Divide functions and conquer ARV rollout glitches

If governments were responsible for treating people living with HIV, and NGOs for supplementary needs like prevention, testing and food, there would be less duplication of services, civil society activists attending the recent Global Citizens Summit in Nairobi, Kenya, were told.

This approach could be a more efficient way of doing things. "Provision of treatment by aid groups might not be sustainable in the long run, because what happens when the funding for ... [the] aid group ... offering the treatment runs out?" said Jamal Mohammed, regional officer for the Horn of Africa at Oxfam International, the UK-based relief organization.

Participants at the conference said even though NGOs and other private actors were doing a commendable job, it would be more appropriate if they left treatment to governments and concentrated on other areas of HIV/AIDS care, like boosting awareness, testing and providing psychosocial support services.

They also suggested that NGOs direct some of their resources to improving government health facilities, making them better able to provide treatment, while governments should train more personnel and improve pay to retain staff in the public health system.

Parallel systems hurting public health care

"When you create parallel systems for treatment - one run by NGOs and the other by governments - then it means NGOs will, in most cases, pluck the best personnel from the government facilities because they can pay them better; hence, government institutions remain understaffed," said Ruth Masha, national HIV/AIDS coordinator for the anti-poverty NGO, ActionAid Kenya.

In India and Ethiopia the government provided treatment exclusively, leaving other areas of HIV management to NGOs. "In Ethiopia for example, NGOs can do testing and referrals, but the administration of ARVs [antiretrovirals] is purely the prerogative of the government, and it has worked well for them," said Oxfam's Jamal.

Alex Mito, a community health worker from Kenya, said most HIV/AIDS patients in rural western Kenya preferred to get their ARVs from NGO-run health facilities because of the additional benefits they received.

"Some NGOs provide food rations and at times monetary assistance to those on their treatment programmes, which in most instances is never done at government-owned facilities," he said.

Investing in public health

If such a system is to work efficiently, African governments will have to overhaul their drug supply systems to limit stock-outs and other supply-related problems. In Kenya and Uganda, for instance, inefficiency has dogged the provision of essential drugs to HIV and TB patients, leading to shortages in government-run health facilities.

Increased investment in the public health system was crucial to the successful expansion of antiretroviral treatment services in Africa, speakers said, which could be achieved if governments fulfilled their 2001 pledge to allocate at least 15 percent of the national budget to health.

According to the Regional Network on Equity in Health in Southern Africa (EQUINET), a network of research, civil society and health sector organizations, African governments account for less than one percent of global health spending, despite carrying 25 percent of the global disease burden.

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