Institutional factors and HIV/AIDS, TB and Malaria.

This paper outlines the principal institutional factors affecting the slow progress in reaching agreed targets in Africa regarding the prevention and control of HIV/AIDS, TB and Malaria. It focuses on three key factors: political analysis, strategic business approach and international inputs. Most of the analyses tend to look at the technical aspects of disease prevention and control, of political analysis there is a marked absence. Yet, we know that wider contextual or macro factors such as power and political decision making can make or break a programme. Many senior managers in public sector institutions are preoccupied with day-to-day work. Successful businesses in the private sector have some things in common with each other. Outstanding leadership, a strategic and action orientated culture, highly focused on comparative strengths on priorities and quality being some of the key ones. Adopting such successful business characteristics might make the difference to public institutions. The move to results based institutions by focussing on outputs and outcomes is for the better. However, we still need to rigorously examine the quality of inputs that the increasing availability of funds is being used on. This is especially so in relation to needing a better balance between aid for health services and that for institutional and health systems development. In addition, technical advisers from development partners need to work more across a ministry of health on institutional and management change to have a greater impact on achieving targets.

Public health, epidemiology and war

delivery of humanitarian aid in wartime is difficult. However it is essential that aid is provided in the most effective manner possible, targeted on those most in need whilist minimizing waste. Furthermore the delivery of aid should be sensitive to the future needs of the communities in conflict. This requires information on the needs of the vulnerable population. There is litle experience of collecting data on the impacts of war on a civilian population. The war in Bosnia disrupted surveillance of communicable disease. The local authorities were assisted by the World Health Organization in re-establishing survillance. The data generated was valuable in planning interventions to munimise the possibility of major outbreaks of infection, reduce the impact of infectious disease and in guiding the humanitarian aid effort. The experience described suggests that public health surveillance of the civilian population in wartime is possible and useful. Besides the need for planning, the public health doctor in wartime has a role as an advocate for those suffering; this funtion can be carried aut much more effectively if is based on objective data collection rather than hearsay (AU)