‘The infrastructure is not there…’

  Surprisingly, this is one of the cheapest parts of the process as it relies on what is already there.  Local communities are a very important resource when it comes to health care in poor countries.  Some are fortunate or foresighted enough to have well-established ‘barefoot doctors’ or community health worker networks.  In many countries there are DOT-TB programmes onto which DOT-HAART could easily be piggybacked.  Other programmes need to be based on other local structures.  Essential, however, is community ownership of the problem. 

  It is important also to recognise that local problems require local solutions, so models of treatment provision should be developed with an inbuilt flexibility to allow appropriate adaptations for different social, cultural or geographic situations.