Because Tisungane Clinic was the only health facility offering HIV-related services in the district at the time, many of the sick had to walk for hours and days from their villages to access treatment. Many more didn’t make it to our clinic simply because they couldn’t afford the cost of a bus ticket. Distance was a critical barrier to health care and was putting tens of thousands of lives at risk. In our view, the fastest and most effective way to reach the rural poor was to bring treatment and care to them. It was a crucial choice. Rather than engaging in direct service delivery, we worked to expand our model of care and trained health workers across the district to deliver HIV services.
From the very beginning, we wanted to create ripple effects that would improve health care across Malawi. We also knew that if our efforts had a lasting positive impact on patients, we could leverage this knowledge to help others beyond Malawi’s borders. So we developed a robust research program to measure our successes and failures, and to publish findings that would be of use to health care providers facing similar challenges all over the world. We have supported up to 174 health centres in six districts, covering a population of more than 3.1 million people. From a standing start in 2004, we have helped more than 2.6 million people get tested for HIV and over 272,000 people start lifesaving treatment. This represents close to half of the total number of people on HIV treatment in the country.