Missing the Target #5: Improving AIDS Drug Access ... - CD8 T cells

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MALAWIStock-outsAccording to an external report on Malawi’s ART program in 2006 2 , all ART siteshad adequate supplies of ARVs—three-month buffer stocks at each facility—exceptfor the central hospitals, all of which had limited buffer stocks. However, stock-outs,ordering, and delivery problems were observed for other commodities relevant toHIV care and support, including cotrimoxazole, some medicines for OIs, and HIVtest kits. The main reason for the problems is that unlike the ordering of ARVs,which has a strong supply chain, procurement of other HIV-related commoditieslacks a comprehensive and coordinated approach. This situation has translated intoa fragmented supply chain for these services. Some MoH officials, however, blamethe Global Fund for such problems, arguing that they stem directly from delays inthe transfer of funds from the Global Fund to UNICEF.A recent sector-wide approach (SWAP) mid-term review 3 nevertheless found thatwhile there were no stock-outs for ARVs, many other drugs were out of stock.According to the report, in February 2007 a total of 151 drug items were out ofstock at one of the main medical supply facilities. The major reason for the stockoutsis inadequate capacity to procure goods and services. Ensuring that sufficientand appropriate drugs are continually in stock remains a perennial challenge forthe MoH.Human resourcesA chronic shortage of health care workers remains one of the key challenges facingthe public health system in Malawi. The government has embarked on a numberof programs to address the challenge, including those designed to improve payand allowances; increase the number of hours worked by staff through use of the‘locum’ (overtime); and relief systems. In relief systems, staff move from one placeto another on a regular basis, which helps ensure that remote health centers areless severely understaffed.The government is planning to allow nurses working in the national ART programto initiate treatment as well (in addition to doctors and other clinicians). Thegovernment has also hired at least 5,000 additional health surveillance assistants(HSAs), who are important elements in ensuring better links between healthfacilities and communities. Task-shifting efforts should however be implementedwith utmost care to ensure that quality of services does not decline—especiallyfor the poor, who are more likely to access services “shifted” to the lower-levelpersonnel. Efforts should also be made to ensure that the task shifting initiative isan inclusive process. The Medical Council, Nurses and Midwifery Council, and otherstakeholders should be involved directly in the process to ensure it is implementedsmoothly.2 Gilks C., Blose S., Carpenter B., et al. Report of the Malawi ART Programme External Review Team,Malawi Ministry of Health. September 15, 2006.3 Carlson et al (2007), Malawi Health SWAP Mid-term Review Summary Draft Report.79
MALAWIConclusionThe shortage of human resources is the major challenge not only to the ARTprogram but to the entire health sector. This ongoing problem threatens to limit theprogram’s effectiveness even as the number of people receiving ART free of chargecontinues to rise. In addition, although more ART sites are being opened every year,ART services need to be further decentralized so that problems with transportationover long distance to health facilities are alleviated.Stock-outs of other commodities relevant to HIV care and support also shouldbe cause for concern to government as well as donors. Given that inadequatecapacity is one of the major reasons for drug stock-outs, efforts should be made tobuild capacity to procure goods and services within the appropriate frameworks.Addressing the human resources challenges, including human resources in theprocurement field, will go a long way toward ensuring that the gains Malawi hasmade so far are not lost.80
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Missing the Target #5:Improving AID
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ArgentinaDr. María Lorena Di Giano
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Executive SummaryAt the G8 meeting
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• UN agencies should provide incr
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Price should not be a barrier when
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The Global Fund and UNITAID: The Fu
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The real cost of free treatmentBy a
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Remaining work for asuccessful prog
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DOMINICAN REPUBLICto access rapid t
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DOMINICAN REPUBLICIn Santo Domingo
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ZIMBABWEtreatment, representing 35
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ZIMBABWEAccording to the Medicines
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ZIMBABWEZimbabwe’s application fo
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ZIMBABWENational government• Addr
Page 36 and 37: RUSSIAMigrantsRussia, with the seco
Page 38 and 39: a person with HIV will die very qui
Page 40 and 41: FamiliesIn Kenya, families are the
Page 42 and 43: INDIA2. Provide pediatric formulati
Page 44 and 45: Linking nutrition and treatmentBy W
Page 46 and 47: Most people living with advanced HI
Page 48 and 49: only available in the capital, Yaou
Page 50 and 51: ZAMBIAFindings in particular provin
Page 52 and 53: The DACA for Chadiza District was a
Page 54 and 55: Many health care workers are inadeq
Page 56 and 57: DRUG REGISTRATION BARRIERS & LOGJAM
Page 58 and 59: Country ATV RLPV/rLPV/r(HS)TDFArgen
Page 60 and 61: development and registration. Likew
Page 62 and 63: Capacity issues and delays in the W
Page 64 and 65: Lack of post-approval quality assur
Page 66 and 67: ARV PROCUREMENT, REGISTRATION,AND S
Page 68 and 69: ARGENTINAParallel importingRelating
Page 70 and 71: ARGENTINAAccess to ARVsNo difficult
Page 72 and 73: Viral load tests are available, but
Page 74 and 75: Cambodiaby Mony PenOnly pharmacists
Page 76 and 77: ChinaBy anonymous Missing the Targe
Page 78 and 79: CHINAThe current process for regist
Page 80 and 81: Dominican RepublicBy Eugene Schiff
Page 82 and 83: IndiaBy Abraham KK, Celina D’Cost
Page 84 and 85: MalawiBy Lot Nyirenda and Grace Bon
Page 88 and 89: MoroccoBy Othman MelloukMorocco has
Page 90 and 91: Determine the patent status of all
Page 92 and 93: MOROCCOThe shortage occurred becaus
Page 94 and 95: As of November 2007, the unit cost
Page 96 and 97: NIGERIADiagnostic testsDiagnostic t
Page 98 and 99: The government’s initial inabilit
Page 100 and 101: Increase training and capacity buil
Page 102 and 103: treatment practice. The Minster ann
Page 104 and 105: Ugandaby Richard Hasunira, Prima Ka
Page 106 and 107: UGANDAExtracts from the MoH’s rep
Page 108 and 109: ZAMBIAIn gathering this information
Page 110 and 111: However, since manufacturing prices
Page 112 and 113: 105SHORT SUMMARY
Page 114: PAKISTANAccess for marginalized gro
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Missing the Target #5: Improving AIDS Drug Access ... - CD8 T cells

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