Free Content International institutions, Global Health Initiatives and the challenge of sustainability: lessons from the Brazilian AIDS programme

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Abstract:

Summary The sustainability of successful public health programmes remains a challenge in low and middle income settings. These programmes are often subjected to mobilization–demobilization cycle. Indeed, political and organizational factors are of major importance to ensure this sustainability. The cooperation between the World Bank and the Brazilian AIDS programme highlights the role of international institutions and global health initiatives (GHI), not only to scale up programmes but also to guarantee their stability and sustainability, at a time when advocacy is diminishing and vertical programmes are integrated within health systems. This role is critical at the local level, particularly when economic crisis may hamper the future of public health programmes. Political and organizational evolution should be monitored and warnings should trigger interventions of GHI before the decline of these programmes.

French
La durabilité des programmes de santé publique efficaces reste un défi dans les régions à revenus moyens et faibles. Ces programmes sont souvent soumis au cycle de mobilisation-démobilisation. En effet, les facteurs politiques et organisationnels sont d’une importance majeure pour assurer cette durabilité. La coopération entre la Banque Mondiale et le programme SIDA brésilien met en évidence le rôle des institutions internationales et des Initiatives de La Santé Mondiale, non seulement pour le déploiement des programmes mais aussi pour garantir leur stabilité et leur durabilitéà un moment où le plaidoyer va en diminuant et les programmes verticaux sont intégrés dans les systèmes de santé. Ce rôle est essentiel au niveau local, en particulier lorsque la crise économique peut entraver l’avenir des programmes de santé publique. L’évolution politique et organisationnelle doit être surveillée et des alarmes devraient déclencher des interventions de l’Initiative de la Santé Mondiale avant le déclin de ces programmes.

Keywords: HIV/AIDS; VIH/SIDA; agences internationales; agencias internacionales; durabilité du programme; facteurs politiques; factores políticos; international agencies; political factors; programme sustainability; sostenibilidad de programas

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2009.02411.x

Affiliations: 1:  Fundação Getulio Vargas, Rio de Janeiro, Brazil 2:  Instituto de Medicina Social, Universidade Estadual de Rio de Janeiro, Brazil

Publication date: January 1, 2010

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