Africa, Development & Aid, Headlines, Health, Human Rights, Poverty & SDGs

/CORRECTED REPEAT*/HEALTH-ZIMBABWE: Only a Few Can Afford Life-prolonging AIDS Drugs

Eunice Mafundikwa

HARARE, Apr 15 2005 (IPS) - Emily Muronda, 55, spent seven months in hospital in 2003. She had been down with AIDS-related complications, which saw her in and out of the hospital, that year. Muronda’s ailments included tuberculosis, severe vaginal thrush and pneumonia.

On her doctor’s advice, Muronda, a widow, had her CD4 counted to measure the strength of her immune system. As her doctor had expected, her count was a mere 52. Because her count was less than 200 she was immediately put on life-prolonging anti-retroviral drugs (ARVs).

‘’To many people, including my own relatives, I am a moving ghost. I look at myself in the mirror every morning and I do not believe my eyes. I am here today because of ARVs,” she said, delightfully.

Muronda is among thousands of Zimbabweans who can afford private medical insurance. For a minimal charge, a person living with HIV can access ARVs through schemes organised by his or her insurer.

CIMAS insurance, one of the pioneer medical aid schemes, to make ARVs locally accessible, charges less than a dollar for its members seeking to access ARVs. The drugs cost between 24 dollars and 57 dollars for generics and the price is higher for branded versions.

Martin Dumba, a seasonal worker at a tobacco firm in Zimbabwe’s capital Harare, has developed AIDS. His family continues to watch his health deteriorate with each day that passes. ‘’The best we can do is pray that the pain eases. We have been to hospital and they discharged him without any medicine,” said his wife Molly, who is also living with HIV. ‘’We heard that some people are being given AIDS drugs. But when we asked at Harare Central Hospital we were told they are no longer signing on new people.”

Dumba’s story reflects the plight of the majority of Zimbabweans whose government has publicly admitted that the country’s health delivery system has collapsed. The government has appealed to the private sector to assist people living with HIV/AIDS.

Half of the 12,000 Zimbabweans on ARVs are doing so through the private sector, while the rest are on the public scheme introduced three years ago.

Due to the continued deterioration of Zimbabwe’s economy, most people have had to sign off medical insurance. Medical insurance charges range from just below 16 dollars for a basic cover to almost 161 dollars for the top of the range cover per person per month.

The majority of workers, especially those absorbed by the informal sector, cannot afford medical insurance.

‘’The government is most grateful to the private sector initiative of making ARVs accessible to our people,” Dr. Owen Mugurungi, head of the AIDS and TB programme at the ministry of health and child welfare, told IPS.

Under the public initiative, Mugurungi said a person is put on ARVs if his or her CD4 count is less than 200 or is showing clinical signs, such as meningitis, of having developed AIDS.

A private laboratory charges almost 161 dollars to have a CD4 count check, making it inaccessible to the majority of the people who need the treatment.

‘’This alone is very prohibitive and we call on the government to do something about it if at all they are serious about rolling out ARVs to all that need them,” said Jonathan Musiiwa, a counselor with The Centre, a hospice for people living with HIV and AIDS.

Despite the low statistics of Zimbabweans on ARVs, Mugurungi is encouraged by the progress the government has made in making the drugs available to the ordinary persons.

‘’We moved from a figure of 2,000 last year to the present 12,000 on ARVs although half of this figure are people on the private sector scheme,” he said. ‘’Our problems gave us an opportunity to be more focused and support national issues. Not many countries, even those receiving foreign grants, can achieve what we have achieved with very little resources.”

Zimbabwe, considered by Britain and the United States as a ”rogue” state, has not received a substantial financial support from the Global Fund Initiative.

The Fund told IPS at the World AIDS Conference in the Thai capital Bangkok last July that the political context in which Zimbabwe finds itself made the country ineligible to receive the funds, a position which outraged human rights campaigners in and outside Zimbabwe. Ironically, the theme for the Bangkok conference was ‘Access for All’.

Denying the claims, the Fund told IPS that President Bush’s Emergency Plan for AIDS Relief provided 16 million dollars in aid to Zimbabwe for HIV/AIDS in 2004. In addition, it said it would provide 20 million dollars to Zimbabwe in 2005.

Mugurungi said all Zimbabwe’s urban hospitals were now in a position to dispense ARVs and that work was in progress to bring the more than 50 district hospitals to the same level.

The massive brain drain of nurses and doctors, said Mugurungi, had also had an impact on the ARV initiative.

‘’ARVs are no ordinary drugs. They need to be dispensed by trained personnel and currently this is where our focus is. We will not have any nurse dish out these drugs,” he said.

Mugurungi is delighted by Zimbabwe’s progress. ‘’I am proud to say we have one of the most sustainable ARV rollout programmes in the region, simply because we are financing the initiative with local funds. We do not have the problem of planning beyond the grant like most countries.”

Except South Africa, most of the countries in the 13-member Southern African Development Community (SADC) such as Mozambique, Zambia, Malawi, Tanzania and Lesotho supplement their national budgets with donor funding to purchase ARVs.

In Zimbabwe, support to the ARV public sector roll out plan comes from the national budget and the National AIDS Trust Fund, set up with resources from a statutory five percent levy on the workers’ tax.

Jacqueline Bataringaya, a consultant on HIV and AIDS with Oxfam-America, an international charity, called for improved health delivery service to levels where it can absorb the stress imposed by HIV and AIDS. ‘’Otherwise we may as well not talk about ARVs roll out,” she said.

She said the 3 x 5 WHO target, three million people on ARVs in Africa by 2005, would remain a dream if the health aspects of the HIV and AIDS epidemic were not given attention. ‘’The piece meal approach will not work. This is why we have been defeated by HIV and AIDS. Most of the time we are not looking at the total picture,” she said, referring the difficulties of attaining the UN World Health Organisation’s (WHO’s) 3×5 target.

Marian Gotha, HIV/AIDS programme officer at Oxfam-America, said: ‘’There is a lot of talk of ARVs in the media and I am afraid this debate has not filtered to the ordinary people in the village.”

‘’There is also need to intensify training to all levels of health workers because we do not want a situation where people come from the cities with ARVs and the health authorities at the rural health point do not know how to administer them. The other challenge is to strengthen food security. We cannot pump ARVs into empty stomachs,” she told IPS in an interview.

Faith Phiri, a vendor at a flea market in Harare, told IPS: ‘’What we know is that there is no cure for AIDS and that is why hospitals send people with AIDS to die at home. If there is medicine that can help people with HIV, I am sure then it goes to the rich people only.”

Ignorance about ARVs is widespread in Zimbabwe, even among the elite. ‘’I don’t know about a government initiative to make ARVs accessible. I know that medical aid societies have programmes on ARVs but again I don’t know how someone can sign on. I think it is the responsibility of employers to ensure that their workers have access to such information. People are dying like flies in the banking sector,” Ralph Muduku, a bank teller in Harare, told IPS.