Case Study Sector
An innovative partnership between the government of Botswana, Merck, the Bill & Melinda Gates Foundation, and African Comprehensive HIV/AIDS Partnerships (ACHAP) made significant progress in expanding access to HIV treatment and care, as noted in a 2006 foundation report. However, Botswana made less rapid progress in preventing the spread of HIV.
Our report shows that:
• Skeptics were wrong when they said treatment programs would not work in Africa. We learned that it is difficult, but possible to “scale up” an existing therapy program.
• Working directly with the government was the right call in Botswana. This partnership allowed us to help Botswana build its own capacity to wage a successful war on HIV. However, it was unrealistic for us to expect that ACHAP's support would quickly cascade to remote villages. As a result, ACHAP decided to devote more time and money to support government and NGO work at the grassroots level.
• The ability to spend resources in a timely manner is a real issue. BY 2006, ACHAP and Botswana's government were not able to spend the funding they had available at the rate anticipated. This indicates that we underestimated how hard it is to build up the system necessary to confront HIV/AIDS across an entire country.
• Next steps: focus on both prevention and treatment. After a strategic review in 2005, it became clear that Botswana will not be able to make meaningful progress towards its goal of "an AIDS-free generation by 2016" without dramatically expanding prevention efforts, including offering education in every classroom, making condoms more widely available, and expanding testing.
- Field Building