However, rapid growth of low income and migrant populations in urban settings in low-income and middle-income countries, including India, presents unique challenges for programmes to improve utilisation of institutional care.
Another example is Chile, where the biggest challenge for programme design is the appropriate planning of the project.
5 11 23 24 A serious challenge for programmes is reaching and engaging parents.
15 Treatment discontinuation is a major challenge for programmes against tuberculosis, in that non-adherence to antituberculosis treatment is associated with reoccurrence of the disease, preservation of reservoirs for micro-organism dissemination, emergence of drug resistant species of mycobacterium and increased tuberculosis related deaths.
Gains in access, however, do not come without cost: isolation of learners, lack of support, and grappling with how to teach and supervise application of skills have remained challenges for this programme [ 24], as they are for distance learning programmes internationally [ 28- 30].
The increasing proportion of women who were already on ART before pregnancy (14%% in 2012) is noteworthy, as this population presents new challenges for PMTCT programmes, including monitoring of treatment adherence and virologic suppression [ 30], and will grow with Option B+.
A key challenge for local programme implementation had been that structures and processes for communication and developing collaborative activities between the two organizations were not defined.
The challenge for a programme to be truly regarded as a centre of excellence is to maintain accreditation based on certain prespecified criteria.
6. Unqualified teachers in most Community Schools are a challenge for the programme- how do we ensure that Community Schools have trained teachers to bring about quality and efficiency? 7. Seasonality of some schools remains a challenge for the CSP programme.
We can summarise the main challenges we face under the following three headings: Balancing community and business needs One of the biggest challenges for the community programme is to demonstrate value to key internal stakeholders while, at the same time, supporting our partners and running volunteering projects that staff enjoy and find rewarding.
