Recorded presentation

Stephen Gloyd, MD, MPH, Health Services/International Health, University of Washington, 1959 NE Pacific Street, H-660 P.O. Box 357660, Seattle, WA 98195-7660, (206) 543 6714, gloyd@u.washington.edu

Background: AIDS treatment programs are proliferating throughout Africa with substantial funding from multiple sources. Much of the funding has gone to NGOs, who have created model ARV treatment centers. Less ARV treatment funding has gone directly to African Ministries of Health (MOH), largely because of difficulties working with inadequate trained health care providers, poorly maintained health clinics, and inadequate equipment, management, and financial systems.

Methods: Observations from AIDS treatment programs managed by NGOs and the MOH in Mozambique demonstrate structural implications of different implementation strategies.

Findings: NGO managed ARV treatment centers usually hire providers who are expatriates or highly paid nationals who leave MOH positions. Facilities are often rehabilitated. Drug procurement and laboratory systems of NGOs typically run parallel to MOH systems for greater reliability and efficiency. Clinical algorithms and monitoring systems vary, not necessarily in conformity with national norms. Uptake of ARV care is significantly faster in the NGO clinics. Overall coverage by NGO clinics has been spotty, serendipitous; services are not necessarily in sites with greatest need. Resentment often occurs between NGO staff, who work with higher pay and better conditions, than their equivalent providers in MOH clinics.

Conclusions: While NGO model clinics usually provide higher quality care in the short term, they are not likely sustainable; moreover, allocation of resources to NGOs is likely to exacerbate low morale and poor productivity in, and brain drain from the public sector. Experience shows that similar investment into MOH clinics can provide high quality care with more sustainability and equity.

Learning Objectives:

• See session overview.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation