WP-Policies & Programs

HIV/AIDS and the

Public & Private Sector

Henri van den Hombergh, MD MPH

Program Leader MOH/GTZ Health Sector Program Kenya

The HIV/AIDS The HIV/AIDS Epidemic Epidemic

is increasingly is increasingly recognized recognized

as a serious as a serious threat threat

to economies, to economies, businesses businesses

and and communities!communities!

Is it

The global Competitiveness Report 2003-2004Executive Opinion SurveyWorld Economic Forum

• 7,789 Firms in 103 Countries• Assesses studies of the impact of HIV/AIDS on

economies and businesses• Executive Opinion Survey, focusing on

questions covering HIV/AIDS and the disparities between prevalence estimates of UNAIDS and the private sector

• Conclusions and recommendations

World Economic ForumKlaus Schwab

• Each person infected represents a legacy of failed prevention

• The private sector need to contribute to the building of the next wave of response

• Business’ main Business is Business

Peter Piot (UNAIDS)

:

1. Starting epidemic: manage risks actively through WP-Policy & Program with focus on prevention

2. Mature epidemic: protect your investment in human capitalby providing VCT, ART, Care&Support as a necessary counterpart to a full-scale WP-Policy&Program

3. Extend the efforts to Families, Communities and Business Partners

3 + 1 key dimensions for action for companies

Reduce stigma,it undermines all efforts!

Standard Chartered Bank’s Motivation for WPP (Mervyn Davies)

1. Protect basic human rights2. Preserve the integrity of the

labour force3. Reduce costs associated with

HIV/AIDS4. Respond to a real challenge

Dean London Business SchoolLaura Tyson

• Most Companies have poor information on which to assess the actual risks to their business posed by the epidemic and to design appropriate responses

• Most companies have not developed company-wide policies and programs to contain the business risks of this epidemic

• Despite their relative inaction, most do express support for a broad societal response in which to play an integral part

Kenya (75 Firms)

(Classified in the 15-19 % prevalence league by UNAIDS)

37% estimate prevalence among the workforce 4-9%

36% say they have no idea

13% has done a form of prevalence survey/study

63% expects serious impact of the epidemic ( compare 43% says so about Malaria, 31% for Tuberculosis)

But13% expects it will seriously impact on:

Productivity and absenteeism

Death and Disability

Medical and Funeral expenses

11% expects the epidemic to impact on revenues

•75%

no WP-Policy and/or Program

•12% Yes!!!

•13% missing value

The average for Africa is 25%!

What is the Business doing?PWC (July-September 2003)

216 Organizations in Kenya, Tanzania, Uganda and Zambia

• The majority is ignoring the epidemic and its impact

• Only 39% has a policy• 71% believed employees had died from

HIV/AIDS• 11% Estimates prevalence less than 5%, 75%

does not know!

On the positive side• 83% follows the ILO code of practice• The majority:

– Do not discriminate on the basis of serostatus when recruiting

– Do not ask staff to leave when identified HIV+• Only 6% felt that HIV/AIDS has no impact

on their business and workplace• 88 of 216 could put a monetary value on

this impact

Kenya59 Organizations

• 44% admits an increase of health care costs

• 27 % admits low, 12% a decline in productivity

• 46% has a formal HIV/AIDS policy!– Protect staff and benefit the

organization– Learnt from others– Makes good business sense– Less expensive– Understood the magnitude of the

problem• 23 offer a form of HIV testing (out

of 35 of the 216!!!!!)

25%

12%

31%

32%

>1000 500-1000

200-500 <200

Kenya59 Organizations

• 80% Runs education & training courses

• 55 % distributes condoms• 68% encourages VCT• 28% excludes HIV/AIDS

from the health care package but 49% explicitly state it is covered

• 33% provides ART• 67% states HIV/AIDS

raises financial issues, 51% says cost are increasing

Private Sector Analysis (3-5/2004)for National AIDS Control Council

by W. Kiarie et al.

19%

6%58%

17%

>1000 500-1000

200-500 <200

Total sample = 52

• 19/52 has written Policy

• 32% has a copy of ILO code of Practice

• 44% has some kind of WP-program (awareness, PMTCT, treatment of opportunistic infections and STI)

• 33 % has some form of VCT (12% in house)

• 17% provides ART

• < 35% uses substantial IEC

Sources of funding and support:

Substantial gaps identified (GF, MAP, DARE, NACC, PEPFAR, UN Global fund)

Reasons for WP-Policy&Program

65% save lives

58% improve productivity

46% reduce costs

38% Corporate image

Private Sector Analysis (3-5/2004)for National AIDS Control Council

by W. Kiarie et al.Total sample = 52

Leadership and “live examples”

58% did not identify a single business organization they look up to

443512Impact on community

174623Future impact (in 5 years)123144Current impactSerious impactSome impactMinimal impact

Percentage of firms selecting response

Program Component Rating

% of firms Programme component Level 1 Level 2 Level 3 Level 4

1. HIV/AIDS policy 62 4 6 29 2. Management and coordination 50 19 4 27 3. Awareness and education programmes 44 21 10 25 4. Condoms 52 21 17 10 5. VCT 69 10 13 8 6. Treatment and Care 48 33 12 8 7. Impact assessment, KAP surveys and HIV prevalence surveys

75 2 23 Nil

8. Involvement of the community, customers, suppliers and other partners

60 29 10 2

Overall Rating 52% 12% 29% 8%

Legend: level 1: <9 out of 48 level 3: 15-35 out of 48

level 2: 9-14 out of 48 level 4 >36 out of 48

80% acknowledges this as a key problem, the other 20% overcame stigma through their WP-Policy&Program

Stigma!

Current Situation: Declining Rates of Economic Growth in the 1980s & 1990s

-3-2-101234567

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

Percent GDP Growth Rate (Real)

GDP Per Capita GrowthRate (Real)

Trends in Real Growth of GDP and Per Capita GDPTrends in Real Growth of GDP and Per Capita GDP

The Public Sector

• NACC in the Office of the president• AIDS Control Units in Line-ministries• Constituency AIDS Control Committees• What plans KNUT• National Health Insurance• Civil Servants benefit schemes?• Unions, Sacco’s etc.

The way Forward (1/3)

Close the info gap at all sides and levels

The way Forward (2/3)

• Balance “Bottom-up” with “Top Down”

• Balance “Supply & Demand• Apply: “Scale up – Scale

down”• Engage the GOK• Keep it simple• “Match your agenda with

your agenda”

The epidemic strips time and human capacity out of the system

Trust and Leadership at all levels

The way Forward (3/3)• PPP: Public-Private or

Private-Private Partnerships

• National Social Health Insurance

• Global Financing Initiatives (3X5, MCA, PEPFAR, MAP, GF)

• Sub-SWAP?• Stop re-inventing the

wheel!!• The 3 Ms: Motivation,

Mechanisms and Money

Mutual respectful exchange will lead to:

WIN-WIN situations