Integrating HIV Care and Treatment into Primary Health Care in Mozambique: Re-defining the role of non-governmental organizations

Context: Major new sources of funding for health in Africa, such as the Global Fund and PEPFAR, have emerged in recent years to finance the scale-up of HIV/AIDS treatment programs. National planners must divide these new resources between public sector health systems and non-governmental organization (NGO) partners. Much of the new funding has been channeled to vertical programs managed by NGOs, raising concerns about the limits of ART expansion and its impact on primary health care (PHC) services.

Approach: Many donors have embraced vertical models and channeled funding to NGOs in local settings where they believe more people can be put on ART faster. Links to PHC services are not developed. Mozambique's three-year experience with ART scale-up provides a valuable opportunity to re-define the best role for NGOs in supporting the integration of anti-retroviral treatment into PHC.

Outcomes and Challenges: Initial scale-up efforts in Mozambique and across Africa have been successful in putting many on ART quickly but are now reaching their limits given the vertical approaches constrained by NGO capacity. To more effectively reach and treat vast and dispersed HIV-positive populations, integration of ART into public PHC systems is urgent.

Key Recommendations: Rather than establishing parallel vertical systems, NGOs can be most effective by providing technical and material support to public sector PHC systems for management, capacity building, monitoring and evaluation at national and local levels. While NGOs can play this positive role, donors should redirect more ART funding toward health system strengthening rather than parallel NGO projects.