How a Program is Selected

At AFCA, we use a tool, developed by the U.S. Agency for International Development, to measure a site’s readiness, based on capacity, vision and activities needed. It can also be used as a site assessment tool, to identify areas that need improvement. Areas are measured on a scale of 1 to 5, with 5 meaning that they have the best conditions for ART to take place. It is usually recommended that a site have a score of at least 3 in each area to begin ART. The following gives a sampling of questions that are asked to establish this rating.

The total scores from the Assessment tell us the site’s Program Readiness State. There are 5 stages.

Stage 1: Program Mobilization
Sites at this stage need training and education, have no leader to champion the ART program, and are doing limited or no HIV care. These sites might be considered for follow up of patients on ARVs with capacity to initiate ARVs in the future.

Stage 2: Service Delivery Planning
These sites have a leader, but with limited experience. Sites at this stage need help with program design and implementation. These sites may also be considered for follow-up of patients on ARVs with capacity to initiate ARVs in the future.

Stage 3: Preparation
These sites are almost ready to begin preparation for introducing ART. They also have a leader who is committed to introduction of ART. They have demonstrated initiative in some areas of HIV care. These sites require capacity building and funding, but can potentially start ARV therapy in less than nine months if resources are available to address their needs.

Stage 4: Action
Sites at this stage are nearly ready or are already providing ARV therapy, but need assistance in some areas. Efforts are aimed at improving or ensuring rational and safe use of ART and associated services while planning or continuing introduction of ART.

Stage 5: Support, Maintenance, Expansion and Serving as a Resource
These sites are already operating and, generally, working well. They may require assistance in maintaining or expanding current work. These sites may provide training for organizations at other stages, although they themselves may need assistance in long term planning. Even at this stage, efforts will be made to continue to evaluate the program and improve quality.

Source: John Source Inc. for the U.S. Agency for International Development

To help put these stages in perspective, our partner in Kampala, Mulago Hospital is a Stage 5 provider of ART. The Community Health Program in Mombasa, Kenya is a Stage 4 provider.