterinary College, School of Oriental and African Studies, and The School of Pharmacy.

Our work is about bringing people together to exchange ideas and solve development problems working across disciplines and across institutions, so a multi-contributor blog seemed like an obvious choice. We would like the LIDC blog to be a platform for innovative and inspiring dialogue on development, cutting across disciplines and bringing together academics, policy-makers and development practitioners.

This blog is also an invitation: we invite LIDC members (staff, students, alumni) from Bloomsbury Colleges to become LIDC bloggers, and we invite our readers from across the development community in London and beyond to join the conversation.

We hope that you join us!