Lusikisiki - Four years after Mr Nelson Mandela launched a pioneering HIV/AIDS treatment programme in Lusikisiki, Eastern Cape, over 2,200 people are now healthy on ARVs. Today the Eastern Cape Department of Health (DoH) announced that it has taken over full responsibility for the programme. 

 Initiated four years ago by Médecins Sans Fronti&egraveres (MSF) and Nelson Mandela Foundation (NMF) in collaboration with the DoH, this programme made possible the implementation of comprehensive HIV services in one of the most resource constrained rural areas in South Africa. 

 Through the implementation of an innovative community-based model of care focused on all 12 of Lusikisiki's clinics and St Elisabeth's Hospital, the programme has achieved universal coverage of ART within the last two years, making it one of the largest rural treatment sites nationally.

 "We were happy to receive the support of MSF and NMF in 2003. We asked them to help us in one of the most difficult rural areas," said Mrs Nomalanga Makwedini, Chief Director of Primary Health Care of the Eastern Cape DoH. 

 "Four years later this experience proves that decentralized HIV/AIDS care is the optimal model for rural areas. At the same time, the model has brought many benefits to primary health care services as whole, with improvements in clinic and laboratory services, infrastructure, drug supply, training, and staff motivation."

 To implement this model in the face of a chronic shortage of health staff, a decentralized model was developed based on these pillars: a mobile team to support nurses at clinics; the recruitment of adherence counsellors; and strong community engagement to support the health system. 

 "Implementing comprehensive HIV services in Lusikisiki has needed many 'out-of-the-box' solutions to overcome the challenges we faced," said Dr Hermann Reuter, MSF project co-ordinator. "The only way to make this programme sustainable and replicable is to ensure that those solutions are urgently translated into policy changes at National and Provincial levels."

 Working in partnership has been crucial to the development of the Lusikisiki model. The partnership was designed to respond to a huge unmet need for access to HIV/AIDS services and to strengthen the primary health care response. From its inception the programme was designed to be integrated into the health care system. 

 "In times of huge challenges, government needs the support of NGO partners with their experience, extra resources and flexibility to move quickly", said Dr Mothomang Diaho spokesperson for NMF. "Following a gradual handover of resources and responsibilities to the DoH over the last eighteen months, the NMF and MSF are now withdrawing from Lusikisiki." 

 The partners are now confident that the programme is well established under the leadership of the Qaukeni district and the provincial teams.

 "This is a model that we are very keen to roll out to other rural areas and to share it with other provinces," said Mrs Nomalanga Makwedini, Chief Director of Primary Health Care at the Eastern Cape DoH. 

 "The last four years of Lusikisiki experience have proved that it is possible to innovate in the public health system under the most difficult circumstances. Today the Eastern Cape is proud to say that it is leading the roll-out of clinic based HIV services in South Africa."

 A full report describing the model can be downloaded from http://www.msf-azg.be/fr/fr/pdf/lusikisiki_final_report.pdf