Luz Maldonado contracted Chagas disease from contaminated fruit juice in her urban upper-middle class Caracas neighbourhood. Credit: Estrella Gutiérrez/IPS

By Estrella Gutiérrez
CARACAS, Dec 21 2012 (IPS)

Chagas disease, the third most serious infectious disease in Latin America, is developing a “new face” and moving into urban areas, while a new treatment may offer hope for millions of sufferers.

The new face of the disease is exemplified by Luz Maldonado, a 47-year-old teacher from Venezuela. Maldonado contracted Chagas disease by drinking contaminated fruit juice, in an outbreak that infected 103 people at a school in Chacao, an upper-middle-class neighborhood in Caracas. One child died, and the lives of the other people infected have been changed forever.

Micro-epidemics caused by contaminated food are a new phenomenon. And, according to the scientific sources consulted for this story, the disease is even more virulent when it is contracted this way, because thousands of parasites enter the bloodstream all at once. The largest of these incidents were reported in 2005 in Brazil, in December 2007 in Caracas, and in 2010 in the nearby town of Chichiriviche de la Costa.

Maldonado now lives with headaches, rashes, joint problems, memory loss, tachycardia, insomnia and depression, largely due to the side effects of the drugs she must take to fight the parasites.

Chagas disease is caused by Trypanosoma cruzi, a protozoan (single-celled) parasite that is transmitted by blood-sucking insects. According to the World Health Organization (WHO), it affects between 17 and 20 million people in Latin America.

In addition, almost 25 percent of the region’s population is at risk of contracting the disease, which kills at least 50,000 people a year.

According to WHO, Chagas disease is one of the world’s 13 most neglected tropical diseases, the third most serious infectious disease in Latin America, after HIV/AIDS and tuberculosis, and the parasitic infection with the highest morbidity and greatest socioeconomic impact in the region. The only country in Latin America to be declared free of the insect that spreads the disease, in mid-2012, is Uruguay.

However, all statistics on the disease are approximate, because “many cases are never diagnosed,” Belkisyolé Alarcón de Nola, the director of immunology at Venezuela’s Institute of Tropical Medicine (IMT), told Tierramérica*.

People whose infection goes undiagnosed either do not develop symptoms, or the symptoms are attributed to other illnesses. They may die decades later of heart failure or a stroke that is never linked to Chagas disease, explained Nola, a medical doctor and researcher who coordinates the follow-up of Chagas patients in Venezuela.

Today, “the image of Chagas disease as a rural disease of the poor has been dispelled,” she said. “We can have cases at any altitude, latitude or stratum, and we need to change the way we confront its vectors.”

Urban sprawl has invaded the natural habitat of the disease’s vectors, said Nola. Caracas, located in a valley at an altitude of 1,000 meters, “has these sort of green fingers that extend into it, and these are the areas that are most accessible for the vectors to reach people’s homes,” she explained.

Logging and the clearing of forests by the slash-and-burn technique have left little food for the “chipos”, as Triatoma infestans, the insect that spreads the disease, is commonly known in Venezuela. It goes by various names in different countries of the region, including vinchuca, chirimacha and chichi, and is referred to as the “kissing bug” in English.

“We have vectors everywhere and even more so with climate change, because the warmer the earth becomes, the greater the reproduction of the insects,” said Nola.

Transmission most commonly occurs when insects infected with the parasites bite humans, ingest their blood, and then immediately defecate. Chagas disease is contracted if the parasites in the insect feces enter the organism through a break in the skin, such as when people scratch the bites, or through other openings, such as the eyes, when people rub them.

In Caracas, there is also a secondary, “poor” vector, Panstrongyilus geniculatus, “which is clumsy and takes longer to defecate,” said Nola.

But this “poor vector” is adapting. “Drawn by the lights in homes in urban and peri-urban areas, it enters through kitchen windows, wanders over utensils and food and defecates where it pleases,” she said.

In the transition to oral infection through contaminated food, “there have been many small outbreaks, many of which have gone undiagnosed.” However, there has been no other outbreak like the one in Chacao, given its fully urban location and the large number of people infected, after drinking guava juice contaminated with infected insect feces at the municipal school.

There are two strains of the Trypanosoma cruzi parasite that cause Chagas disease. One is found from Mexico to the north of South America, and the other from Brazil to the southern tip of the continent. The first primarily damages the heart, while the second also damages the esophagus and colon.

