AEGiS-15IAC: Health systems strengthening and ART: Evidence from South Africa.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Health systems strengthening and ART: Evidence from South Africa.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WeOrB1279)

Schneider H, Gilson L, Blaauw D, Chabikuli N, Goudge J
Centre for Health Policy, Johannesburg, South Africa

ISSUE: Health system strengthening now features centrally in discussions of access to antiretroviral therapy (ART). Universal access to ART requires a functioning health system, the corollary of which is that massive investments in ART should serve to benefit the health system more widely. South Africa is embarking on the biggest programme of ART roll-out yet. It is a middle-income country able to mobilise considerable financial resources for ART roll-out and as such is a useful case study of the dimensions of capacity other than financing.

DESCRIPTIONS AND LESSONS LEARNT: Drawing on empirical evidence from a number of health system evaluations conducted by the authors in recent years, this paper reviews the key issues at stake in ART roll-out in South Africa. These can be summarised as: Shifting the emphasis in the primary health care (PHC) system from acute to chronic care, from authoritarian to patient-centred care, and from facility to community-based activities Creating better continuity within the health system, between levels of care, in drug and other supply systems, and in information flows Occurring against a backdrop of deep inequalities, a human resource crisis and a decade of post-apartheid restructuring in which AIDS has been a frequent source of political conflict, ART roll-out has to deal with the complexity of improving both macro systems (e.g. drug procurement and supply chains) and changing local cultures of service provision.

RECOMMENDATIONS: Given these dual sets of challenges, careful thought needs to be given to innovative strategies that combine top-down processes with bottom-up approaches to learning. For example, the presence of an energetic AIDS social movement and large numbers of NGOs able and willing to partner with the state provides a key opportunity for accelerating change at a local level.

Keywords: AEGIS, South Africa, Primary Health Care, Acquired Immunodeficiency Syndrome, Health Resources, Health Services Needs and Demand, Socioeconomic Factors, Evaluation Studies, Culture, Humans

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