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Ethical and programmatic challenges in antiretroviral scaling-up in Malawi: challenges in meeting the World Health Organization's "Treating 3 Million by 2005" Initiative goals.
Croatian Medical Journal. 2004; 45(4):415-421.The Fifty-seventh World Health Assembly's (WHA's) resolution on the "scaling up of treatment and care within a coordinated and comprehensive response to HIV/AIDS" is welcomed globally, and even more so in Sub-Saharan Africa, where the majority of the people currently in need of antiretroviral therapy do not have access to it. The WHA identified, among others, the following areas which should be pursued by member states and the World Health Organization (WHO): trained human resources, equity in access to treatment, development of health systems, and the integration of nutrition into the comprehensive response to HIV/AIDS. The WHO Director-General was requested to "provide a progress report on the implementation of this resolution to the Fifty-eighth World Health Assembly." Much of what happens between now and that time depends on the actions of the WHO and the member states and also on the contribution of the international community to the fight against HIV/AIDS. Much of what is to be done will be based on what is available now in terms of practice, human resources, and programs. This paper explores the WHA's resolution, especially regarding the scaling up of antiretroviral therapy, taking Malawi as the case study, to identify the challenges that a Southern African country may be facing which will eventually influence whether the initiative to "Treat 3 Million by 2005" ("3 by 5") will be achieved or not. The challenges southern countries may be facing are presented in this paper not in order to undermine the initiative but to create an awareness of these factors and initiate the appropriate action which would surmount the challenges and achieve the goals set. (author's)
Washington, D.C., PAHO, Pan American Sanitary Bureau/Regional Office of the World Health Organization, 1985. xix, 265 p. (Official Document No. 201)Efforts to meet the goal of health for all by the year 2000 have been hampered by the internal and external problems faced by many countries of the Americas. The pressures of external debt have been accompanied by a reduction in the resources allocated to social sector programs, including health programs. In addition, the conflict in Central America has constrained solutions to subregional problems. The health sector suffers from uncoordinated services, lack of trained personnel, and waste. Thus 30-40% of the population do not have access to basic health services. In 1984, the governments in the region, together with the Pan American Health Organization (PAHO), undertook projects in 5 action areas: new approaches and technology, development, intra- and intersectoral linkages, joint activities by groups of countries, mobilization of national resources and external financing, and preparation of PAHO to meet the needs of these processes. New approaches include the expansion of epidemiological capabilities and practices, the use of low-cost infant survival strategies, the improvement of rural water supplies, and the development of domestic technology. Interorganizational linkages are aimed at eliminating duplication and filling in gaps. Ministers of health and directors of social security programs are working together to rationalize the health sector and extend coverage of services. Similarly, countries have grouped to deal with common problems and offer coordinated solutions. The mobilization of national resources involves shifting resources into the health field and increasing their efficiency and effectiveness by setting priorities. External resources are recommended if they supplement national efforts and are short-term in nature. In order to enhance these strategies, PAHO has increased the managerial and operating capacity of its central and field offices. This has required consolidating programs, retraining staff, and instituting information systems to monitor activities and budgets. The report summarizes health indicators and activities by country, for all nations under PAHO.