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HEALTH-AFRICA: Financial Crisis Scapegoat for ARV Stockouts?

Ntandoyenkosi Ncube and Kristin Palitza

PRETORIA, Sep 23 2009 (IPS) - Shortages in supply of antiretroviral (ARV) drugs are caused by lack of political will and bad supply management, not by the global economic crisis, health experts say.

Blaming drug shortages on the financial crisis "is just an excuse," declared Dr Hugo Tempelman, chief executive officer of community health development organisation Ndlovu Care Group, noting that "finance to deal with HIV/AIDS is definitely lacking, but it's because of lack of political will in Africa."

While African governments manage to set aside budgets for projects that are high on their priority list and create international prestige – such as the construction of several, costly, high-profile stadiums for the 2010 Soccer World Cup in South Africa – they claim not to have enough money to finance public health care, health experts lamented.

"I haven’t heard of one stadium in South Africa which cannot be finished because of the financial crisis," argued Tempelman. "That shows that (ARV stockouts) have a lot to do with lack of political will from governments."

Stockouts of ARVs, the drugs HIV-positive people have to take for a lifetime once they have started treatment, can have serious repercussions for patients. They can develop resistance or AIDS if they don’t take their medication twice a day.

According to independent international humanitarian organisation Doctors Without Borders, disruptions in the supply of ARVs in African countries have already started to put HIV patients' lives at risk. Funding gaps and supply management problems have led to the delay, suspension or risk of suspension of the supply of the life-saving HIV drugs in numerous countries on the continent.

Last November, for example, several public health facilities in South Africa's Free State province ran out of ARVs due to bad financial planning. Hospitals had to stop initiating HIV-positive patients on ARV treatment, while existing patients did not receive their monthly drug supply.

During the three-month stockout, 15,000 people didn't receive their medication, according to the Southern African HIV Clinicians Society; an estimated 30 people died each day.

South African health minister Aaron Motsoaledi warned South African media in September that the situation might get worse. A severe shortage of health workers, combined with a HIV budget shortfall of more than $130 million, could keep the country from providing 80 percent of HIV-positive people with ARV treatment by 2011 – a target noted as part of the health department’s National Strategic Plan for HIV/AIDS and sexually-transmitted infections 2007-2011.

South Africa is not the only African country that has run short of funds for HIV. In May, Tanzania announced a 25 percent cut to its health budget, blaming the economic downturn for a shortage of cash in government coffers, while in Uganda, at least 17 HIV-positive people on ARV treatment died due to stockouts in June.

Making excuses

But health experts and AIDS activists at the second Access for Health Care in Africa Conference held in Pretoria on Sep 15 and 16 urged African governments to stop using the global economic crisis as a scapegoat. Instead, governments should stop relying on funding from the international donor community and take responsibility for their countries’ health services provision.

"Governments must build the capacity (of their health systems) and (implement) proper drug management systems," said Lorenzo Witherspoon, procurement adviser of Swiss non-profit organisation UnitAid, which aims to improve ARV treatment access in developing countries.

"Lots of drugs are lost through mismanagement, drugs expire on shelves, and many get damaged because of bad management and improper packaging."

Using generics

The South African AIDS activist organisation Treatment Action Campaign (TAC) used the conference to call once again on the South African government to increase HIV budgets. Rather than blaming the global financial crisis for funding shortfalls, the health department should find alternatives to ensure continuous drug supply. For example, it should explore opportunities to procure cheaper, generic drugs.

"Governments should negotiate with the private sector, (pressurising pharmaceutical manufacturers) to reduce the price of drugs. They should also talk to donors to (ensure they purchase generics)," suggested TAC national programme manager for women’s rights Nomfundo Eland.

The South African health department should make HIV programming an utmost priority, because the country has the world's largest/HIGHEST HIV infection rate. According to the South Africa National AIDS Council (SANAC), 5.7 million people are infected with HIV, but only 700,000 people are on ARV treatment, and about 1,000 die daily as a result of AIDS.