Dear forum,

WHO's Executive Board meeting ended on 27th January 2006. The board resolutions
on HIV/AIDS: Universal access to prevention, care and treatment and others will
be forwarded to the 59th World Health Assembly (WHA). The WHA runs from 22-27
May 2006. The Executive Board is composed of 32 members technically qualified in
the field of health. Members are elected for three-year terms. The main Board
meeting, at which the agenda for the forthcoming Health Assembly is agreed upon
and resolutions for forwarding to the Health Assembly are adopted, is held in
January, with a second shorter meeting in May, immediately after the Health
Assembly, for more administrative matters. The main functions of the Board are
to give effect to the decisions and policies of the Health Assembly, to advise
it and generally to facilitate its work. The following is the full text of the
report by the WHO secretariat to the Executive board. Please note: The original
format of the document was lost due to conversion of the document format.
[Moderator]
___________________________
117th Executive Board meeting of WHO resolution on Universal access to HIV/AIDS
prevention, care and treatment
Date: 23-28 January 2006, Location: Geneva, Switzerland
WORLD HEALTH ORGANIZATION: EXECUTIVE BOARD. EB117/6. 117th Session 8 December
2005. Provisional agenda item 4.5. HIV/AIDS: Universal access to prevention,
care and treatment. Report by the Secretariat

1. HIV/AIDS remains the world’s most serious public health threat. Since the
start of the epidemic over 20 years ago, 60 million people have been infected
and more than 20 million have died. The toll of the epidemic worsens every year,
with almost five million new infections and more than three million deaths in
the 12 months to December 2005.

2. In the four years since the United Nations General Assembly adopted the
Declaration of Commitment on HIV/AIDS, the global response has steadily gained
momentum, and significant
resources are now being made available to tackle the epidemic. A global fund has
been established to provide developing countries with additional financing to
counter HIV/AIDS and other diseases.

The World Bank is providing large grants through its Multi-country HIV/AIDS
Program, and individual high-income countries have provided significantly
increased bilateral support to WHO’s Member States and United Nations agencies.
Many organizations, whether community- or faith-based, philanthropic,
international nongovernmental, academic, professional or private-sector, are
working to extend prevention and treatment through advocacy, education,
research, policy development and service delivery.

3. In December 2003, WHO and UNAIDS jointly launched the “3 by 5” initiative to
support the
expansion of access to antiretroviral treatment in low- and middle-income
countries to three million people living with HIV/AIDS by the end of 2005. In
2004, the Fifty-seventh World Health Assembly, in resolution WHA57.14, welcomed
the “3 by 5” strategy and urged Member States, inter alia, to take a series of
measures to assure their capacity to deliver effectively HIV/AIDS prevention,
treatment, care and support services within the context of overall national
health strategies and to pursue a range of appropriate policies and practices.

4. Many Member States have risen to the challenge set by the “3 by 5” target.
The pace of
expansion of access has been most encouraging in sub-Saharan Africa (the region
most heavily
affected by HIV/AIDS) where about 500 000 people were receiving treatment by
June 2005, a more than three-fold increase in just 18 months. Progress in Asia,
eastern Europe and central Asia has also been significant, with the number of
people receiving treatment trebling in Asia and doubling in the other regions in
the 12 months to June 2005. In Latin America and the Caribbean, it is estimated
that about two out of three people in need of treatment are now receiving it.
Overall, more than 50 countries doubled the number of people receiving treatment
between June 2004 and June 2005, and the global total of people receiving
treatment increased from 440 000 to about one million in the same period

5. National commitment to expanding access to treatment has increased
significantly. When the “3 by 5” initiative was launched, only three of the 49
most heavily burdened and vulnerable countries – the “3 by 5” focus countries –
had drawn up comprehensive national plans to expand access to antiretroviral
treatment. By June 2005, at least 34 of these countries had national treatment
plans, the number of “3 by 5” focus countries that had set a national treatment
target increased from four at the end of 2003 to at least 40, and at least 14
countries were treating half or more of those in need, consistent with the “3 by
5” target. Many countries have reported that focusing on the “3 by 5” target has
made a significant contribution to mobilizing efforts and accelerating expansion
of access to treatment.