The disease has three stages. In the first, acute stage, symptoms can be very marked or very mild and easily confused with other diseases. The second, known as the intermediate or latent stage, lasts a variable period of time – sometimes many years or even decades – and is asymptomatic.

In the final, chronic stage, “the myocardial tissue is destroyed and does not regenerate, and is replaced with fibrous tissue. The heart increases in size and no longer contracts effectively; it pumps less blood into the lungs, and cardiac insufficiency gradually sets in,” explained Nola.

There are only two drugs indicated by WHO to eradicate the parasites: nifurtimox, introduced in 1960, and benznidazole, developed in 1974.

But eradication is only partial when the parasites have lodged into deep tissue and in the chronic stage of the disease.

Moreover, the side effects of these drugs cause collateral damage. “The ones that are most feared are the neurotoxic effects, because they cause peripheral neuropathy symptoms, such as sensations of extreme cold or heat, extreme sensitivity of the feet, and severe headaches,” said Nola.

But the promising findings of two Venezuelan researchers, Julio Urbina and Gustavo Benaim, have led Argentina and Bolivia to conduct clinical trials based on their experiments, while in Venezuela, “we hope to conduct a pilot study as well,” she reported.

Benaim, head of the cell signaling and parasite biochemistry laboratory at the state-run Institute of Advanced Studies, told Tierramérica that the goal is “to attack the parasite without affecting the human being, like current treatment methods do,” as well as “to develop drugs for the chronic stage, which are currently non-existent.”

The study is based on a specific property of Trypanosoma cruzi: its membranes do not contain cholesterol, but rather ergosterol, another sterol. “If you eliminate the ergosterol, which is indispensible for it, you eliminate the parasite,” he explained.

There are drugs that block the synthesis of ergosterol, such as posaconazole, which is approved by the United States Food and Drug Administration, although only for the treatment of fungal infections.

The researchers linked this fact with another clinical observation: Chagas patients whose arrhythmia (irregular heartbeat) was treated with amiodarone showed substantial improvement. “When it is applied to the parasites it is lethal for them,” Benaim enthusiastically reported in his laboratory.

Amiodarone is already used to treat arrhythmia, and 30 percent of Chagas sufferers in the United States receive it. It is not completely harmless, since it contains iodine, but its side effects are much milder than those of current treatments, said Benaim.

“We studied the mechanism of action of posaconazole and amiodarone; both of them were already known to be sterol inhibitors, but we demonstrated that amiodarone also alters the calcium regulation of the parasites,” he reported.

“Combining them boosts their effect, makes it possible to lower dosages, and cuts down on side effects,” he added.

Another new antiarrhythmic drug, dronedarone, which contains less iodine and is more easily eliminated, was also tested in their laboratory and “proved to be very successful. It is more powerful and acts more rapidly” in destroying the parasite, said Benaim.

An article on the new treatment was published in October in Nature Reviews Cardiology. In addition to Chagas disease, it can also be effective against other diseases caused by parasites, such as leishmaniasis.

“A good sterol inhibitor can bring an end to these parasitic diseases, which are viewed as diseases of the poor, and are therefore neglected,” stressed the Venezuelan researcher. In the case of diseases like these, “it isn’t profitable to conduct research into treatments for them. That is the sad reality.”
* This story was originally published by Latin American newspapers that are part of the Tierramérica network. Tierramérica is a specialised news service produced by IPS with the backing of the United Nations Development Programme, United Nations Environment Programme and the World Bank.

Buruli ulcer is a tropical disease reported in about 30 countries, including Ghana, where doctors are this year predicting about 1,000 cases. Credit: Paul Carlucci/IPS

By Paul Carlucci, Henrietta Abayie, and - -
GREATAER ACCRA WEST DISTRICT, Ghana, Nov 24 2011 (IPS)

For the past 10 years, Buruli ulcer has been eating Benjamin Essel’s leg. The skin above his ankle is totally gone, and a swollen, pulpy and reddish wound rises almost up to his knee and wraps around his calf. Even still, this is an improvement over recent years.

Buruli ulcer is a tropical disease reported in about 30 countries, including Ghana, where doctors are this year predicting about 1,000 cases. Credit: Paul Carlucci/IPS

Buruli ulcer is a tropical disease reported in about 30 countries, including Ghana, where doctors are this year predicting about 1,000 cases. Medical professionals say it is little known in afflicted communities and among staff at local hospitals, even though its early stages are easy to treat. It occurs in wet, rustic areas, and, consequently, its victims tend to be the rural poor.

