Public-private options for expanding access to human resources for HIV/AIDS in Botswana

Botswana is a sub-Saharan African country in which the HIV prevalence is among the highest in the world (see Table 1). The epidemic reached mature proportions over the past decade, with deaths from the disease affecting all strata of society. Given the alarming prevalence figures reported during the 1990s, presidential level commitment assured a strong response to the expanding epidemic throughout Botswana society by creating the National AIDS Coordinating Agency in 2002.As of the mid-1990s, ART became increasingly affordable globally. As a middle-income country, Botswana decided with the highest political commitment to invest heavily through creating the ART Programme to address the need to provide access to antiretroviral therapy. In 2000 the government contracted the McKinsey consulting company who conducted a situation assessment for the establishment of the ART Program. In addition, they provided an analysis of treatment needs and a way to organize the ART programme. The target coverage of need for ART and care was established at 110 000 patients as a result of this consultancy [1].As an initial emergency response, a public-sector antiretroviral programme was created to focus support on delivery of this specific component of HIV/AIDS prevention, care and treatment services.In mid-2004, this programme had evolved to consist of specialized antiretroviral therapy public clinics established in existing health care facilities and operating in four sites across the country. A site consists of one hospital with up to four satellite clinics. At that time, the population response to the need for testing for HIV was such that 10 000 patients who had tested positive and were found to be in need of ART could not start therapy due to insufficient access to the health workforce. Thus, there was a need to identify other health system resources to provide access to human resources for ART.In the meantime, many other donors and bilateral aid agencies, including the Bill & Melin