Q&A With EGPAF’s new Director of Health Systems Strengthening

By Chelsea Bailey, Elisabeth Glaser Pediatric AIDS Foundation

This fall, Francesca Celletti, MD, joined the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) as the new Director of Health Systems Strengthening. We sat down with Dr. Celletti to talk about the hallmarks of a robust health system, how to navigate the complex landscape of global health partnerships, and what motivates her to continue the work of capacity building.

Welcome, Dr. Celletti. Could you tell us what attracted you to the Elizabeth Glaser Pediatric AIDS Foundation?

I think the first thing that attracted me to EGPAF was its groundbreaking work and the amazing reputation it has in the global health arena. EGPAF has played a central role, both domestically and internationally, in making possible the scale-up of prevention of mother-to-child transmission (PMTCT) of HIV services and pediatric HIV care. This is very inspirational. I know that EGPAF will play a central role in the elimination of pediatric HIV—and joining this fight at this time in history is a big privilege and honor. I really hope I will be able to contribute in the best way possible.

In what way are robust health systems essential to developing a sustainable HIV/AIDS response?

Health systems are the sine qua non [the essential element] of a sustainable HIV/AIDS response. Strengthening health systems means increasing access to quality health services. It is also the gate to country-owned sustainable programs.

The health systems strengthening (HSS) agenda is broad and complex. However, if we look at what has to be done from the lens of our mission—elimination of pediatric HIV—it can be narrowed down to a more manageable piece of work.

Let me give you an example, if you look at the most recent data of the Global Plan [UNAIDS Report, 2013], many of challenges of pediatric HIV elimination relate to health systems: inadequate human resources for health (HRH), inadequate and stock-outs of medications and commodities, inadequate financing, insufficient integration and decentralization of services and loss of mother-baby pairs.

At EGPAF, a lot of work has been done with local health systems to address the very same challenges. We champion the district approach, performance-based financing, integration of HIV services, and community systems strengthening—just to mention a few. We need to build on these consolidated experiences and take them forward, bring them to scale, make them sustainable and support country ownership.

How do we begin to overcome those hurdles?

We need our efforts to be focused. Our goal is to eliminate pediatric HIV. As such, any system intervention that we put in place needs to strengthen those enablers who can increase the access and coverage of HIV services and ensure a standard quality. Most importantly, whatever we do to support countries in their efforts to fight the HIV epidemic has to be something they can sustain. For example, under Option B+, a woman will start antiretroviral therapy (ART) when pregnant and will continue it throughout her lifetime. How can something we do today in an antenatal clinic be sustainable in 20 or 30 years from now and allow the very same woman to be retained in care?

Global health agendas are shifting toward promoting country ownership of their response to the HIV/AIDS pandemic. What are some of the elements needed for a successful transition?

There are many ways to support transition to country-owned sustainable programs. What we have learned so far is that successful transition, and particularly transition to a Ministry of Health (MOH), requires careful planning and phasing – if we do it too early we risk to delaying the agenda even further. A phased approach that progressively supports and hands over management, leadership, financing, and program responsibilities to a broad range of local entities (government, NGOs, CBOs, FBOs, academia, private services providers, etc.) might provide the best chance for success.  The political will and buy-in from all relevant stakeholders is also important.  If we think carefully, EGPAF has been a pioneer in supporting transition to countries. Let us think of the affiliates model, the support to national civil society organizations, the comprehensive capacity building at central and local level – these are all ways to progressively shift ownership to countries while ensuring that the critical elements for a comprehensive transition are in place. I think we have a lot to offer in the current debate on transition taking in place both globally and in countries.

I think we’re going in the right direction.

Do you see the multi-stakeholder global health landscape as a benefit or a hindrance when it comes to health systems strengthening?

Health systems strengthening needs to have a multi-stakeholder approach. However, all stakeholders need to work in the same direction and with the same goal, which is to accompany the country’s movement toward sustainable programs throughout the years. So many elements need to go in this multi-stakeholder relationship: coordination, harmonization, accountability, transparency, and finally, mutual trust.

I know you have a 5-year-old son; how has becoming a mother has impacted your work?

I have radically changed since I’ve become a mother. I finally understand the power, the energy, and the love a mother can have in order to protect her child. I think that I also understand better, but maybe not fully, how that energy, power, and love can be transferred from protecting your own child to protecting all children.

We have the towering and inspiring example of Elizabeth Glaser who was incredibly selfless and able to convert that maternal tension—that energy, and most importantly, all that love—to make it useful for the world. If, as a mother and a professional, I can learn from her and even minimally help children and their mothers, it would be extremely rewarding and satisfactory from both a professional and a personal point of view.

Prior to joining EGPAF, Dr. Celletti spent more than a decade as one of the World Health Organization’s leading authorities in the world health systems arena, specializing in the scale-up of HIV services.