In settings where basic health-care systems are weak, the launching of an HIV program can and should be used to strengthen—rather than siphon resources from—primary health services and the public sector.1 Such was the experience in Haiti, where Partners In Health, working through its Haitian counterpart, Zanmi Lasante, has scaled up HIV services in partnership with the Ministry of Health. In Rwanda, too, Partners In Health, through Inshuti Mu Buzima, is working closely with the Ministry of Health and the national AIDS program.
The public sector is best positioned to provide health care to the poorest communities. In many impoverished settings, however, public clinics stand empty or underutilized because the national health budget can provide neither a decent wage to retain health professionals in the public sector nor the tools necessary for a clinic to function. Thus, both the staff and the community become demoralized. The toll of HIV further devastates the health system by causing death and illness among clinic staff and their families and increasing the volume of extremely ill and seemingly “terminal” patients.2
Partnerships between NGOs and the public sector that result in a positive flow of money, essential drugs, personnel, and other resources will help revitalize public clinics and improve both the uptake of HIV services and the overall health of the community.3 This synergy has long been evident to us, as the majority of Zanmi Lasante patients present for clinical care of non-HIV-specific symptoms such as cough, fever, diarrhea, or weight loss, without the specific intention to seek HIV testing.