6. The target has also been catalytic at global level, and is being acknowledged
as an important
step in a longer-term global effort to realize the objectives set out in the
Millennium Development
Goals. In July 2005, leaders of the G8 countries announced their intention to
work with WHO,
UNAIDS and other international bodies “to develop and implement a package for
HIV prevention,
treatment and care, with the aim of as close as possible to universal access”
for those who need it by 2010. In September 2005, Heads of State and Government
attending the High-level Plenary Meeting of the sixtieth session of the United
Nations General Assembly, committed themselves to coming as close as possible to
the goal of universal access by 2010.

7. In light of these developments, consultations have begun to ensure that
countries receive the
necessary guidance and technical support to implement the package of
health-sector interventions
needed to achieve universal access. The framework that results from these
consultations will
subsequently be submitted to the governing bodies.

8. This report outlines the process proposed by WHO and UNAIDS to build global
commitment to the goal of coming as close as possible to universal access to
HIV/AIDS prevention, care and
treatment by 2010. It also reviews the lessons learnt in expanding national
HIV/AIDS programmes.

PROCESS

9. The concept of universal access provides important guidance for the continued
expansion of a
comprehensive response to HIV/AIDS – including prevention, treatment, care and
support – in the period 2006-2010. In particular, the acceptance of this goal
will help to galvanize and focus efforts around the steps that must now be taken
to overcome major obstacles, such as insufficient humanresource capacity and
other health-systems constraints. Working towards universal access also requires
clear strategies for ensuring that HIV/AIDS programmes are sustainable,
equitable and of good quality over the long term, and that they contribute to
the attainment of broad health and development goals.

10. A Global Task Team on Improving Coordination among Multilateral Institutions
and
International Donors on HIV/AIDS was created in early March 2005 to consider how
countries could be better supported. In its final report in June 2005, the Team
recommended measures that should be taken by the United Nations to assist
countries in using such funds, including: working more closely with national
AIDS coordinating authorities to support high-priority national AIDS action
plans; establishing joint United Nations teams on AIDS at country level;
creating a problem-solving team with members from bodies in the United Nations
system and the Global Fund to Fight AIDS, Tuberculosis and Malaria in order to
overcome obstacles to implementation at country level; a clear division of
labour among the UNAIDS cosponsors and the Global Fund; and both increasing and
refocusing UNAIDS Programme Acceleration Funds so as to enable greater financing
of technical support.1

11. Since June 2005, WHO has been closely involved in designing the expanded
programme
acceleration funding mechanism and drawing up a plan for the division of labour
and technical
support, and has chaired the newly created Global Joint Problem Solving and
Implementation Support Team.

12. It is proposed to establish a rapid and participatory process at country
level for setting country specific targets on prevention, treatment, care and
support services to be reached by 2010, and drawing a road map for reaching
those targets, with obstacles and opportunities identified. The process will be
grounded on the principle of country ownership of planning and priority-setting,
with external support aligned with countries’ priorities (as recommended by the
Global Task Team).

13. A country-driven process is expected to build on current efforts to
accelerate the national AIDS response and national development within the
context of harmonization and alignment as spelt out in the Three Ones principle,
the Monterrey Consensus (the outcome of the International Conference on
Financing for Development, Monterrey, Mexico, 2002) and the Paris Declaration on
Aid Effectiveness. Thus the setting of ambitious yet realistic targets for the
expansion of access by 2010 and frameworks for attaining those targets should be
based on existing national plans, both for development (e.g. poverty-reduction
strategies) and to counter HIV/AIDS, together with their review and updating
processes. Crucial to the work at country level will be the inputs of a broad
range of stakeholders, including ministries, the private sector, faith-based
organizations, civil society, networks of people living with HIV/AIDS, and
bilateral and multilateral partners. Ideally, existing national partnerships
will be mobilized, with joint reviews of national AIDS plans. Countries’
continuing collection and analysis of data for national progress reports on
implementation of the United Nations Declaration of Commitment on HIV/AIDS will
also provide valuable information for target-setting and planning for the
realization of universal access.

