Health Economics and HIV/ADIS Research Divison (HEARD), University of KwaZulu-Natal, KwaZulu-Natal, South Africa; University of Toronto, Department of Physical Therapy, Toronto, ON, Canada
Nixon, S., Health Economics and HIV/ADIS Research Divison (HEARD), University of KwaZulu-Natal, KwaZulu-Natal, South Africa, University of Toronto, Department of Physical Therapy, Toronto, ON, Canada; Veenstra, N., Health Economics and HIV/ADIS Research Divison (HEARD), University of KwaZulu-Natal, KwaZulu-Natal, South Africa
The scale-up of anti-retroviral treatment (ART) in sub-Saharan Africa (sSA) is unquestionably a positive development. To be successful, however, scale-up must be understood as more than the technical delivery of pills. A central dimension of the challenge involves the health systems through which services are delivered. Part 1 of this article explores how the scale-up of ART could impact on health systems in sSA. We conclude that the current expansion of access to ART potentially involves an approach to health delivery that runs counter to many aims of health system strengthening. Part 2 addresses the question of whether this impact is justified. We argue that the potential erosion of health systems strengthening in the region is justified, provided simultaneous efforts are undertaken to optimize the possibility for realizing the "AIDS transition". We discuss these simultaneous efforts, drawing on recent research to illustrate the emerging scenario in sSA. In Part 3, we identify lessons that may inform scale-up of ART in sSA in ways that, at least, minimize detrimental effects and, ideally, serve to strengthen health systems in the region. We discuss the value of solidarity as a guiding principle for ART scale-up, followed by concrete lessons for moving forward. © YOZMOT 2008.
antiretrovirus agent; Human immunodeficiency virus vaccine; microbicide; acquired immune deficiency syndrome; Africa; article; drug cost; health care access; health care availability; health care delivery; health care organization; health care planning; health care policy; health care system; health program; human; Human immunodeficiency virus infection; infection control; maternal care; patient compliance; patient counseling; patient education; primary medical care; public health service; sexual transmission; social discrimination; social justice; vertical transmission; Africa South of the Sahara; Anti-Retroviral Agents; Health Manpower; Health Services Needs and Demand; HIV Infections; Humans; Public Health Administration
