Leadership for change
Providing wider access to antiretroviral therapy creates a set of challenges and opportunities that will require strong government leadership and guidance, while still involving local innovation and participation. Among the essential ingredients of good leadership are the ability to mobilize institutions and individuals around common goals and give a clear sense of direction, enlisting public and political support for health actions, as well as ensuring the application of common standards. Good leadership also means facilitating communication, brokering knowledge, identifying gaps and taking steps to fill them. It means promoting partnerships where appropriate, arbitrating in conflict, actively promoting accountability, and, crucially, making sure that vulnerable groups are protected.
Four aspects of leadership are particularly relevant. The first is to define a clear national strategic framework for prevention, care and treatment that gives the vision and direction needed by all actors across the health system. This has to be set in the context of a broader framework for responding to threats to population health, and needs to take a long-term view. The second element is the ability to build coalitions and maintain stakeholders' commitment to the agreed objectives and strategies. The third is the formulation and enforcement of a system of rules and incentives for all providers to ensure quality care, whether in the public or the private sector. The fourth element, oversight, involves maintaining a strategic overview of what is happening across the health system. It also means determining whether policies are being carried out, what is on course and what is not, and responding as needed. Designing a health information system and managing a monitoring process are critical to ensuring the factual basis on which sound leadership decisions can be made.