Cambodia National Hiv/aids Program

Summary

Cambodia National HIV/AIDS Program was a challenge to Government in understanding how to start, scale and lead cross-sector public health initiatives with NGOs. Motives of both the parties were common but the infrastructural & functional impediments were bounding both to work in a restrictive frame with limited capabilities. If combined together, the tie-up could result in a lethal weapon against the growing HIV/AIDS cases.

The case provides a good insight & challenge the discovery & implementation of operating models that balance the needs of for-profit, non-profit, and government organizations. More effectively manage situations where required resources are not under one's direct control. It demands innovative solutions for large-scale, socially relevant challenges.

As the case describes, there were 3 decisions to be made.

One was whether continue expanding National HIV/AIDS Laboratory support infrastructure by purchasing CD4 machines (used for testing virus) independently or establish National CD4 Lab System via lease.

Second was regarding logistics & Supply Management for ARVs (drug to fight against HIV) & other supplies. Options were either continuing current practices of separate procurement or turn over supply ordering & distribution to CMS (govt. body). Third option was to work collaboratively & establish supply management, forecasting & purchasing capacity within NCHADS.

Lastly, the challenge was to decide if NCHADS should go ahead treating children immediately by adult physicians or let National Pediatric Hospital take lead.

After analyzing individual options in isolation & cross-functionally considering inter-dependency, inter-functional aspects & inter-related issues following is suggested to enhance efficiency of the program effectively. The suggestions are provided based on assumptions made to cover for the lack of data at some instances.

NCHADS should consider selective beneficial dynamics of PPP model of working as the NGOs contribute to 38% of the funding. The cost & financing aspects are critical & cannot be ignored.

It is suggested that education campaigns be initiated. Develop clear and appropriate interventions while balancing partnerships between all stakeholders.

Atlast, it is sacrosanct for NCHADS to select "Best for All" or "Hard Choice" to design the program (specially in handling pediatric cases) while building entire system to cater all.

Effectiveness without Efficiency is no good & Vice-a-Versa.

Analysis

Decision 1

Treatment protocol can only be initiated after careful detection of the HIV. It is sacrosanct for Doctors before prescribing ARV & hence resulting in hesitation due to non-access of the CD4 testing. Strengthening the machine availability & access will surely affect ARV distribution effectively. The data is in-sufficient to track / predict the realistic impact of CD4 machine in supplying and managing of ARV & other supplies. But concretely it does affect the initial spread & can be utilized effectively in curbing the root cause of HIV/AIDS. So, this decision will not only affect the infrastructural availability but also the credibility & effectiveness of the entire campaign. The decisions of managing the supply chain for ARV & other drugs is in turn dependent on successful detection of the virus. All the new cases can efficiently be handled only if stage one activities are successfully conducted.

Data for machine's cost & capability is unknown ( for example, machine's capability in conducting tests per hour or per shift of 8 hours). Also, number & quality of man power requirement is not provided for the machine. Depending on the qualifications of the man power required, capacity of the machine etc. cost benefit analysis can be carried out which can provide clear picture in weighing both the options. The cost for running these machines is also not provided to evaluate whether the NGOs would consider providing $0.25 for access or they would be better off by forming their own group & leasing their own equipment in the long run.

Assumptions: While choosing one of the option or creating other option, it is assumed that the cost is really high (as high as not been able to afford more than 2 machines with an entire budget of the program slightly more than $14 million. These 2 machines are not sufficient in capacity for the entire nation as it is discussed that the NGO machines will also be engaged).

Option Analysis

If the Government & NGO stake holders independently purchase CD4 machines, the operational cost would be high as compared to a shared effort. The location of these machines would be critical as the number for the people covered per machine, will be critical to provide service & utilize these machines effectively & efficiently by both the parties given their limited budgets. The effectiveness will only be achieved efficiently by proper distribution of these machines across provinces of Cambodia. The more the number of people covered per machine depending on the capacity of the machine, the more people can be effectively diagnosed for the virus. if we believe information available on the symptoms of HIV, most people do not notice any immediate changes in their health. Most people have a "window period" of 3 to 12 weeks during which antibodies to HIV are still being produced and are not yet detectable. That makes the CD4 machines inevitable so that early detections can kick-start early treatment.

Decision 2

The decision regarding "Logistics & Supply Management for ARVs & other HIV/AIDS Supplies" would be significant in delivering the effectiveness of the program once detections are done. After diagnosis, if the program is not able to sustain the distribution of drugs, the effort goes in vein. With options as varied as keeping the control & authority of distribution at one single standpoint (i.e. with government or NCHADS) or keeping it as wide as the current system of everyone handling their own system, the supply chain management options are quite extensive to evaluate on effectiveness scale.

The cost of medicines also goes with economy of scale. The more the procurement quantity, the cheaper they are. With all the bodies in action, the end user is the common man infected with virus. Nobody is gaining any monetary gains out of it (as of now), but to able to help more and more, it becomes all the more critical when the budgets are fixed / limited and one needs to pull out more from the penny.

The decision

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