“Doing the Best We Can”: Providing Care in a Malawian Antiretroviral Clinic

ABSTRACT

Following a national policy shift toward universal access to antiretroviral therapy (ART) in Malawi, hospitals and clinics around the country made major changes to enable the provision of ART. In this already resource-limited environment, the provision of ART brought new health care delivery challenges to bear on both patients and health care professionals. The substance and form of these local interventions are affected by a multilayered global context. Drawing on fieldwork in an antiretroviral clinic in rural Malawi, this article discusses the daily implications of providing and receiving care in the context of a massive global shift in health policy, and argues that in order to fully understand the process of service rollout in all its complexity, care should be explored not only from the patients’ perspective but also from that of local and international health care professionals and policymakers.

KEYWORDS:

• Antiretroviral therapy
• global health policy
• HIV/AIDS
• Malawi
• sub-Saharan Africa

Notes

1. A recent issue of Medical Anthropology (33, 4) was dedicated to the normalization of AIDS in times of treatment.

2. The guidelines clarify that some cases may be ill fitting with the standardized clinical parameters, and will require a different course of action. However, the guidelines for these cases are not necessarily specified.

3. Patients receiving second-line treatment regimes, as well as cases of suspected treatment failure, were not managed by the clinic. In these cases, patients were referred to the central hospital for continuing care and follow-up.

Additional information

Funding

The study was funded by various postdoctoral fellowships at McGill University, Harvard Medical School, and the Fulbright Foundation.

Notes on contributors

Anat Rosenthal

Anat Rosenthal is a lecturer at the Department of Health Systems Management at Ben Gurion University of the Negev. Her work focuses on healthcare delivery in resource-limited settings.