Reflections on ART policy and its implementation: rebuilding the ship as we sail?

Abstract

This paper reflects on the early experience with ART implementation in South Africa in the light of the policy goals of increasing ART access whilst improving prevention and strengthening the public health system. It reviews evidence on the state of ART roll-out and suggests that achievements to date have been significant, even if unevenly distributed and not meeting the set targets. The paper then considers what may be important future challenges — ensuring sustainable financing, addressing health system weaknesses (especially those related to human resources), building integrated systems of care and prevention, and developing appropriate national stewardship of the programme. Dealing with these challenges will be essential, both for building equitable ART access and leveraging wider benefits from the large investments in ART.