Access to Essential Drugs in Africa

by Daniel Etim Bassey

"Treatment is technically feasible in every part of the world. Even the lack of infrastructure is not an excuse—I don't know a single place in the world where the real reason AIDS treatment is unavailable is that the health infrastructure has exhausted its capacity to deliver it. It's not knowledge that's the barrier. It's political will."
- Peter Piot, Executive Director of UNAIDS 

Many countries in Africa barely produce enough food locally to feed their citizenry. Many lack capacity to protect their nationals from the ravages of basic preventable communicable diseases like malaria, tuberculosis, cholera and other childhood infectious diseases. Yet, almost all African countries are being 'induced' to implement vertical programmes like the World Health Organisation's 3 by 5 Initiative among many others. The goal of the '3 by 5' initiative is "universal access to antiretroviral therapy for all living with HIV/ AIDS". The target of the initiative is "to have 3 million people living with HIV/AIDS (PLWA) on anti-retroviral treatment by 2005". Over 70% of the world's population of PLWA is reportedly in Africa (UNAIDS).

Access to drugs is increasingly recognised as a key component to comprehensive AIDS strategies. ARVs play a central role in prevention as well as treatment. People are more likely to come forward for testing if there is some hope of receiving treatment and are more likely to adopt lower risk behaviours to avoid infecting others. ARVs also reduce the amount of HIV in the blood, thus reducing the risk of further transmission. Slowing the onset of AIDS allows people to continue leading a relatively normal life, fully contributing to the social and economic life of their country.

Nigeria for example, with an estimated population of 130 million people initiated sometime late in 2001 into early 2002, what was touted in international circles as Africa's most ambitious ARV treatment plan. The plan targeted placing 10,000 adults and eventually 5,000 children on ARV drugs within the year at fifteen or so designated treatment centres. According to reports, an initial US $3.5 million worth of ARV drugs were imported from India at a cost of US $320 for a full year course per person. The drugs were delivered at a subsidized monthly cost of US $7.0 per person in the targeted population of people living with HIV/AIDS (PLWA). UNAIDS and Nigeria's Health Ministry figures indicate that around 3.5 million of Nigeria's 130 million people have the HIV virus as of the end of 2003. With this in mind, it is clear that the near 14,000 people actually enrolled in Nigeria's pilot ARV programme are just a little drop in the ocean of its PLWA. Notwithstanding, the pilot programme was bedeviled by many logistic problems, including supply chain snafus, lack of awareness by beneficiaries of programme, inadequate provider capacity, inability of beneficiaries to bear the cost of ancillary diagnostic and laboratory services and drug expiration among others. Many beneficiaries had no continuous supply of ARV drugs and consequently suffered treatment stoppages that lasted for over three months in some cases with attendant risks of drug resistance. With new clamour by local activists, another US $3.8 million worth of ARV drugs has recently been ordered and received by the Federal Ministry of Health. In spite of this new order, the jury currently out there, is that Nigeria's ARV treatment initiative has so far not achieved any desirable public health goal against the background of the estimated people in need and in the context of other competing public health needs. For example, many Nigerian communities still lack access to clean water and basic sanitation. Malaria, cholera and cerebro-spinal meningitis among many other preventable diseases exert deadly and daily tolls on the citizenry and many primary health centres across the country lack adequate personnel and funding. Many regularly have "stock-out" positions on basic essential drugs such as antimalarials, common analgesics like aspirin and common antibiotics like penicillin.

In contrast, in some African countries, ARVs are available for under $140 per person per year (pppy). They are supplied by drug manufacturers in India, South Africa, Brazil, Thailand, and China,who have manufactured generic copies of patented ARV drugs. Fees are not paid to the patent holders and the drugs can consequently be distributed at prices agreeable to the governments and people of developing countries. The reduction in cost has come about from a combination of generic drugs. The DREAM (short for "Drug Resources Enhancement against Aids and Malnutrition", which used to be "Drug Resource Enhancement against AIDS in Mozambique") promoted by the Community of Sant'Egidio has proven to be an efficient means of giving access to free ARV treatment with generic HAART drugs to the poor on a large scale: So far, 5,000 people are receiving ARV treatment, especially in Mozambique, but the program is being built up also in other countries: Malawi, Guinea, Tanzania and others. Despite being free, the program aims at excellence in treatment, providing the best existent range of drugs (HAART) and regular blood testing according to European standards. It is linked with a nutrition program as well as guidance and sanitary education by volunteers (other HIV patients taking part in the program), which encourages new patients to comply and come to the appointments. The compliance rate is very high (94%).

Access to essential drugs in Africa still has a lot of bottlenecks which hinder the effectivness of distribution to the common man. It is our hope that with time, all these issues will be resolved with better planning by the governments in Africa.