Two more readers have sent in comments on constraints to doubling the number of people on treatment. Both add valuable content on simplicity and solidarity to the dialogue. Would anyone else care to join us?
[him] moderator
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"Simplicity. Successful ART scale-up is a story of stripping away everything that is not essential. This requires first and foremost an acceptance that compromise is necessary. And then, making hard, pragmatic choices about community support, labs, regimens etc . . . "
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"No doubt the point raised ("lack of culturally and linguistically appropriate information reaching people in their own language most particularly, minorities") is a constraint. But the language is not the main thing. Such a comment can seriously undermine solidarity between ethnic nationals and the so-called "the majority Bamars" whom we know are not at all homogeneous these days. It can mislead the resources on "more appropriate" IEC. The inequity between rural and urban populations will be much more significant a barrier than the ethnic divide.
Based on the experience and insight of some local professionals working in the response, there are two factors (beyond insufficient resources; and among others) acting as constraints:
1) Low level of capacity (particularly number of staff or their contribution to services) working in the public sector (e.g. government hospitals, NAP or NTP). They humanly can not manage more patients even with higher availability of drugs. Health authorities recently have admitted that they can not employ more health personnel without the approval of the cabinet as more health staff would mean more obligation putting pressure on the Union's budget.
2) Low level of interest and understanding among the public on promoting or protecting health (such as germ theory, treatment with anti-microbials, etc.) as messages of health eduction activities and campaigns (in any language) are ignored. Low functional literacy is and union thing and common in every national group."
