Global Healthcare Comparison Matrix

The World Health Organization regularly reviews various health issues across the world and determines serious ones that countries
need to prioritize. Even though WHO usually recommends best practices for a dealing with a given global health issue, each country
often takes its own measures to deal with the health problem. The specific measures employed by a country depend on, among other
things, the country’s financial resources, robustness of the healthcare system, healthcare expertise, and political goodwill. This paper
examines how two countries, the U.S. and Botswana, approached the fight against HIV/AIDS, a major global health issue that has
reached epidemic proportions in some countries. The differences in approach of the two countries can largely be attributed to
differences in financial resources and gravity of the problem in the U.S. and Botswana.
Global Healthcare
Issue HIV is a major global health issue which as of 2020 had caused the deaths of more than 33 million people
across the world with a further 38 million people living with the disease (WHO, 2020). In early years of the
disease, death rate was relatively high. However, the recent past has seen improvements in HIV prevention,
treatment as well as care. As a result of these improvements, HIV has largely become a manageable chronic
condition, with most of the people living with the condition living long and fruitful lives. Thus, even though
there is still no cure for the condition, HIV is no longer the death sentence that it was in early years of its
emergence.

Description

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HIV stands for human immunodeficiency virus. When a person is infected with the virus, they develop
acquired immunodeficiency syndrome (AIDS) overtime. The condition usually leads to progressive failure of
the body’s immune system which makes it easy for the thriving of life-threatening opportunistic infections.
HIV is classified as an STI because it is mainly transmitted through sexual intercourse. Since its emergence in
early 1980s, various efforts have been made to combat it. At a global level, the most significant one is perhaps
the Global Program on AIDS that was a 1987 initiative of the World Health Organization (WHO) (Valdiseri &
Holtgrave, 2020). Others are Global Fund to fight AIDS and Joint UN Program on HIV/AIDS.

Country United States Botswana

Describe the policy
in each country
related to the
identified healthcare
issue

The United States has had a number of policies
meant to combat the HIV/AIDS pandemic. However,
the most far-reaching is the President’s Emergency
Plan for AIDS Relief (PEPFAR). Initiated in 2003,

With 25% of its adults infected with the virus,
Botswana has one of the highest HIV/AIDS
prevalence in the world (Makhema et al., 2019). Only
two countries, Eswatini and Lesotho, have a higher
prevalence of HIV/AIDS. To fight the pandemic,

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PEPFAR is one of the most ambitious plans for
combatting HIV/AIDS by a single government
(Jacobson, 2020). It focuses on three areas. First, it
seeks to help millions of people infected with the
virus across the world to access life-saving
treatment. Secondly, the plan provides essential
services to people, such as orphans, who have been
permanently affected by the condition. Third, it
seeks to put the pandemic under control in countries
that have been hardest hit by it (Jacobson, 2020).

Botswana has focused on two areas. The first one is
prevention to extensive HIV/AIDS education,
especially among teenagers and younger adults. The
second one is treatment where the government has
instituted universal free antiretroviral treatment
(Makema et al., 2019).

What are the
strengths of this
policy?

Generous funding of PEPFAR from the U.S
government has enabled it to help millions of people
living with the virus not just in the U.S but also
across the world.

The government’s plan has invested huge financial
resources in providing free antiretroviral treatment
which has significantly reduced the number of people
dying from the condition. Additionally, the plan does
not just focus on treatment but also on supporting
preventive measures, such as sex education which has

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led to fall in new infections.

What are the
weaknesses of this
policy?

Investment in prevention measures, such as sex and
HIV/AIDS education among teenagers and young
adults, is relatively small.

Even though the government’s program includes sex
education, the plan does not employ targeted approach
in the education.

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Explain how the
social determinants
of health may
impact the specified
global health issue.
(Be specific and
provide examples)

Combatting HIV/AIDS requires a combination of
preventive measures, such as sex education, and
treatment. The efforts can be affected by various
social determinants of health such as poverty,
racism, education, and unequal access to healthcare
services. In the U.S., the social determinants of
health that most affect the fight against HIV/AIDS
are racism and poverty. African American
communities, who are the most affected by HIV, are
sometimes treated poorly by prejudiced healthcare
workers and professionals. Additionally, widespread
poverty makes it difficult for many people infected
by the disease to effectively treat opportunistic

The main social determinant of health hindering fight
against HIV in Botswana is poverty and stigma.
Poverty prevents infected people from receiving
effective treatment for their condition. As for stigma, it
keeps people from testing for the virus or going to
seek treatment when they discover that they have been
infected.

