With the approach of the management consultant he once was, Ernest Darkoh sketches out an organisational diagram of a network linking private doctors, a mail order pharmacy, a laboratory and a disease management group in order to bring antiretroviral therapy to hundreds of South African patients.

Over the past two years, BroadReach Healthcare, the company he founded, has run a programme called ARVCare that is extending treatment into rural areas beyond the reach of the government’s programme at a cost he believes could be equivalent to or lower than that incurred by the state once it reaches greater scale.