Dignitas International

For Malawi, the fourth poorest country in the world, HIV/AIDS is a national emergency that is overwhelming the health of the population and the social and economic structures that are needed to respond to the pandemic. Malawi has a population of 12.8 million, but only 94 qualified doctors (i.e., one doctor per 136,000 people), 1/3 of the required number of nurses, and an annual social services budget of $15 per capita (including foreign aid). Approximately 7% (940,000) of Malawians are HIV+, including 91,000 children and 500,000 women.

In 2004, an estimated 88,656 adults and children died of HIV/AIDS, and by 2010, this number is expected to rise to 96,295. An estimated 170,000 Malawians now need ARV therapy. So many have died of AIDS in Malawi that now 10% of all families are headed by a child, and half of all families are headed by a person over 65 - and most often by a grandmother. As of the end of 2005, there were 550,000 orphans in Malawi: in five years, there may be over one million.

Take for example the Zomba district in Malawi, with a population of 676 000, 100 000 of whom live in the urban centre. Zomba has the second highest adult HIV infection rate in the country at 17.8%. Zomba Central Hospital and Zomba District Health Office cannot meet the demand for HIV/AIDS related health services. Over 50% of healthcare posts remain vacant. There is a lack of financial resources, an erratic supply of medicines and medical material, a lack of technical knowledge about the treatment of HIV/AIDS patients, and a dysfunctional referral system. Populations in the periphery have very limited access to health services.

To be honest, conventional health care is not realizable in the situation facing the Zomba district of Malawi. Does this mean that health care cannot be delivered? No! ...but it does mean that the structure of health care delivery needs to change.

Community based care is a system for delivering health care that helps to overcome some of these obstacles. CBC addresses the shortages in Human Health Resources by providing health care under a sustainable model. Concern for the cost-effectiveness of health care system developed allows for increased access. CBC is characterized by three concepts:

1. Developing treatment capacity at local health centers
2. Creating a network of trained home-based volunteers
3. Integrating medical services: linking formal & informal community groups with public health systems and centralized medical services.

Dignitas is developing a health care delivery system in Malawi based around the CBC model. At the same time research is being done to improve understanding of how such a health care system works in the real world.

Intervention research is conducted alongside all of Dignitas's programs to monitor and evaluate effectiveness, improve programming, and inform the work of other stakeholders. The research conducted is focused on directly improving the lives of people affected by HIV/AIDS. Dignitas also works with other stakeholders to conduct monitoring & evaluation of programming. Intervention research will be in line with, and seek to support, the monitoring & evaluation and research agendas of the countries in which Dignitas is working. Knowledge generated through intervention research will provide new understanding to policy makers, donors, other governments and NGOs, as well as Dignitas itself, in order to improve both practical interventions and policy. Dignitas is collaborating with partners at the University of Toronto to ensure rigor and high ethical standards.

In partnership with the Malawi Ministry of Health, Dignitas has provided life-extending antiretroviral (ARV) therapy to thousands of children and adults in Malawi in southern Africa, a country devastated by the AIDS pandemic. Each month, hundreds of new patients are gaining access to medications that will not only keep them alive and improve their health, but also enable them to work, support their families, contribute to their communities, and allow children to continue their education.

Since 2004, and as of August 2007:

• More than 3,000 children and adults have started on life-saving antiretroviral therapy (ART)
• An average of 200+ new patients are gaining access to antiretroviral (ARV) medications each month
• An average of 6,000+ medical consultations are being conducted each month
• An average of 4,000 people are tested for HIV each month at 30 HIV Testing & Counselling (HTC) sites
• 20,000+ mothers-to-be have accessed Prevention of Mother-to-Child Transmission (PMTCT) services to help prevent transmission of HIV to their newborns
• An average of 1,000+ mothers-to-be access PMTCT services each month at 15 PMTCT sites
• Hundreds of home-based care workers have been trained, enabling thousands of the most ill patients to receive essential care at home
• 14 community-based organizations in Zomba District are supported
• An average of 700+ people monthly are directly reached by HIV/AIDS prevention education activities