Central Programmes

Continued support of ARV treatment

Advanced HIV/AIDS Care – The Masa Program

In January 2002, the Government of Botswana took the bold step of launching Africa's first national anti-retroviral (ARV) Program – “Masa”. Masa, a Setswana word meaning "new dawn," heralds the rising of a dawn over Botswana's struggle against the HIV/AIDS epidemic and promises Batswana the opportunity to live longer and healthier lives by giving people living with HIV/AIDS more time to nurture their families and to help build a better future for Botswana.

The National Plan

In 2001, the Government of Botswana decided to provide ARV therapy to its citizens free of cost after a feasibility study that was commissioned by ACHAP and conducted by Mckinsey and Co.  The feasibility study culminated in a strategy document that detailed how the Ministry of Health could build the requisite capacity and scale up treatment. Additionally, GOB activated a national emergency fast track system to build capacity for launching and maintaining the national program as well as forming a dedicated ARV team to implement the program by adopting a phased approach.  The phased approach began by prioritizing four patient groups for the first wave of treatment, by using 19,000 patients (out of an estimated need of 110, 000 most in need of immediate care) as the target for building capacity in the first year, and by selecting four strategically-located sites (Gaborone, Francistown, Maun and Serowe) for rolling-out the therapy program. The implementation plan developed by the Masa ARV team also addressed the main areas requiring capacity/capability building. These areas included:

• Policy, planning, and project management
• Information, Education, and Communication (IEC), and community mobilization
• Training of healthcare professionals
• Staff recruitment and retention
• Drug logistics
• Laboratory and testing logistics
• Information technology for nationwide tracking and monitoring of patients, laboratory samples, and medication utilization
• Procurement and upgrading of space
• Monitoring, evaluation, and operational research

Because of these strategic and farsighted policies, the Masa Program has been a huge success and has grown rapidly. The program has been fully rolled-out to the 32 planned ARV sites across Botswana (each site has 2 to 4 associated satellite clinics). Currently there is a plan to roll-out ART therapy to clinics in order to reduce congestion and to bring ART services closer to people.

ACHAP's support of the Masa Program has been extensive. ACHAP has funded the recruitment and hiring of a Masa Operations Manager during the first three years, supported the roll-out of an IT-based patient management system,funded the recruitment and training of healthcare workers, increased laboratory capacity, procured ARV drugs, renovated drug storage space at Central Medical Stores, helped develop infrastructure, and funded information, education, and communication activities. In addition, with the Ministry of Health and the Ministry of Local Government, ACHAP has constructed 20 prefabricated clinics at the ARV introduction sites and at satellite facilities in nearby villages.


Masa Operations Manager
Dr Ndwapi Ndwapi

Rolling out the Masa ARV Program

• 2001
  • Situational analysis by the Mckinsey & Co., Consultancy
• 2002/2003
  • ARV launched in 4 Sites: the 4 sites enrolled 3500 patients on therapy
• 2003/2004
  • Additional seven sites operational :  the 11 sites enrolled 11, 500 patients on therapy
• 2004/2005
  • remaining 22 sites launched :32 sites enrolled 38,492 patients on therapy
• 2005/2006
  • 32 sites enrolled 54, 969 patients on therapy

Treatment Eligibility

HIV Positive with:

• CD4 cell count ≤ 200
• And or presence of an AIDS-defining illness
• Or a child under the age of 13 years

Priority Groups

• Pregnant women and with CD4<200 and/or AIDS defining illnesses and qualifying partners who fulfilled the same criteria
• All HIV infected children older than 6 months of age who are inpatients
• All HIV infected TB patients with CD4 <200
• All adult inpatients with CD4<200 and or AIDS defining illness

KITSO Program

ACHAP has partnered with Harvard AIDS Institute and The Ministry of Health to develop curriculum on HIV/AIDS clinical care.  The program – known as KITSO ‘knowledge’ - has provided critical training in HIV/AIDS care and ARV therapy to Botswana’s health care workers through classroom training.  As of May 2006, 4566 of Botswana’s health care workers have been trained in HIV/AIDS clinical care fundamental, of these; 663 doctors, 2951 nurses & nurses midwives, 134 pharmacists , 244 pharmacy technicians, 144 nurse lectures, 80 family nurse practitioners, 107 social workers, 69  lab technicians and 204 others.

Clinical Preceptorship Program

In the clinical Preceptorship program, HIV specialist doctors from the United States and Europe come to Botswana for a period of at least 3 months to provide hands on training to local medical staff.  In addition to on-site training and supervision of treatment teams as new sites were rolled-out, the program produced improvements in clinical management. 

Assessment and Upgrading of Laboratory Capacity

ACHAP helped to upgrade the quality and capacity of Botswana’s clinical laboratories, purchasing and installing equipment for CD4 cell count and viral load testing at the Botswana-Harvard AIDS Institute HIV Referral Laboratory in Gaborone and at health facilities in Maun, Ghanzi, Hukuntsi, Serowe, Tsabong, Selibe-Phikwe and Kasane. Twelve laboratory technicians were recruited and trained and placed in clinical laboratories throughout the country.  Additional Laboratory equipment is being purchased for District Hospitals and training of additional laboratory staff is being undertaken to support efforts of decentralizing this work. This expansion of HIV testing will relieve the pressure put on the two referral hospitals and improve the turn around time of test results from up to 8 weeks down to 2 days.Back to top

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