human resource capacity—required to individualize treatment when complications arise, as can the United States and other resource-rich countries (Redfield, 2004).

Within 10 years, ART scale-up will have evolved into a US$30–100 billion annual effort, demanding an enormous amount of program success to meet donor goals. In the rush to achieve a quick fix, initial expectations should not be set too low such that they compromise the long-term sustainability of ART scale-up. At the same time, there can be no delay in responding to the ethical imperative to act now.

Recommendation 5-9. Monitoring and evaluation measures and requirements, as directed by various donors and other stakeholders, should be harmonized across programs to minimize time-consuming inefficiencies in data collection and program management. Additional efficiencies would be achieved if these efforts were coordinated by a single national ministry or agency. Donors should avoid attempting to ascribe results solely to individual funding sources in order to minimize the in-country confusion and inefficiency created by mandates to conduct multiple, uncoordinated monitoring and evaluation efforts in the midst of rapid scale-up.

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