Researchers know that it is caused by mycobacterium ulcerans, the same thing that causes leprosy and tuberculosis, but they are not sure how it is transmitted, which makes prevention very difficult.

Catching and curbing the disease in its early stages inevitably leads to full recovery with medication like antibiotics, but poverty, ignorance, spiritual beliefs, and underfunded health facilities conspire to stall treatment.

About 50 to 60 percent of this West African country’s victims end up with lesions like Essel’s or larger.

Disfiguration, disability, and amputation are common outcomes. Doctors and nurses are calling for more resources to educate endemic communities and train local health care providers.

“This disease affects rural poor, whose voices are not heard anywhere,” says Dr. Edwin Ampadu, the country’s national Buruli ulcer chief. “The public has very little knowledge about this. When we had opportunities to bring this to the media or TV, people shied away. That is very sad, because when you talk to people, they think the disease is far away. But it is very close to this place.”

According to the World Health Organization (WHO), Buruli first surfaced in Uganda in 1897. Fifty years later, Australian researchers provided the first full description of the disease, and, in 1960, a rash of cases broke out in Buruli County, Uganda, giving the disease its modern handle.

Since 1980, it has spread across West Africa, and, in 1998, WHO began addressing it on a global scale. The disease is present in 30 African countries, as well as the Americas, Asia, and the Western Pacific. In Ghana, there have been 11,000 cases recorded since 1993.

Buruli comes in four progressive stages: nodule, plaque, oedema, and ulcer. The first stage is just a lump in the skin, while the fourth phase can produce wounds several times as dramatic as Essel’s.

While prevention remains a puzzle – some researchers in Australia think the disease may be transmitted by mosquitoes – early treatment could not be easier. According to a 2003 survey, all it takes is 20 to 50 dollars worth of antibiotics. On the other end of the treatment spectrum is a price tag of nearly 1,000 dollars, not to mention the social fallout from that degree of illness.

“Education is ongoing,” says Martin Oppong, the Buruli ulcer programme coordinator for the Ga West District, where Amasaman Hospital is located. “But it’s a disease that no one can pinpoint as to the mode of transmission, so people’s perception as to the cause determines where they seek help.”

Some, like 50-year-old Ama Foa, think they have been cursed. Others, like 50-year-old Victoria Oppong, think it is a boil. Like Essel, both women let the disease progress before getting treatment. Now none of the three can work, and Essel and Victoria Oppong live in the ward.

Ghana’s National Buruli Ulcer Control Programme was struck in 2002, almost 30 years after the disease was first detected in the coastal province of Greater Accra Region. But doctors complain that it is grossly underfunded.

Amasaman Hospital’s ward exists mostly with the help of World Vision, the Christian relief, development and advocacy non-governmental organisation. In 2005, World Vision introduced a three-year programme to help with dressings, surgery, drugs, and general care, all of which are allocated from the government, but only every four months, and not in sufficient quantities.

World Vision also helps feed patients, who would otherwise have to fend for themselves, as the hospital does not pay for food. In 2008, the NGO renewed the programme. This September, it expired.

“Maybe they will renew,” says Oppong. “Maybe they won’t.”

Meanwhile, Ampadu is trying to build capacity in other endemic jurisdictions. He wants to train more local health care providers on detection, so the disease can be caught and stopped in its early stages. He also wants to build surgical capacity, so doctors can perform skin grafts and other surgeries with minimal damage to the patient.

So far, capacity is spotty. While Amasaman has one doctor who can assist in operations with the guidance of a surgeon from Korle Bu Teaching Hospital, one of the country’s central medical facilities, larger places like Nsawam in Eastern Region have no one. Ampadu chalks this up to professional interest.

“The gaps are many in terms of capacity building,” he says. “We have very few doctors who have shown serious interest. The cases are not many if you compare to tropical diseases.”

And then there are the financial limitations. Ampadu frames the whole thing as an issue of corporate responsibility. As it happens, many of the afflicted rural areas are also hotspots for Ghanaian industries like farming and mining. He’s calling on more companies to provide funds for education and outreach so the disease can increasingly be stopped in its early stages, which is currently the closest thing to prevention available. It should be an easy fix.

“If we invest seriously in early prevention,” he says, “maybe in three years time I can assume that we will not see this ugly lesion.”

Excerpt:

By - - and Kristin Palitza
CAPE TOWN , Nov 16 2011 (IPS)

South African health experts are calling on governments to use legally available mechanisms to promote the production or import of generic drugs in their countries.

