experts; data analysts; and experts in monitoring, evaluation, and operations research.

Recommendation 5-4. Countries should establish information systems at the regional and national levels so they can regularly assess and coordinate their evolving human resource needs. Both countries with relatively adequate human resources and those that are more resourceconstrained must pursue appropriate policies and programs to stem the “brain drain” of local expertise that is critically needed for the scale-up of ART programs. The current shortage of trained, dedicated personnel for monitoring and evaluation programs should be rectified in conjunction with meeting other training and personnel needs.

SECURING AND DELIVERING EFFECTIVE DRUGS

Purchasing drugs is about more than the price of the pills. Continuous drug availability and the safe, timely distribution of quality-assured drugs to the people who need them will be critical to the viability of any ART program, as interruptions in the drug supply can rapidly lead to treatment failure and the emergence of drug resistance even in the most motivated patients who are otherwise receiving good care. In many resource-limited areas, the requisite infrastructure for the regular procurement, distribution, regulation, and safe storage of ARVs may not be functional. The numerous problems currently facing many resource-limited countries include weak procurement strategies; a lack of sufficient and appropriate warehouse space for stocking drugs; too few people and vehicles to deliver the drugs to their intended, often remote, destinations in a timely manner; and poor communication along the drug delivery line. Addressing each of these components and ensuring the safe delivery of quality ARVs and related products to a number of sites across different sectors and for a growing number of people presents a much more complex set of challenges than those faced by pilot projects. Even in such projects, reports abound regarding the complications associated with the safe procurement, storage, and delivery of products. A well-planned and -executed logistics system can help alleviate many of these problems.

Procurement

For a number of reasons, ARV procurement is more challenging than is the case for other types of essential medicines. Cost issues aside, stock management is crucial for maintaining uninterrupted drug supplies; procurement systems must be flexible enough to adapt to the rapidly changing and wide range of treatment regimens; and a lack of quality reference



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