Assessing HIV/AIDS Initiatives in China - Center for Strategic and ...

6 Assessing HIV/AIDS Initiatives in China
expected to terminate funding in 2006, although the UK foreign aid agency, the
Department for International Development (DFID), is currently considering options to
continue funding programs that support and complement Global Fund–sponsored
programs in seven southwestern provinces. In addition, it was announced in May 2005
that Merck & Co., the U.S. pharmaceutical company, will work with the Chinese
Ministry of Health to implement a five-year, $30-million program of comprehensive
HIV/AIDS patient management, to include elements of education, awareness, prevention,
health care worker training, treatment, care, HIV-drug research, and job training
programs for recovering drug users.
This international support, while delivering valuable funding and technical assistance,
also provides an increased profile to HIV/AIDS issues at local levels and pushes officials
outside the health sector to take increasing notice of public health issues and commit
greater local resources.
Persistent Challenges and Gaps
Despite, however, major increases in new resources, the establishment of new programs,
and an unambiguous shift in the central government’s stance toward dealing with the
disease, significant gaps in capabilities and policies exist and formidable challenges lie
ahead.
Poor Coordination within and across Relevant Agencies and Actors
Combating HIV/AIDS is still largely seen as a “health problem” to be tackled by the
bureaucratically weak and poorly funded Ministry of Health, rather than as a broader
socioeconomic challenge requiring a more comprehensive and coordinated response
across the governmental and nongovernmental spectrum. China’s government system is
highly “stovepiped,” with each government unit operating within its own vertical
command chain, frustrating coordination between departments and across bureaus.
For example, the Chinese government—not unlike others around the world—grapples
with how best to deliver preventive interventions to certain at-risk groups such as IDUs.
Differences persist across China between local public health and public security
authorities over the appropriate response, ranging from officially supported needle
exchanges and methadone replacement therapy to “strike-hard” campaigns of
incarceration and cold-turkey detoxification. Such differing approaches across the
Chinese bureaucracy undermine the government’s ability to deal with the task at hand:
stemming the spread of HIV/AIDS.
Because government-implemented programs are relatively independent, there is
frequently inadequate oversight. Accountability within government organizations is often
difficult to assure, sometimes leading to inefficiencies, waste, and possibly fraud. With
the new HIV/AIDS regulations issued in January 2006, greater day-to-day responsibility
for implementing prevention, treatment, and care will fall to county-level governments,
which may exacerbate existing problems of implementation, oversight, and
accountability.