Leaving no one behind.
Doctors Without Borders (Médecins Sans Frontières) has been working in support of the Mozambique government on HIV since 2003. When HIV treatment was first rolled out, the government followed a traditional approach with doctors working in centralized clinics controlling the care and treatment for HIV patients. In a country where one in 10 adults was living with HIV, clinic staff were so overburdened that they often could spend just a few minutes with each patient. Patients regularly travelled hours to reach clinics and waited in long lines to receive care.
While the program was successful in putting thousands of patients on treatment for the first time, it wasn’t serving the needs of the patients as well as it could. Not surprisingly, around 30 percent of patients dropped off treatment due to the difficulty of receiving their medication.
In 2007, small groups of HIV patients from villages around Tete, Mozambique, decided to challenge this approach. Instead of walking for hours every month to pick up their ARV medication, they would send one of their group to pick up meds for all the other group members on a rotating basis. And that’s how a new model of care, known as the Community antiretroviral therapy (ART) Groups (CAGs) got started.
Reduced wait times and less frequent visits to the clinic made getting HIV treatment easier, and more patients stayed on treatment and stayed healthier. It also eased the burden on the country’s overloaded health care system.
With clear evidence that these new models of care were making a difference, Doctors Without Borders worked with Mozambique’s Ministry of Health to expand these groups across the country. The Community ART Groups are now being applied in many different ways and settings across Africa – in some countries, communities even operate their own pharmacies to distribute HIV medication or have adapted approaches to meet the specific needs of the patients and their communities.
Tom Ellman of Doctors Without Borders is looking to build on the progress that’s been made. “If the goal is to provide treatment to everyone who needs it, the world needs to go further. We need to adapt models of care for the hundreds of millions left behind in conflict zones, in fragile states, for migrants and refugees,” he said.
“The essence of these models is very simple. You listen to patients, you trust them, and adapt your services to their needs. You simplify things, you de-medicalize things,” Tom says.
Tom’s vision is to develop health care systems based on trust and equal partnership between health professionals and communities. By empowering communities, he imagines a world where “leaving no one behind” is not just a slogan.
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