Patented drugs limit patients access to public health care. Credit: Kristin Palitza/IPS

Pharmaceutical patents continue to drive up drug prices, making it expensive to treat patients. This often leads to limited access to health care, especially in developing countries where the disease burden is high, but public health budgets remain low, experts said.

Governments can revert to the Doha Declaration – a declaration on the Agreement on Trade-related Aspects of Intellectual Property Rights (TRIPS) and Public Health, which was signed 10 years ago by member countries of the World Trade Organisation in Doha, Qatar – which exits to ensure that patents do not undermine the ability of countries to achieve the right to health.

“Countries, like South Africa, may interpret TRIPS as they see fit. They can enact national legislation to allow fewer patents and promote generic production of drugs to promote access to medicine for all,” explained Médecins Sans Frontières (MSF) South Africa access and innovation officer Mara Kardas-Nelson.

The availability of generic medications can have drastic consequences for public health. “When generics were produced for antiretroviral (ARV) treatment for HIV-patients, costs rapidly decreased from over 10,000 dollars per patient per year to about 600 dollars,” said Kardas-Nelson. “It allowed increased access to medicines for millions of people.”

But when the TRIPS agreement was signed in 1995, pharmaceuticals were allowed to apply for 20-year patents for their drugs, which meant that during that period, no generic versions of those medicines could be produced. This drastically reduced the global availability of generics. Only six years later, when the Doha Declaration was signed, were governments allowed to circumvent the strict patenting regulations in the interest of protecting their citizens access to health care.

Surprisingly, very few developing countries, including South Africa, have amended their Patent Acts to make use of the possibilities the Doha Declaration provided – mainly due to international pressure from the pharmaceutical industry, the United States and European Union, where many of the world’s patented drugs are manufactured, health experts argue.

“Countries must not bow to this pressure,” warned Treatment Action Campaign (TAC) senior researcher Catherine Tomlinson. South Africa currently provided patent protection beyond what is required by the TRIPS agreement, she said.

“Unlike South Africa, India, Brazil and Thailand have used flexibilities allowed under TRIPS to curb excessive patenting of pharmaceuticals and promote public health. While South Africa granted 2,442 pharmaceutical patents in 2008 alone, Brazil only granted 278 pharmaceutical patents between 2003 and 2008,” Tomlinson explained.

Publicly, the South Africa government repeatedly confirmed the need for generics. In a joint declaration with India and Brazil, South African President Jacob Zuma officially acknowledged earlier this year that the impact of intellectual property on health, access to drugs and prices can best be tackled by scaling up production of generic medicines. But up until now, such declarations have remained lip service.

“We demand Zuma lives up to his commitment. We have not yet seen any concrete indications that government will take steps to change the Patent Act law,” said Tomlinson. “There is lack of political will.”

TAC and MSF also demand stricter and independent review of patent applications, as well as for third parties to be able to oppose patents pending approval and the first year after they have been granted.

Moreover, South Africa should make use of its right to issue compulsory licenses under the Doha Declaration that would allow it to access generic versions of otherwise patented medicines in cases where prices are prohibitively expensive, the organisations say. In contrast to other developing nations, such as Thailand, South Africa has not once made use of this option.

The consequences of South Africa’s strict patent protection are high medicine costs and the delayed availability of affordable generic medicines. South African pharmaceutical benefit management company Mediscor reported in its 2010 medicines review that drug expenditure increased by 25.2 percent between 2008 and 2010, while medicine use only increased 5.8 percent.

For patients receiving chronic, life-saving medication, such as ARVs, availability of generic medication can mean the difference between life and death.

Nokwanda Pani, an HIV-positive woman who lives in South Africa’s third-largest township, Khayelitsha, near Cape Town, has been receiving ARV treatment since 2005. Four years later, when she developed resistance to the drugs, she was put onto a second line of medication.

She now worries about what will happen to her if her body stops responding to the medication again. Because, in South Africa, third-line treatment is only available in the private health care sector, at a high cost of 4,200 dollars per patient per year – an amount that Pani cannot afford.

Without generic competition, the cost of second- and third-line ARVs can be up to 20 times more expensive than first-line ARVs, confirmed MSF. Such price differences do not only apply to HIV treatment but to all drugs, including those needed to treat cancer, tuberculosis, diabetes or high-blood pressure.

