A recent study by the Center for Global Development of the membership of the IAEN (representing 9000 global AIDS professionals) asked about greatest impediments to AIDS programs in Africa. The top five impediments identified were:

1) Limited healthcare delivery capacity (66% "very important")
2) Lack of political will (62%)
3) Weak national AIDS strategies (56%)
4) Lack of healthcare personnel (53%)
5) Lack of money (51%)

(More survey detail here.)

AIDS professionals closest to the epidemic recognize the enormous limitations of healthcare delivery systems across Africa. This constraint becomes even more significant as programs and funding attempt to scale up.

Against this backdrop, it is noteworthy that Partners in Health, the international NGO which runs respected programs in rural Haiti (best described in the recent bestseller "Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World"), has agreed to begin operations in Rwanda in partnership with the Clinton Foundation and Government of Rwanda. In the press conference announcing the initiative, Paul Farmer expressed optimism:

We’ll be working to serve an area that has quite literally been abandoned after the genicidal war and the hospital is empty. And it’s a hospital that could be made vibrant and full and in service to the population of that and a neighboring district, and I believe with all my heart that this will happen in very short order.

Partners in Health outlines their ambitions for work in Rwanda in their Spring 2005 newsletter (PDF | 1.1 meg). Their success in Rwanda can serve as a powerful and welcome model of how to provide quality care for AIDS and other diseases in resource-poor settings in Africa.