Since doctors diagnosed the first case of AIDS in Botswana in 1985, the disease has spread through the population of 1.7 million at a staggering rate. Today, nearly 2 in 5 adults are infected with HIV. Life expectancy in this small sub-Saharan country has plunged from over 65 to under 40 years. [Source: ACHAP]
Five years ago, Merck approached the Government of Botswana and the Bill & Melinda Gates Foundation to develop an innovative partnership to support and enhance Botswana's national response to HIV/AIDS through a comprehensive approach to prevention, care, treatment and support. The partners sought to create a model approach that could be applied to other countries and regions.
ACHAP helps to provide counseling and support services.
(Photo: Bill Vanderdecker, Merck & Co., Inc.)
Formally established in 2000, the Botswana/Gates/Merck partnership (also known as the African Comprehensive HIV/AIDS Partnerships, or ACHAP) works in full integration with government strategy to build institutional and management capacity, strengthen Botswana's health care system, promote behavior change and support grassroots efforts to tackle HIV/AIDS. The Merck Company Foundation and the Bill & Melinda Gates Foundation are each providing $50 million to the effort. In addition, Merck is donating its two antiretroviral medicines to Botswana's national ARV treatment program, known as "Masa" ("dawn"). In 2006, The Merck Company Foundation and partners agreed to extend their commitment to 2009 and further funding by $6.5 million each.
Since it was launched, the Botswana/Gates/Merck partnership has funded a wide range of projects aimed at helping to address HIV/AIDS in Botswana. This has included:
- Improving the effectiveness and availability of voluntary testing, referral and diagnostic services
- Supporting a condom distribution and marketing program, including the installation of more than 10,500 condom dispensers providing free condoms throughout the country
- Providing small grants to fund community-based initiatives
- Building resource centers at hospitals and daycare facilities for orphans
- Establishing support and counseling services including faith-based services, pre- and post-test counseling and interventions targeting youth and other vulnerable groups
- Implementing awareness, knowledge and de-stigmatization campaigns through the national education and broadcast systems
- Providing funding for health care worker training, encompassing both theoretical and clinical training
Progress to Date
While success has not come overnight, progress to date is encouraging:
- As of August 2006, more than 63,000 patients were receiving ARVs in the public sector in Botswana
- More than 2,000 new HIV-positive patients are being enrolled in Masa each month
- Statistics on adherence show that 85 percent of patients enrolled remain in the program and follow-up rates are 90 percent
- Botswana is one of only three countries in Africa to have achieved its treatment goals under World Health Organization (WHO) 3 X 5 guidelines, and at 85 percent leads all countries in Africa in the proportion of people receiving treatment.
The Botswana/Gates/Merck partnership has supported Botswana's national treatment effort by helping to construct four Infectious Disease Care Clinics and 16 satellite clinics. The partnership joined with Harvard University and the Botswana Ministry of Health to provide training for more than 3,900 of Botswana’s health care workers on the first of eight core modules on HIV/AIDS clinical care fundamentals, while more than 3,200 physicians, nurses and other health care professionals have received hands-on, clinic-based training from international HIV/AIDS experts through the partnership’s preceptorship program.
Other programs have included a prevention initiative with the Ministry of Education, Botswana Television and the UN Development Programme (UNDP) to provide distance education for primary and secondary school teachers to raise awareness of HIV/AIDS and destigmatize the disease among students and their peers. To date, the program has reached more than 21,000 teachers in over 970 educational institutions. In addition, the partnership is working with the Botswana Ministry of Health to improve distribution of free condoms. Condom distribution machines have been installed in 10 districts, with plans to install an additional 800 condom dispensers at ARV clinics nationwide.
Looking Forward
While we are proud of the partnership's success to date, formidable challenges remain.
Strategic priorities for the partnership include continued ARV program support, expansion of HIV testing capacity, development and strengthening of post-test services to improve prevention and care, and empowering people living with HIV/AIDS and their communities to enhance critical programs. In addition, the partnership is in the process of rolling out a pilot program that will focus on expanding services in seven health care districts around the country.
Lessons Learned in Botswana
The partnership's success to date reflects the fact that it is fully integrated with Botswana's national strategy, that it leverages the benefits of the private sector to support public health aims and that the complement of initiatives are locally driven. Most importantly, the partnership is enhancing local capacity through the strengthening of the health care infrastructure and the transfer of managerial, leadership and technical skills to Botswana - elements critical to ensuring the sustainable and effective delivery of health services.
Our work in Botswana has taught us valuable lessons about implementing an appropriate response to HIV/AIDS:
- A successful national response to HIV/AIDS requires sound, enabling policy to drive and guide the right course of action
- Local, national and international partners must integrate and align all efforts to the national blueprint
- Success depends on building local capacity and achieving buy-in at all levels
- A comprehensive approach to treatment and prevention is required
- It is possible to implement effective ARV therapy, even in a resource-limited setting
Today, we are applying these lessons to projects elsewhere to help governments, aid organizations and others address HIV/AIDS.
To learn more about Merck's commitment to addressing HIV/AIDS, click on the links below:
