Reaching Enrollment Goals

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Reaching Enrollment Goals
International Center for AIDS Care and Treatment
Programs Annual Meeting, March 2006 Dar Es
Salaam, Tanzania

• Introduction
• T. Hardy
• ICAP/NY

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Why Do We Have Enrollment Goals?

• As benchmarks for measuring site and program
  performance
• To quantitatively identify our responsibility
  within a larger national program
• To satisfy donor demands for measurable results

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Why Are They Important?

• Quotations from the PEPFAR Second Annual Report
• PEPFAR (has) ambitious goals, including support
  for treatment for 2 million HIV-infected people
  (3rd paragraph cover letter)
• after just two years of implementation, PEPFAR
  supported treatment for 401,000 people (4th
  paragraph)
• These are repeated on the first page of the
  report itself

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Why Are They Important? (2)

• To keep the funding flowing
• To provide information to other constituencies
  concerned about numbers of people treated
• To provide one means for us to judge our own
  performance
• To provide an impetus for meeting our long-term
  target Care and treatment for all who need it

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What Are Some of the Challenges in Setting and
Working to Meet Targets?

• Targets may be imposed on us, either by funding
  agencies or national programs or both
• Externally imposed targets may be set
  unscientifically they may be overly ambitious
• Once set, targets are difficult to change even
  when circumstances change
• Good performance in some places (sites, regions,
  countries) may raise expectations for similar
  performance in others
• Working to meet targets in the short term is not
  necessarily consistent with achieving program
  success in the long term

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Can Ambitious Targets be Misleading or
Counter-Productive?

• Masking success
• Initiating services at sites that are not ready
• Not adequately preparing service providers
• Favoring initiation of services at new sites
  instead of providing supervision and other
  support to sites that are already enrolling
• Bias in site selection

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Enrollment Targets vs. Quality?

• Is there an inherent conflict between ambitious
  enrollment targets (rapid site expansion) and
  service quality?
• If ambitious targets are a fact of life, how can
  we work to both meet our targets and still stress
  and promote high quality services?

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