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diseases associated with HIV/AIDS. The poverty
also makes it hard to afford nutritious foods that are
especially useful for people under HIV treatment

How has each
country’
government
addressed cost,
quality, and access
to the selected
global health issue?

The United States has invested significant number of
financial resources to help improve access to life-
saving treatment to American citizens and other
infected people in other parts of the world. As a
result of the investment, costs of HIV treatment have
dropped and access improved.

To reduce cost of HIV treatment and improve access
to such treatment, the government of Botswana, with
the help of donor funding, has managed to offer free
HIV treatment across the whole country (Makhema et
al., 2020).

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How has the
identified health
policy impacted the
health of the global
population? (Be
specific and provide
examples)

PEPFAR has enabled millions of people across the
world to access free or affordable treatment of HIV
treatment. As a result, it has managed to prevent loss
of millions of lives.

The government’s extensive sex education has
managed to lower HIV prevalence in the country.
Additionally, by providing free antiretroviral treatment
to infected persons, the government has managed to
significantly reduce deaths related to HIV/AIDS
(Makhema et al., 2019).

Describe the Nurses have become major advocates of patients Nurses offer counselling services to people affected

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potential impact of
the identified health
policy on the role of
nurse in each
country.

living with HIV with many of them advocating for
policies that improve the health of such people.

and infected with the virus. They also engage in
educational activities aimed at reducing stigma against
people living with HIV/AIDS.

Explain how global
health issues impact
local healthcare
organizations and
policies in both
countries. (Be

HIV has led to local healthcare organizations such as
Centers for Disease Control and Prevention to put
greater focus on the problem due to its large scale. A
significant portion of the organization’s resources are
now used in research of HIV.

Like the U.S., the sheer scale of HIV problem in
Botswana has compelled local healthcare
organizations to put more attention on HIV problem.

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specific and provide
examples)

Part 2: A Plan for Social Change

The success of PEPFAR shows the importance of taking a global perspective in the fight against HIV. Rather than simply
focusing on the disease as an American problem, PEPFAR took the view that HIV was a global problem and took measures to address
it at the global level. The measures resulted in increasing access to useful HIV treatment to millions of infected people across the
world. The treatments prevented millions of people from dying. In advocating for incorporation of a global perspective in my local

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practice, I will cite PEPFAR’s success story. I will also explain that HIV remains an incurable diseases and research is still on-going in
many parts of the world. Taking a global perspective to the problem will result in sharing of resources and knowledge which can speed
up the discovery of the disease’s cure.
Incorporating a global perspective in my local practice is likely to have a positive impact on my local activities. Having a global
perspective to the problem will allow me to use information and knowledge from other parts of the world in diagnosing, caring, and
treating HIV patients. Using the most effective methods of treatment and care of HIV patients from different parts of the world, I will
be able to provide more effective care.
The incorporation of global perspectives into my local practice represents social change because I will be implementing best
practices internationally in local settings. Such implementation will lead to change as people and organizations will start doing things
differently and align their practices with best international practices. For instance, starting age and gender specific sex education is
likely to spark social change that will help in fighting HIV.
Conclusion
As the comparison between the approach of U.S. and Botswana in the fight against HIV reveals, both approaches have strengths
and weaknesses. Therefore, there are lessons that both countries can learn from each other. For instance, the U.S. can learn about
focusing on sex education as a H.I.V infections preventive measure. As a nurse practicing in local settings, it is important to take a
global perspective of the health issue and examine how the issue is being dealt with in other countries. By looking at what is being

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done in other countries, the nurse can learn best practices which they can apply in local settings through, among other measures,
advocacy for the health issue.

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References

Jacobson, L. E. (2020). President’s Emergency Plan for AIDS Relief (PEPFAR) Policy Process and the Conversation around
HIV/AIDS in the United States. Journal of Development Policy and Practice, 5(2), 149-166.
Makhema, J., Wirth, K. E., Pretorius Holme, M., Gaolathe, T., Mmalane, M., Kadima, E., & Lockman, S. (2019). Universal testing,
expanded treatment, and incidence of HIV infection in Botswana. New England Journal of Medicine, 381(3), 230-242.
Valdiserri, R. O., & Holtgrave, D. R. (2020). Responding to pandemics: what we’ve learned from HIV/AIDS. AIDS and
Behavior, 24(7), 1980-1982.
World Health Organization. (2020). HIV/AIDS: Key facts. Retrieved from https://www.who.int/en/news-room/fact-sheets/detail/hiv-
aids