Question 1 (150-200 words): Describe the political climate in your chosen country. Does your country’s leadership demonstrate a credible commitment to health services? If yes, how? If no, why not? Honduras was run by military dictatorships from 1963 to 1972. For nearly two decades the authoritarian Honduran military was in control of the country, however in 1980 the first democratic government was voted in to office, in 1982 the Honduran constitution was enacted and allowed Honduras from 1982 to 1990 to be a weak but strengthening democracy.
Then in 2009 another military coup took over the government, halting the progress of democracy in the country. After the transition to democracy (and two and a half years after the rupture of that democracy), old and new social conditions coexist across Honduran society, politics, and the military and police. Over three decades, Honduras has changed gradually from a rural to an urban society and opened its doors to information, education, and technology.
Yet for all its efforts to modernize and democratize, high social inequalities still prevail. (Salomon, 2012) Currently, the Honduran government is headed by an anti-military conservative national party member, named Juan Orlando Hernandez Alvarado. Hernandez was elected as president first in 2014, and in spite of the Honduran constitution only allowing a single-term as president he was reelected again in 2017. Unfortunately the Honduras president is not so dedicated to bettering the healthcare services of Honduras.
Recently it was revealed that millions of dollars of public funds from the country’s health care system had been funneled to the ruling National Party and the election Campaign of Juan Orlando Hernandez. (Main, 2016) Question 2 (150-200 words): Describe the constraints on your country’s ability to provide health services. For instance, is your country under structural adjustment? To what extent does the country dictate its own policies?
One constraint on Honduras’s ability to provide health services is that most of the program development is not based on any previous design, and there is no regular discussion regarding the adaption of the program to human resources training and the health needs of the population. (Dal Roz, et al. , 2015) In other words there is weak human resources for health information systems, and the governance of the human resource for health is fragile and weak.
Another constraint is that, as it was illuminated in the previous question, Honduras lacks the political will and devoted support from their president Juan Orlando Hernandez. This is a major issue because the president has control over the ability to maintain and regulate health care of the people of Honduras. Honduras also lacks the financial support and has been on a structural adjustment plan since the 1980s, this is also a result of previous presidencies and the current president Hernandez’s unsuccessful use and development of the country’s economic and financial policies.
Other reasons health services in Honduras are inhibited is the difficulty of training human resource health officials and difficulties in hiring and retaining health professionals in the public sector because of their allocation in remote and rural areas. Question 3 (200-300 words) : Describe the current national capacity (state of systems and services) that exists in response to your chosen disease (e. g. , level of human resources available, health and other relevant infrastructure, types of interventions provided).
National efforts to reduce the number of new HIV infections in Honduras have been in place since the late 1980s. The Honduran government has coordinated HIV/AIDS control efforts through a series of national HIV/AIDS strategic plans. During the first plan 1998-2002, the government formed CONASIDA, a national commission on aids, with the goal of coordinating the national policies and programs in support of HIV/AIDS. The second national strategic plan took place from 2003 to 2007, but its focus and application were hindered by a lack of national funds for its implementation.
The third national strategic plan took place 2008 to 2012, the request particularly focused on the need to develop a strategic plan which was evidence-informed and focused on the achievement and monitoring of measurable results. Assistance was to be provided by ASAP (AIDS Strategy and Action Plan), a new UNAIDS program managed by the World Bank Global HIV/AIDS Program, while at the country level the thematic group on HIV/AIDS led by UNAIDS would support and contribute to the effort.
The approach was to be participatory so as to ensure that Honduras’ civil society and government ministries would work together with the technical assistance that was to be provided. (Gaillard, Rodriguez-Garcia, & Bortman) The national response to HIV/AIDS has been led by a main stakeholder, the Ministry of Health, along with collaboration from other ministries, bilateral agencies and several nongovernmental organizations (NGOs).
Honduras main goal of their long term plan of preventing infections is to provide services to those who are at the most risk of HIV/AIDS infection. One example of an intervention provided by the Honduran government is the antiretroviral treatment, given to an individual infected with HIV/AIDS. Question 4 (150-200 words): Name the main non-governmental and international agencies involved in national responses to your chosen disease/condition in-country, and describe their main programs.
