La coordination nationale des centres de traitement ambulatoire au Gabon : une expérience novatrice de décentralisation opérationnelle de la prise en charge du VIH-sida
Gabonese authorities are strongly mobilized in the fight against AIDS. With a national seroprevalence of 5.9%, 54,000 people are living with HIV-AIDS. Starting from the experience conducted on three ambulatory treatment centers (ATC) [Libreville, Franceville, Port-Gentil] in collaboration with the French Red Cross, Gabonese authorities decided the scaling up of HIV patients' care to seven new ATC at a national level. The increasing number of structures conducted to standardize treatment's guidelines, training of caregivers, quality of care, coordination, monitoring and evaluation. Technical and medical supervision of the ten ATC were attributed to the French Red Cross by Gabonese authorities with the financial support of the French Agency for Development. The ten ATC, founded by the ministry of public health, were then organized within a network under the responsibility of a national coordination. This structure created in September 2007 represents the main organism to conduct, evaluate and follow-up activities and functioning of the ten ATC. All these activities are conducted in agreement with the national program of fight against AIDS. Within one year this structure of coordination allowed to organize the training of 208 caregivers, to elaborate a team of national and international experts, to start a process of national guidelines, to elaborate technical procedures and indicators for monitoring, follow-up and evaluation. In June 2007, 5 ATC were in function taking care of 7,062 PLWA. In November 2008, 9 ATC were in function taking care of 8,174 PLWA. This project is planned for four years. It might allow to structure and organize a national network of care for PLWA according to the national strategy. This procedure of scaling up under the responsibility of a national team of technical and operational coordination is a new process. It completes and strengthens the national organization process.