“Because I rely on the public health sector, third-line treatment is not available to me. If I build up resistance again, it’s the end of the road for me,” Pani says. For her, it all comes down to one central question: “Why is our government putting the profits of pharmaceutical companies before our lives?”

Excerpt:

Doctors in Mogadishu are warning that famine victims in internally displaced camps have become vulnerable to contagious diseases like cholera and measles, as conditions here are ripe for an outbreak. This comes as internally displaced persons complain that relief aid to some camps has dwindled or stopped.

A four-year-old girl with meningitis sleeps in a makeshift tent in Sigale camp. Her parents left her to go beg for aid. Credit: Shafi'i Mohyaddin Abokar/IPS

The leader of a group of Somali volunteer doctors aiding the famine victims living in camps outside of Mogadishu, Dr. Abdi Ibrahim Ahmed, told IPS that sanitation in the camps was of concern and that many did not have access to clean drinking water.

“Conditions in the camps are very ripe for killer diseases. Doctors are ready to contribute their time, knowledge and energy, but we call on the Somali government to take our warnings seriously,” Ahmed told IPS.

He said people at IDP camps have contracted various diseases including upper and lower respiratory infections, measles, malaria and meningitis.

Ahmed said that standby medical units need to be established in the camps, adding that improved sanitation was needed to help prevent the spread of disease.

“If torrential rains fall and there are no mobile teams operating at the camps, I am afraid that contagious diseases will kill many,” the doctor told IPS.

While international aid continues to be delivered to Somalia, relief efforts at some camps have dwindled or stopped.

The Sigale camp on the outskirts of Mogadishu holds more than 3,000 people, according to the camp chairman Mohamed Hassan Sheik Abdi. However, they have not received relief aid since early August.

“We received our last food assistance from Qatar in the early days of Ramadan. Since then no one has come to us. We only heard on the radio that assistance from the international community is coming daily and that food distribution is continuing at some IDP camps,” Abdi told IPS.

He said that every morning mothers and fathers from the camp go to the city where they beg for food and charity.

“They return with what they get in the evening and feed their children who don’t eat all day,” he added.

The living conditions here are deteriorating rapidly.

While the United Nations Children’s Fund built a few toilets in Sigale and other IDP camps, they are not sufficient to meet the needs of the increasing population of these camps. While adults form long queues to use the few toilets at Sigale, children opt to defecate outside.

Also, there is a severe lack of water and women are forced to walk vast distances to find water.

It is no wonder that the drinking water is contaminated and has led to a number of watery diarrhoea cases, now one of the main causes of death at the camps.

According to Abdi, 10 persons, mostly children under the age of five, died from watery diarrhoea, whooping cough and diphtheria at Sigale since late September.

Since August, at least 38 people from Sigale and four other surrounding IDP camps have died from watery diarrhoea and other diseases.

The non-governmental relief organisation Qatar Charity was one of the first agencies to arrive in Somalia with aid for famine and drought victims. The drought has been described as the worst in the East African region in over 60 years.

Duran Ahmed Farah, Qatar Charity country director for Somalia, told IPS said that his agency has provided food aid to thousands of Somalis and now intends to tackle sanitation and health issues at the camps.

“We first tried to do a life-saving campaign because people were dying of hunger and wanted something to eat. Now we are going to establish mobile medical teams that will be responsible for health care at IDP camps,” Farah told IPS.

He added that aid agencies had not stopped their relief efforts but were feeding the new arrivals to Mogadishu.

“The huge need here cannot be met within a short time,” he said.

Meanwhile, the relief organisation Usmani Community Centre has started digging wells at some camps.

“We dug the wells at two camps in Hamar-Weyne and Abdel Aziz districts. In January we intend to dig wells at the seven camps that have the highest number of IDPs in Mogadishu,” Abdulaahi Mohamed Saneey, the Somali representative of the charity, told IPS.

The Somali government’s Mogadishu spokesman Mohamed Abdullahi Arig told IPS that the government needed help to prevent a possible cholera outbreak and to prevent other communicable diseases from spreading in the camps.

“The government is more vigilant, but our capacity is too little. We need the international community’s assistance in this sector,” Arig said.

Malawi is experiencing a drug shortage as the country’s international donors remain reluctant to release aid meant for the health sector.

Malawi is experiencing a drug shortage. Credit: Claire Ngozo/IPS

About 60 million dollars in funding has been withheld amid allegations of pilfering and corruption in the procurement of drugs at the government’s Central Medical Stores. The Central Medical Stores procures and distributes drugs to government health facilities.

