B2. Monitoring Equity in scaling up anti-retroviral therapy
I. Makwiza; G. Bongololo; L. Nyirenda; S. Theobald
Objectives and Scope: The main aim of the study is to conduct an equity and health systems analysis of the provision and expansion of ART in Malawi, which could be used as a working example of country level monitoring and evaluation using available routine monitoring data. To meet this aim information has been collated under the following thematic areas: the process of developing policy; equity in ART delivery; fair financing; public private mix; integration of ART delivery within the health services and human resource capacity considerations. The study is being peer-reviewed by the Equity in ART working group (chaired by the Ministry of Health).
Methodology: Collation and analysis of pre-existing information and indicators from different Malawian stakeholders such as the Ministry of Health, National AIDS Commission and Ministry of Finance. Analysis of sentinel site data from Thyolo District
Results/Conclusions: Illustrative results are as follows. The process of developing a policy on ART was done in a participatory way and included perspectives from diverse groups, such as People Living with HIV/AIDS, civil society organisation and religious representatives. From data available there are some regional and district disparities in ART provision, with the northern region having the least number of ART providers. There is also an urban bias with more sites functioning in city areas.
Recommendations: It is critical to ensure that equity is considered in the process of ART scale up, so that we can ensure that all groups – by age, gender, socio-economic status, district - are able to access these life-preserving drugs. It is also imperative to make sure that ART provision is not having a negative effect on other health services, through displacement of human resources or finances. A process of ongoing Monitoring and Evaluation that mainstreams equity concerns and shapes policy practice is therefore crucial.