The main NGOs and international agencies involved in national responses to HIV/AIDS in Honduras are as follows; Global Fund, UNAIDS, USAIDS along with prevention partners, and COMCAVI. Global Fund or GAFTA has aided Honduras with money, its Honduras program focuses on promoting and defending the human rights of people living with HIV/AIDS, protecting at risk populations through adoption of risk-reducing behaviors, and strengthen comprehensive integrated services for people living with HIV/AIDS.
UNAIDS goals are leadership and advocacy for effective action on the epidemic; strategic information and technical support to guide efforts against AIDS; tracking, monitoring and evaluation of the epidemic and of responses to it; civil society engagement and the development of strategic partnerships; and mobilization of resources to support an effective response.
COMCAVI (Communicado Cambio para la Vida) goals in Honduras are to strengthen NGO capacity to implement sustainable HIV/AIDS activities; support NGO implementation of high-quality programs for the care of people living with HIV/AIDS; support NGO implementation of effective HIV/AIDS interventions reaching most-at-risk populations; and ensure coordination between NGOS and other programs and institutions throughout Honduras.
USAID along with AIDSTAR 1 and 2 goals are to improve access to and the quality of HIV/AIDS services; support for implementation of VCT using rapid-tests; social mobilization; development and distribution of tools related to information, education, and communications; and the creation of opportunities and mechanisms to share lessons-learned, materials and best practices. USAID alongside ULAT (Unidad de Apoyo Tecnico) goals, increase knowledge of HIV prevention methods to the general population; improve sector equitable social sector investments; and to increase the use of quality maternal, child and family planning health services.
PASMO (Pan American Social Marketing Organization) along with USAID goal is to contribute to the overall reduction in STIs and HIV/AIDS through social marketing, and condom distributions in high-risk outlets. CDC alongside USAID major focus is to provide direct support to building country capacity in the areas of surveillance and laboratory testing. Question 5 (150-200 words): Does this work supplement national health systems effectively? How does the work of these other entities impact health systems nationally? Does the work of other organizations possibly interfere with the work of the government?
The Honduran government has coordinated with many HIV/AIDS control efforts. Most of the financial support comes from the international agencies and non-governmental organizations rather than the Honduran government. A range of nongovernmental organizations, international agencies and bilateral donors work alongside the government in mobilizing communities and supporting people living with HIV/AIDS. The Honduran Association of People Living with HIV/AIDS participates actively in the national response to the epidemic.
Medecins Sans Frontieres is involved in providing antiretroviral therapy. The Pan American Social Marketing Organization supports prevention and behavioral change communication interventions among vulnerable population groups. The NGOs and international agencies define their goals based off of what the people of Honduras effected by HIV/AIDS need. The biggest issue is not that the work of these organizations interfere with the work of the government, it is the lack of dedication or priority of these issues by many of the Honduran government officials, such as their current president.
Question 6 (150-200 words): Does the government appear, from past and current actions, genuinely committed to addressing your chosen disease? Over the past few years the central government has greatly expanded its expenditures on general public services, but these have not shown an improved performance, particularly for health and education. President Juan Orlando Hernandez, during his first campaign promised to do “whatever he needed to do” to confront these challenges.
Among the many pledges in his governance plan, the so-called “Vida Mejor” plan, he committed to continuing endorsing the decentralization process. Yet, upon taking office, the President seems to have changed his priorities, and as people interviewed for this evaluation reported, “placed the decentralization agenda on the backburner. ” As many of his detractors fear, his promise to do whatever he needs to do to improve the security situation and alleviate poverty might include re-centralizing power in the hands of the presidency (citation).
In his second campaign it was yet again placed on the back burner, better yet badly taken advantage of, “…reported that President Juan Orlando Hernandez that millions of dollars of public funds from the country’s health care system had been funneled to the ruling National Party and his election campaign” (Main, 2016). Past and present actions of the Honduras government officials continually lack the genuineness and dedication to addressing any public health issues.
