Integrated and indivisible: What the fight to end pediatric AIDS tells us about the future of sustainable global health

By Charles Lyons 24 September 2015

Regardless of their HIV status, mothers like Farai in Zimbabwe (pictured) can access health information from a Prevention of Mother to Child Transmission program, during pregnancy and the birth of their children. Focusing on a very specific and attainable goal, such as the elimination of mother-to-child transmission of HIV, can be a catalyst for progress across SDG 3 on ensuring healthy lives and promote well-being for all at all ages and among other SDGs. Photo by: Elizabeth Glaser Pediatric AIDS Foundation / CC BY-NC-ND

It’s amazing how quickly 500 days become 100.

It was just last summer that we found ourselves 500 days from the target end date of the Millennium Development Goals: Dec. 31, 2015. Now that date is only a little more than 100 days away, and the conversations, studies and analyses of how far we’ve come in the past 15 years are in full swing.

The world has been waiting with both excitement and trepidation for the new global development agenda that lies beyond Dec. 31, referred to for so long as simply “post-2015.” Finally, with the sustainable development goals set to be adopted at the United Nations Sustainable Development Summit this weekend, the landscape is clear: a new ambitious agenda around 17 goals and visible commitment by world leaders to act together to realize this shared vision.

One of the defining characteristics of the SDGs is that they are intended to be integrated and indivisible. Success or failure in achieving a single goal is inextricably linked to efforts to realize every goal. In no instance is the need for collaboration across goals more evident than in the effort to end AIDS in children.

At the beginning of the MDG era, stakeholder communities working on global health tended to focus primarily on the MDG that was most central to their cause, without considering how addressing the goals together, as well as separately, could leverage activities and improve health service delivery and patient outcomes across the board.

This held true for my organization as well. While the Elizabeth Glaser Pediatric AIDS Foundation’s mission — to end AIDS in children — was initially rooted in the global HIV and AIDS response, its execution has actually proved to be extremely crosscutting. Our mission required us to focus on not just one MDG, but three: Goal 4 on reducing child mortality,Goal 5 on improve maternal health, and of course Goal 6 on combat HIV and AIDS, malaria and other diseases.

For EGPAF, the realities of treating pediatric HIV and eliminating mother-to-child transmission of HIV in resource-poor settings made it clear early on that integration and collaboration across these goals was not only desirable, but necessary. We found that in order to make lasting progress toward eliminating pediatric HIV, it wasn’t enough to reach and treat children; we also had to reach their mothers, families and communities.

This meant going beyond just the provision of HIV treatment and care, and addressing the weaknesses of maternal and child health services as well as the overall health systems that provide the foundation for these services. Strengthening these health services and systems at the country level requires the cooperation of the government, which is why long-term, close partnerships with ministries of health are a core feature of EGPAF’s work and of any successful, sustainable global health effort.

One such example is the Virtual Elimination of HIV Infection in Infants and Young Children in Zimbabwe and Beyond project: a collaboration between EGPAF, Children’s Investment Fund Foundation and the Zimbabwe Ministry of Health and Child Care launched in 2010. The project focuses on strengthening Zimbabwe’s health system through the integration of HIV services into maternal, newborn and child health programs and the dramatic expansion of availability and access to comprehensive prevention of mother-to-child transmission of HIV services in primary care centers.

Five years ago, Zimbabwe had a staggering mother-to-child transmission rate of 28 percent. Today, Zimbabwe is on track to achieve near elimination of mother-to child transmission of HIV by the end of 2015. Improving maternal and pediatric HIV services has also contributed to reductions in maternal and child mortality in Zimbabwe. This joint effort across health areas and among implementing partners, government, and private funders embodies the type of work needed to achieve the SDGs.

The ambition and scope of the sustainable development goals is to be commended. But it is also important to keep our eye on the specific, targeted initiatives and investments that will drive country-level progress under the SDG framework.

Focusing on a very specific and attainable goal, such as the elimination of mother-to-child transmission of HIV, can be a catalyst for progress across SDG 3 on ensuring healthy lives and promote well-being for all at all ages and among other SDGs. Particularly in the countries with a high HIV burden, combatting pediatric HIV and AIDS will result in a whole host of positive outcomes: healthy and empowered mothers and children, thousands of lives saved, a surge in confidence as specific  goals are achieved, and a strengthened health system more capable of delivering health services of every kind — not just for HIV.

As we embark on the new Sustainable Development Agenda, more important than knowing the mechanics of how the SDGs will all connect will be embracing the interconnectedness of the agenda as a whole. As diverse and different as these 17 goals are, we must weigh their individual possibility for success and danger of failure as one: integrated and indivisible.

Sustaining Development is a three-month online series exploring the post-2015 development agenda hosted by Devex in partnership with Chevron, FXB, Global Health Fellows Program II, Philips, Pfizer, UNIDO, U.N. Volunteers and the U.S. Council for International Business. We will look at the practical steps needed to move the sustainable development goals from concept to reality. Visit the campaign site and join the conversation using #SustainDev.

About the author

Chiplyonsegpaf
Charles Lyons

Charles "Chip" Lyons is the president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation, the world’s leading organization committed to the global elimination of pediatric HIV and AIDS. Lyons joined the foundation in 2010 after many years managing and developing programs for leading global nonprofits, with a professional emphasis on children's welfare, HIV/AIDS, and global development.


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