The lack of aid has had a significant impact on the country’s health sector as international donors fund up to 90 percent of Malawi’s medical budget.

While some donors are supplying key medical facilities with life-saving drugs, this is not sufficient to meet the widespread demand as the supplies are mainly for the country’s three main referral hospitals located in Blantyre, Lilongwe and Mzuzu.

Throughout the country, patients seeking medical treatment at government-run medical facilities are unable to access medication such as anti-retrovirals (ARVs), anti-malarial drugs and even painkillers.

Health facilities are also experiencing a shortage of medical equipment such as gloves, and malaria and HIV/AIDS testing kits.

Agnes Makwasa, a 45-year-old HIV-positive patient from the country’s commercial capital, Blantyre, is struggling to obtain free ARVs. For five years, she received a free one-month supply from her local government clinic, until recently.

“They told me that they could not give me my whole dosage because the clinic had limited stock. I had to return for more drugs after a week, but by then the clinic had run out,” Makwasa told IPS. She said she ended up paying 50 dollars for the medication at a private pharmacy.

“I am a widow with five young children, and I am not employed. I make a living selling doughnuts and only make about 90 dollars a month. This means that my family is living on a very tight budget. This is also a threat to my health now that I cannot afford a balanced diet, which HIV patients are advised to be on while on treatment,” said Makwasa. Up to 60 percent of Malawi’s 13.1 million people live below the poverty line.

The situation has also caused concern in rural Malawi as some health facilities have run out of basic painkillers like aspirin.

Malita Nalikata from Mulanje, southern Malawi, told IPS that medical staff at her local hospital told her that they and the other medical facilities in her district did not have anti-malarial drugs to treat her malaria. They advised her to buy painkillers for treatment, as they did not even have that in stock.

“I don’t have money, so I ended up going to see a traditional healer who gave me some herbs to eat with porridge,” said Nalikata. She gave the medicine man a chicken as payment.

“That is all I could afford and traditional healers accept such kind of payment,” Nalikata said. ? It is common practice in rural areas for poor people to patronise traditional healers when they cannot access medical care from government health centres.

About 80 percent of Malawians use public health facilities, according to the Malawi Health Equity Network, a group of civil society organisations in the health sector.

The Malawi Health Donor Group, a network of international donors including Britain, the United States, Germany and United Nations agencies, have refused to release assistance until the government cleans up the health sector.

Chairperson of the Health Donor Group Athanase Nzokirishaka told IPS that the international donors want the government to work on the shortcomings facing the health sector, especially the way medical drugs and supplies are managed by the Central Medical Stores.

The donors, according to Nzokirishaka, are also concerned with poor record management for the country’s drugs and delays in auditing the process of drug procurement.

“Government has a long way to go towards restoring the trust of the international community, and of Malawians, in the national drug system,” said Nzokirishaka.

“Malawi will need to demonstrate that it can fully resolve issues to do with inefficiency, leakage and corruption at all levels of the system. Indeed weaknesses in the supply chain have already been a major factor in reduced or delayed funding for some donors in the past,” said Nzokirishaka.

For the past year, the donors have left the government to procure drugs for the country’s health facilities, a situation which has led to the critical drug shortage.

For many years, up to 40 percent of Malawi’s national budget has been dependent on donors and 80 percent of the country’s development budget was provided under the Common Approach to Budget Support.

This included contributions from Britain, Germany, the African Development Bank, Norway, the European Union and the World Bank. However, the British and German governments have refused to release up to 400 million dollars this year accusing the Malawian government of bad governance.

The government of Malawi has acknowledged the shortcomings in the health system.

Responding to the concerns by the Health Donor Group, Minister of Health Jean Kalirani admitted to IPS that the lingering weaknesses in the Central Medical Stores and the supply chain of drugs have affected the supply of medicines in health centres and hospitals across the country.

“Government is addressing the drug crisis by strengthening the capacity of the Central Medical Stores as a long term solution. In the short term, we are procuring drugs through an emergency tender while resolving issues that have been raised by the donors,” said Kalirani.

She explained that the government is working on establishing a viable financial model, which will be used to track the flow of drugs efficiently.

By Francis Kokutse and - -
ACCRA, Aug 25 2011 (IPS)

Counterfeit medicines have flooded the market in Ghana and have even made their way into government hospitals as the country’s drug regulator struggles to control the importation of drugs.

