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The following HTML text is provided to enhance online readability. Many aspects of typography translate only awkwardly to HTML. Please use the page image as the authoritative form to ensure accuracy. 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. REFERENCESAttawell K, Mundy J. 2003. Provision of Antiretroviral Therapy in Resource-Limited Settings: A Review of Experience up to August 2003. London: DFID Health Systems Resource Centre. Brugha R. 2003. Antiretroviral treatment in developing countries: The peril of neglecting private providers. British Medical Journal 326:1382–1384. Bundred P, Levitt C. 2000. Medical migration: Who are the real losers? Lancet 356:245–246. Caminero JA. 2003. Is the DOTS strategy sufficient to achieve tuberculosis control in low-and middle-income countries? 2. Need for interventions among private physicians, medical specialists and scientific societies. International Journal of Tuberculosis and Lung Disease 7(7):623–630. Campaign for Access to Essential Medicines. 2004. Surmounting Challenges: Procurement of Antiretroviral Medicines in Low- and Middle-Income Countries. [Online]. Available: http://www.accessmed-msf.org/prod/publications.asp?scntid=201120031530452&contenttype=PARA& [accessed January 5, 2004]. Chandani Y. 2004 (January 28). Distribution of ARVs: Issues of Security, Logistics, and Quality. Paper presented at the Institute of Medicine Workshop on Antiretroviral Scale-up in Resource Constrained Settings, Washington, DC. Institute of Medicine Committee on Antiretroviral Drug Use in Resource-Constrained Settings. de Castella T. 2003. Health workers struggle to provide care in Zimbabwe. Lancet 362(9377): 46–47. Delay P. 2004 (January 28). Monitoring and Evaluation for ARV Programs in Resource Poor Settings. Paper presented at the Institute of Medicine Workshop on Antiretroviral Scale-up in Resource Constrained Settings, Washington, DC. Institute of Medicine Committee on Antiretroviral Drug Use in Resource-Constrained Settings.
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