14. The process will rely heavily on facilitation by subregional groupings and
their identification of common obstacles to universal access faced by their
member countries. To the extent possible, these groups will bring together
existing leaders in the AIDS response.

15. A multi-partner global steering committee, coordinated by UNAIDS, will be
established to
initiate this process. The Committee will explore global-level solutions, review
country work and
formulate a global action plan for consideration by the United Nations General
Assembly at its special session on HIV/AIDS in September 2006. This plan will
reflect the shared responsibility for expanding prevention, treatment, care and
support services in WHO’s Member States and coming, as close as possible, to
universal access by 2010.

LESSONS LEARNT

16. The effort to reach the “3 by 5” target has provided valuable lessons for
the continuing
expansion of HIV/AIDS programmes. Antiretroviral treatment can be delivered
efficiently and
effectively in diverse settings, including countries with different
epidemiological patterns, severely
1 Global Task Team on Improving AIDS Coordination among Multilateral
Institutions and International Donors:
final report. Geneva, UNAIDS, 2005. resource-constrained communities, rural
areas and in widely varied health-care systems. In all cases, sustained,
high-level political commitment, including the allocation of domestic resources,
has been a prerequisite for success. A public health approach with simplified
and standardized treatment regimens and clinical monitoring is enabling the
optimal use of available resources and capacity. Successful programmes have also
been marked by concerted efforts to integrate treatment into existing health
services – including those for tuberculosis, reproductive health and substance
dependence – so that maximum use is made of available infrastructure and
capacity.

17. Reviews of national health legislation and policy in several strategic areas
have helped countries to facilitate the rapid expansion of programmes and to
increase their effectiveness. The model of health-care provider training
developed by WHO and its partners – now being applied in at least 30 countries –
strongly encourages decentralization of treatment sites as close as possible to
the community and the delegation of routine aspects of care to nurses and
trained community health workers; these key policy shifts have been shown to
enhance equity and make the most of available human resources. In a growing
number of countries, it is evident that health-financing policy can be
successfully adjusted in order to eliminate user fees for HIV treatment at the
point of service delivery. This move contributes significantly to higher uptake
of treatment and improved adherence rates.

18. In most countries in which programmes are being expanded, critical – and
usually chronic –
weaknesses in health-care systems are being identified. These include gaps in
current systems to
manage and supply drugs and diagnostics, poor laboratory infrastructure and
limited human resource capacity. Both experience and operational research are
helping to inform the development and implementation of new policies,
strategies, programmes and approaches that will help to overcome these
difficulties and ensure that expanding HIV/AIDS prevention, treatment and care
contributes to overall strengthening of health systems.

19. WHO has provided human-resources support at country level in order to help
to coordinate
efforts with local partners and tackle technical issues relating to HIV/AIDS
treatment, care and
prevention.

20. Major challenges still exist for many countries. Despite the dramatically
increased global
resources available for HIV/AIDS, an estimated funding gap of US$ 18 000 million
exists for the
period 2005-2007. The price of first-line medicines remains high in some
countries that have not been able to negotiate price reductions, while the cost
of second-line treatments is prohibitive for many countries. Particular
attention must be paid to the treatment needs of children, including new
paediatric antiretroviral formulations. The limited capacity to produce
medicines and the scarcity of certain active pharmaceutical ingredients are of
growing concern. Equitable access to treatment, prevention, care and support
must be ensured for vulnerable groups such as young people, sex workers,
injecting drug users, men who have sex with men, and prisoners. More effort is
also needed to expand the reach of programmes to prevent transmission of HIV
from mothers to children. Across the health sector as a whole, greater
investment in human resource development is essential, while the closer
engagement of communities and private-sector health services will help to
mobilize untapped resources in the fight against AIDS and other diseases.
Finally, continued investment in research for new medicines and technologies,
such as new antiretroviral agents, simplified drug formulations, improved
diagnostics, and effective vaccines and microbicides, is vital.

ACTION BY THE EXECUTIVE BOARD
21. The Executive Board is invited to take note of the report.