Monitoring 3 by 5
A sound strategy for 3 by 5 will involve monitoring indicators such as the number of patients receiving different services, treatment adherence, quality of care and availability of drugs. It will also require monitoring indicators that assess whether the goal of strengthening the wider health system is being achieved; these indicators include overall trends in inputs, processes, outputs and outcomes.
Although much information is already being produced, some critical gaps remain: these include details of the activities of the private sector and estimates of service requirements relative to those actually delivered. Making monitoring manageable will require selectivity and creativity in the information to be collected, in the ways information flows are managed, and in the ways information is synthesized and presented.
The ability to monitor resource flows is an essential element of monitoring, evaluation and policy development. It is important to know how much is spent on health, the sources of funds, through whom they are channelled, what goods and services are purchased, and who ultimately benefits. Tracking health expenditure using the national health accounts framework is the starting point for assessing the level of domestic and international commitment to supporting health, and can be adapted to show the commitment to particular activities such as HIV/AIDS prevention and care. It is also critically important to develop ways of tracking additional external resources to make sure that they do not replace normal expenditures on health or HIV/AIDS, and that they are used efficiently and equitably. Innovative processes will be required to collect and analyse new knowledge and disseminate the findings both nationally and internationally.