Effect of an armed conflict on human resources and health systems in Côte d'Ivoire: Prevention of and care for people with HIV/AIDS

Abstract

In September 2002, an armed conflict erupted in Côte d'Ivoire which has since divided the country in the government-held south and the remaining territory controlled by the ‘Forces Armées des Forces Nouvelles’ (FAFN). There is concern that conflict-related population movements, breakdown of health systems and food insecurity could significantly increase the incidence of HIV infections and other sexually-transmitted infections, and hence jeopardize the country's ability to cope with the HIV/AIDS epidemic. Our objective was to assess and quantify the effect this conflict had on human resources and health systems that provide the backbone for prevention, treatment and care associated with HIV/AIDS. We obtained data through a questionnaire survey targeted at key informants in 24 urban settings in central, north and west Côte d'Ivoire and reviewed relevant Ministry of Health (MoH) records. We found significant reductions of health staff in the public and private sector along with a collapse of the health system and other public infrastructures, interruption of condom distribution and lack of antiretrovirals. On the other hand, there was a significant increase of non-governmental organizations (NGOs), some of which claim a partial involvement in the combat with HIV/AIDS. The analysis shows the need that these NGOs, in concert with regional and international organizations and United Nations agencies, carry forward HIV/AIDS prevention and care efforts, which ought to be continued through the post-conflict stage and then expanded to comprehensive preventive care, particularly antiretroviral treatment.

Acknowledgments

We thank the MoH and the Ministry of AIDS Control for their collaboration and sharing of relevant documents. We are grateful to the various key informants for their time and willingness in responding to our questionnaires, including political and military leaders, public and private health staff and representatives from international and local NGOs engaged in prevention of and care for people with HIV/AIDS. Thanks are also addressed to colleagues from the Centre Suisse de Recherches Scientifiques for administrative support and Dr Gary R. Krieger and an anonymous reviewer for valuable comments on the manuscript.

This investigation received financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria for the project, entitled ‘Prevention of the spread of the HIV/AIDS epidemic in the context of severe political and military crisis’. At the time this investigation was carried out, B. G. Koudou, G. Cissé and M. Tanner were partially supported by the National Centre of Competence in Research (NCCR) North-South, ‘Research Partnerships for Mitigating Syndromes of Global Change’ and Individual Project #4 (IP4) entitled ‘Health and well-being’, which is financed through the Swiss National Science Foundation (SNF). J. Utzinger is a recipient of an ‘SNF-Förderungsprofessur’ (Project No. PPOOB–102883).