E-DRUG: Lessons Learned from ARV Scale-up in Malawi
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Dear E-druggers,
I recommend this new paper from the Government of Malawi, WHO, MSH and
others on the experience of the use of the public health approach to
achieve a massive increase in ART coverage:
http://www.who.int/bulletin/volumes/94/10/15-166074.pdf
ABSTRACT
Problem In Malawi: health-system constraints meant that only a fraction of people infected with human immunodeficiency virus (HIV) and in immediate need of antiretroviral treatment (ART) received treatment.
Approach In 2004: the Malawian Ministry of Health launched plans to scale-up ART nationwide, adhering to the principle of equity to ensure fair geographical access to therapy. A public health approach was used with standardized training and treatment and regular supervision and monitoring of the programme.
Local setting: Before the scale-up, an estimated 930 000 people in Malawi were HIV-infected, with 170 000 in immediate need of ART.
About 3000 patients were on ART in nine clinics. Relevant changes By December 2015, cumulatively 872 567 patients had been started on ART from 716 clinics, following national treatment protocols and using the standard monitoring system.
Lessons learnt: Strong national leadership allowed the ministry of health to implement a uniform system for scaling-up ART and provided benchmarks for implementation on the ground. New systems of training staff and accrediting health facilities enabled task-sharing and decentralization to peripheral health centres and a standardized approach to starting and monitoring ART. A system of quarterly supervision and monitoring, into which operational research was embedded, ensured stocks of drug supplies at facilities and adherence to national treatment guidelines.
The Malawi experience has been widely discussed over recent years, and for
me this encapsulates the approach, challenges and results very well.
Kind Regards
David Jamieson
Mr. David G JAMIESON
Deputy Director, Project Planning and Global Partnerships
Supply Chain Management System (SCMS)
Partnership for Supply Chain Management (PFSCM)
1616 Fort Myer Drive, 12th Floor
Arlington, VA 22209 USA
Email: djamieson@pfscm.org