The president of the Pharmaceutical Society of Ghana, Alex Dodoo, said the country’s Food and Drugs Board (FDB) is not a stringent regulator when it comes to the care and management of medicines in Ghana.

Dodoo said fake medicines have found their way into public hospitals as there have been instances where patients on effective antibiotics did not get well until there was a change in the brand of drug administered. This clearly showed that the first line of treatment used had been counterfeit drugs.

He says this has happened because the gangs smuggling the counterfeit drugs into the country have even been able to infiltrate the hospital supply chain.

However, Dodoo says he has no statistics of the number of times this has occurred.

“Unfortunately, these things are not being documented to find out what went wrong so that a clear picture could be seen of the extent of the damage that fake medicines have on patients in the health care delivery system,” he added.

“Importation of medicines is only allowed through the Kotoka International Airport in Accra and the Tema Harbour near Accra, to ensure that only quality medicines enter the country,” the Ministry of Health’s Director of Pharmaceutical Services Martha Gyansa-Lutterodt said of the country’s drug import laws.

“But we have realised that a lot of fake medicines, especially from Nigeria, have found their way into the country because of the porous nature of our land borders,” Gyansa-Lutterodt admitted.

The situation is becoming serious as the FDB, has been forced, over the past two years, to intensify raids on pharmacies to eliminate the sale of counterfeit medicine.

The country’s Pharmacy Board also ensures that only approved pharmacies sell medication. However, there have been cases where both approved and unapproved pharmacies have been found selling fake medicine.

Last year, when Issac Akologo had malaria, he was prescribed Fansidar (a first line treatment against the disease). He bought it at a pharmacy in Bolgatanga in the Upper East Region of Ghana, but after taking the full course, Akologo still did not feel well. He returned to his health centre and was described a different course of treatment.

“It was not until I read in the newspapers that the FDB had arrested the pharmacy owner … that I realised the Fansidar I bought might have been fake,” Akologo told IPS. The FDB has confirmed that the pharmacy in question sold counterfeit Fansidar tablets.

The trade in fake medicines is known to be widespread in pharmacies throughout the country and some have even found their way onto local market stalls.

But it is difficult for consumers to tell the difference between a fake and the real thing.

One hospital pharmacist told IPS that the packaging of the counterfeit medicines was expertly copied and it was difficult to identify a fake.

However, Gyansa-Lutterodt said the ministry of health has no data on the extent of sale and use in the country of counterfeit medicines. It is using a World Health Organisation study estimate that 30 percent of medicines on the market in Ghana are fake.

She said the ministry was aware of the problem and that procedures were in place to ensure that “fake medicines do not enter the public system, because we want public access to medicine to be without any taint.”

The system, Gyansa-Lutterodt said, was buying from approved sources only, strictly following the procedures, which she said were not new. But she did not clarify why this procurement process was not followed in the past.

Charles Allotey of the Health Access Network, a non-governmental organisation that aims to ensure that the public gets healthcare and proper medicines at an affordable cost, says that the ministry has had a difficult job detecting counterfeit medicines.

“It is a technical problem that is difficult to detect and it would be harsh to say the ministry had not done any work on this issue. Suspicion arises only when a particular medicine is used and produces no result and this must be proved by analysis.”

Gyansa-Lutterodt was concerned that the use of counterfeit medicines will have serious implications on people’s health, as many believe they are taking the legitimate drugs to treat their illnesses.

Thomas Amedzro, head of the FDB’s drug post market surveillance, agrees with Gyansa-Lutterodt that the sale and use of fake medicines has a serious impact on the health of Ghanaians.

“We have found out that some fake antibiotics have found their way into the country, and any patient that is given them could die because of the poor efficacy of the drug – this shows that we are battling a real problem.

“It is a serious threat … we have come across some aphrodisiacs being sold in the country that contain 10 times (the approved level of) active ingredients and impurities.”

Amedzro said as a regulator, the FDB’s duty is to ensure that products are safe for use by the public.

“We do this by ensuring that manufacturers register their products as well as packaging. In the case of importers, we send our officers to the countries of origin to ensure that the manufacturing site really exits,” he said. He explained this usually happens when suppliers of generic drugs apply to sell medicine in Ghana.

“The FDB does not have the personnel to patrol our vast land borders and it is this problem that we now encounter,” he added, referring to the way counterfeit medication was entering the country.

Amedzro said: “There is also the need to educate the people first so that they understand what fake medicines mean to their health.

