Can the initial success of the Malawi ART scale-up programme be sustained? The example of Queen Elizabeth Central Hospital, Blantyre.

The antiretroviral therapy clinic of Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi was established as a fee-paying clinic in 2000. In 2004 a successful transition to free-of-charge antiretroviral therapy (ART) provision was made with the introduction of the national ART scale-up programme. Despite the human resource crisis in the healthcare system, remarkable improvements in quantity and quality of care, a reduction of defaulters, favourable ART outcomes and better access to ART for the poor, women and children were achieved. A number of challenges need to be overcome to sustain the initial success of the national ART scale-up programme in QECH, the most important being the shortage of ART staff in relation to the ever-expanding patient population.