Like many low and middle-income countries, Zambia initially adopted a vertical ART programme structure to respond to the urgent need to provide treatment to the large number of people living with HIV/AIDS. The vertical approach was also partly driven by the growth of disease-specific funding. Now that 2 million people in Africa are on ART, a critical health systems issue is how best to move ART from the phase of emergency scale-up to a long-term chronic care programme. There is a wide consensus that these efforts will only be sustainable if ART is integrated into the existing health system. However, the most appropriate forms of integration will depend on the epidemiology of the health issue in question, the structure of the underlying health system, and the resources available.
This policy brief addresses the challenges and opportunities for integration, in particular on: health information, health workforce and health services. It examines the likely impact on effectiveness, efficiency and equity, and makes recommendations on how best to proceed. Key points from the policy brief are:
- The establishment of a vertical system for delivering ART in Zambia enabled the rapid scaleup of antiretroviral therapy (ART)
- The ART programme has strengthened some aspects of the health system, while also drawing attention to weaknesses which need to be addressed
- Significant progress has been made towards integrating ART into the
health system. However, long-term sustainability of chronic care for
people living with HIV in Zambia will require further integration.
Priority areas include:
-Health information - increase efficiency of information system and strengthen quality assurance
-Health workforce - harmonise incentives and improve coordination of training
-Health service delivery - strengthen linkages with other services and assess strengths and weaknesses of different delivery models.
Rajaraman, D.; Chishinga, N.; South, A.; Banda, J. Integrating HIV services in Zambia: effectiveness, efficiency and equity? Evidence for Action Briefing Paper, Issue 02. (2009) 4 pp.