GrantWatch : Report Public - Private Partnerships And Antiretroviral Drugs For HIV

The African Comprehensive HIV/AIDS Partnerships (ACHAP) played a major role in initiating Botswana’s antiretroviral (ARV) program in 2001. ACHAP is a prominent public-private partnership involving Merck and its foundation, the Bill and Melinda Gates Foundation, and the government of Botswana. This paper analyzes ACHAP’s efforts to assist Botswana with its ARV program, the first and most advanced in sub-Saharan Africa. It identifies five features of the model and shows how they contributed to the ARV program. It also raises questions about ACHAP’s role in scaling up and sustaining the program, as Botswana faces the challenges of treating growing numbers of HIV-infected people. T he afr ican comprehens ive HIV/ AIDS Partnerships (ACHAP) started as a five-year partnership (July 2000– July 2005) between Merck and its foundation, the Bill and Melinda Gates Foundation, and the government of Botswana.1 ACHAP was created with a financial commitment of US$100 million, half each from Merck and Gates, to support prevention, care, and treatment for HIV/AIDS in Botswana. Botswana has the unfortunate distinction of having the world’s second-highest adult HIV prevalence rate (37.4 percent in 2003, after Swaziland).2 Life expectancy in Botswana fell from 65.0 years in 1990–1995 to 56.3 years in 1995–2000 and is projected to drop to 39.7 years in 2000– 2005, which would be a loss of twenty-eight years in life expectancy compared with the projected level in the absence of HIV/AIDS.3 Botswana also has several advantages. It is a middle-income country with a relatively welldeveloped health care system among subSaharan African countries.4 Botswana’s political stability and leadership in HIV/AIDS are among the factors that have attracted multiple donors such as ACHAP. ACHAP created a model for responding to HIV/AIDS that requires intensive collaboration among its partners. One of its major activities is to support the national antiretroviral (ARV) treatment program, known as the Masa Program.5 This paper investigates the strengths and challenges of the collaboration of public and private partners as they worked together to start, scale up, and sustain a national ARV program. It is based on data collected from documents and more than sixty interviews in Botswana and the United States.6 G r a n t W a t c h H E A LT H A F F A I R S ~ V o l u m e 2 4 , N u m b e r 2 5 4 5 DOI 10.1377/hlthaff.24.2.545 ©2005 Project HOPE–The People-to-People Health Foundation, Inc. Ilavenil Ramiah ([email protected]) is a Bell Research Fellow at the Harvard Center for Population and Development Studies in Cambridge, Massachusetts. Michael Reich is the Taro Takemi Professor of International Health Policy and director of the center.