Monitoring equity in ART scale up in Malawi

Abstract

Issues: ART scale up is gathering pace in many African countries. In light of the limited health resources, analysis of equity in access to treatment requires not only the assessment of who will receive the drugs, but also, the analysis of the impact of the provision of ART on the broader public health system. Description: Working with key stakeholders, REACH Trust has conducted two equity analyses of ART scale up using data up to April 2005 (1), and data up to April 2006 (2, in progress). This analysis was informed by the key principles in the equity in access to ART policy in Malawi and a framework to analyse equity in ART scale up in the context of health systems developed by EQUINET. Data sources include analysis of routinely collected data, sentinel analysis, synthesis of findings from operational and qualitative research, participation in Technical Working Groups and key informant interviews. Lessons learned: Malawi is unique in having an equity in access to ART policy that was developed through a participatory process. Scale up of ART started in 2004 and ART has been provided free in all public facilities. At the end of September 2005, 30,055 patients had ever started ART in public health sites: 39% of the patients were male and 61% female; 95% were adults while only 5% were children. A key challenge in Malawi is human resource constraints, in light of this efforts have been made to integrate ART delivery within the broader public health system (with particular success with Tuberculosis services) and strengthening links with the private sector. Recommendations: There is need for ongoing monitoring and evaluation of equity and impacts on existing health systems. The results should be widely disseminated and complemented by qualitative data. This should help to ensure that challenges are understood and addressed early on in the programme