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.
Attawell 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.