This paper reflects on systemic challenges to scaling up antiretroviral access in countries with both massive epidemics and weak health systems. It draws on the authors' experience in southern Africa and the World Health Organization's framework on health system performance. Whilst acknowledging the still significant gap in financing, the paper focuses on the challenges of reorienting service delivery towards chronic disease care and the human resource crisis in health systems.
Reproductive Health Matters, 14 (27), 12-23 pp. [doi:10.1016/S0968-8080(06)27232-X]