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Experts Study Challenges to Anti-Retroviral Delivery in Africa


Experts in the battle against HIV/AIDS and other infectious diseases have met in Pretoria, South Africa to discuss ways to more effectively deliver Anti-Retroviral (ARV) medicine. Many believe improving ARV delivery systems would also help victims of other infectious diseases.

A conference sponsored by the Anti-Retroviral Access for Africa organization, is focusing primarily on challenges to delivering ARV's to victims of HIV/AIDS.

But organizers noted similar challenges face those trying to help victims of tuberculosis, malaria and other infectious diseases. They suggested that developing better systems to fight AIDS would also help the struggle against other diseases.

Project manager Estinah Chidzanira of ARV Access for Africa, which stockpiles and delivers medicine to African governments experiencing unexpected shortages, says such shortfalls often occur because of lack of information. "The major problem that we currently face is accurately focusing and quantifying what (medicines) a country requires. And the main reason for that is we do not have enough information. Even if we had, that information is not reliable," she said.

Chidzanira says governments need to establish reliable systems to determine who needs anti-retroviral medicine. "Once you know where the (sick) people are you quantify and see how much they require. And then they (governments) have to work with an organization with expertise in distribution and logistics. Then they will be able to send the items to the places where they are required," she said.

But she says many government health ministries lack the human resources and expertise to carry out the research and logistics needed for a successful ARV program.

Another problem is ensuring medicine sent to Africa is of good quality, has been approved for use in that country, and is used before it expires.

Jennifer Erie is a program manager with Supply Chain Management System, which helps African governments build agencies to oversee sustainable supplies of good medicines. "They (governments) can set up quality systems such as pre-qualification requirements, vetting suppliers, making sure you check their dossiers, to make sure that they are doing their own quality testing. And if your country cannot afford to do your own quality testing, (you can) refer to other organizations across the continent that have done the testing and refer to their testing evaluations," she said.

She says some countries, like South Africa are relatively efficient at licensing medicines, but others find it challenging. "We are working hand in hand with regulatory authorities in countries to help build their capacity. We try to bring in efficiencies to show them how within their process they can reduce time and cost to process more applications so that they create a bigger pool of medicines available that can be registered locally," she said.

The head of South Africa's HIV Clinicians Society, Francois Venter, says the obstacles to effectively delivering ARV's vary from country to country. "In some countries, corruption is a problem. In other countries just not having the management systems to deal with distribution-of-medication or provision-of-services is an issue. In South Africa the problem is systems failure, that we have enough money, but we do not have the systems to administer it in a cost-effective manner," Venter said.

He notes that donor fatigue is also a problem, but says African governments can counter this by devoting more resources to health care. "When we throw up our hands and say we are a poor country, we need more resources, we need donors to come to the table there must be recognition of the fact that we have taken choices. We have funded other projects, grand projects, over and above the health of our people. And we need to take some personal political responsibility for the fact that we need to increase amounts of money that we are actually giving to the health system," he said.

He notes that African governments have signed a declaration pledging to dedicate 15 percent of their budgets to health care. But he says even the richest of them have only reached about half of that goal at best.

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