Darkoh E, Mazonde PN; International Conference on AIDS (15th : 2004 : Bangkok, Thailand).
Int Conf AIDS. 2004 Jul 11-16; 15: abstract no. B11388.
Achap, Min of Health, Gaborone, Botswana
Issue: Botswana embarked on providing ARV therapy in January 2002 using a phased rather than a "big bang" approach. There are critical pros and cons associated with this approachDescription: Due to lack of any precedent with large-scale ARV provision on the African continent, Botswana deliberately proceeded to implement in a phased manner, starting with 4 sites in the first year and scaling up rapidly thereafter. Lessons Learned: Implementation of the first 4 sites revealed the following positive benefits of a phased approach Easier to focus and build initial capacity at a small number of sites- "do it right" Program managers gain critical insights from how actual implementation differed from expected (patient uptake, speed of resource mobilization, true critical path needs) However, as implementation proceeded, a number of negative features of a phased approach began to emerge: Small number of initial sites had to support entire national treatment needs ("perverse" demand). Long lag time between launches exacerbates the situation Patients travel long distances and return to areas lacking in supportive services Patients cannot afford transportation for monthly drug pick-up "Perverse" demand creates pressure for "perverse" resource build-up in a small number of sites at the expense of rolling out (politically difficult to stop the buildup as requests are justified) Non-active sites abdicate all responsibility to active sites and as such do not learn (still end up having the same learning curve and teething problems when they eventually start) Non-active sites do not experience appropriate ARV patient demand pressure, making it is difficult to gauge real demand in other regions. As such, rational resource allocation is difficult. Recommendations: New programs should combine elements of phased and "big bang" approach. Use initial sites as a learning pilot and then simultaneously roll out as many sites as possible so as to set them on their learning curve early.
Publication Types:
Keywords:
- Botswana
- Health Services Needs and Demand
- Humans
Other ID:
UI: 102276676
From Meeting Abstracts