title: The impact of ART (anti-retroviral treatment) scale-up on health systems de-strengthening in sub-Saharan Africa: justice and justification.
abstract: The scale-up ofanti-retroviral treatment (ART) in sub-Saharan Africa (sSA) is unquestionably a positive development. To be successful, however, scale-up must be understood as more than the technical delivery of pills. A central dimension of the challenge involves the health systems through which services are delivered. Part 1 of this article explores how the scale-up of ART could impact on health systems in sSA. We conclude that the current expansion of access to ART potentially involves an approach to health delivery that runs counter to many aims of health system strengthening. Part 2 addresses the question of whether this impact is justified. We argue that the potential erosion of health systems strengthening in the region is justified, provided simultaneous efforts are undertaken to optimize the possibility for realizing the "AIDS transition". We discuss these simultaneous efforts, drawing on recent research to illustrate the emerging scenario in sSA. In Part 3, we identify lessons that may inform scale-up of ART in sSA in ways that, at least, minimize detrimental effects and, ideally, serve to strengthen health systems in the region. We discuss the value of solidarity as a guiding principle for ART scale-up, followed by concrete lessons for moving forward.
authors.affiliation: Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, South Africa.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nixon
authors.forename: Nina
authors.initials: N
authors.lastname: Veenstra
mesh_terms: D017954:Africa South of the Sahara; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy*; D006301:Health Services Needs and Demand; D006280:Health Workforce; D006801:Humans; D011635:Public Health Administration
chemical_list: D044966:Anti-Retroviral Agents