“We also need to encourage the public to stop buying just from any place of sale. In addition, there is the need for the public to report those who sell medicine without registration,” he added.  

Excerpt:

By Rosebell Kagumire and - -
LIRA, Uganda, Aug 12 2011 (IPS)

Ester Abeja has experienced both physical and emotional atrocities. She was captured by Uganda’s feared rebel group the Lord’s Resistance Army (LRA) and was forced to join them. But not before the soldiers made her kill her one-year- old baby girl, by smashing her skull in, and then gang raped her.

Ester Abeja, who was abducted by Lord's Resistance Army says it is important for sexual violence survivors to have a face. Credit: Rosebell Kagumire/IPS

In Ogur, Lira in northern Uganda, Abeja has come to a temporary medical camp run by Isis-Women’s International Cross Cultural Exchange (Isis-WICCE), a women’s organisation working with women in conflict and post-conflict settings.

The camp is specifically for women with reproductive health complications, which they have mostly sustained from being raped during the almost two decades of war.

For most of the women here it is the first time they have been offered special medical attention since the war ended in 2006, and for many it is the first time they have been treated by a doctor. It is also the first time that many of these women have ever spoken out about the violence they had to endure.

Abeja is one of the many women struggling to survive the horrors of the war. Her home is a few kilometres from Barlonyo, where the LRA massacred over 200 people in a single attack in February 2004.

The LRA fought in the north and north eastern parts of Uganda for 23 years. The war, which forced close to two million people into internally displaced persons camps for decades, was the most brutal that Uganda has faced since independence from Britain in 1962.

Thousands of people died as a result and the war was characterised by its use of child soldiers and the conscription of civilians into the rebel group. The LRA were forced out of the country in 2006 and are currently operating in the Democratic Republic of Congo, the Central African Republic and western South Sudan.

Abeja was captured in 2002. She was a wife and a mother of six children when the LRA abducted her with her youngest daughter and her son.

“When they abducted me I had my one-year-old baby girl and the boy. A few kilometres away from home, they forced me to kill my child,” she says tearfully. “I hit her head on the tree and she died. The rebels immediately began to rape me.”

Abeja can’t remember how many men they were; she says there could have been 10 to 15.

“The group that captured me raped me right after (I killed) my child. They even pushed different objects inside me as they raped me. Others were cutting (me) with machetes as some raped (me),” Abeja says as she shows the scars that remain on her arms and thighs.

She doesn’t know what happened to her son or if he’s still alive.

Abeja was sick for many weeks in the bushes of what is now South Sudan. Once she recovered she had a man waiting to be her ‘husband’. Like many abductees, Abeja had to kill or be killed. In her four years with the LRA she tells IPS she can’t recollect the number of people she was forced to kill, but she puts the number at more than 40.

Abeja was one of the lucky few that escaped. She returned home in 2006 with a boy who is now about five years old.

Since the war ended in 2006, people went back to their original homes and depended on emergency aid.

A recovery and development plan was put in place in 2009 by the Ugandan government but this has not covered the emergency medical needs of the population. Most of the money went into building new blocks of health units and rehabilitating the destroyed ones.

It is not surprising that of the 400 women screened here at the Isis-WICCE medical camp, many are found to have pelvic inflammatory diseases.

Dr. Tom Charles Otim, a lead gynaecologist at the camp, says Abeja has lived with a prolapsed uterus for years now.

Uterine prolapse – the descent of the uterus into the vagina or beyond – is one of the long-term complications associated with sexual violence.

In Abeja’s case, her uterus is hanging out. But she allows her photo to be taken saying it is important for sexual violence survivors to have a face.

She and 39 other women are referred for further treatment to a regional hospital many kilometres away. She will need surgery, which costs about 200 dollars, to remove her uterus.

Like the many women who were raped during the war, Abeja not only has to live with the physical scars of the rapes but the psychological effects as well. She and women like her have to endure intense stigma from the community.

Her husband rejected her after she returned, and left her to raise their four surviving children and her child from the war.

As Abeja struggles to narrate her story, fighting back the tears she wonders: “Do they think I wanted to be abducted and raped by the rebels? Do they think I wanted to kill my own child?”

Otim tells IPS that women like Abeja need more support than just surgery.

A majority of the women seeking medical treatment at the camp have chronic pelvic pain as a result of pelvic inflammatory infections.

“The infections are high here; because of the war, the women were not able to access medical care early,” says Otim.

“This has had an effect on the women’s sexual lives and the majority of them have painful sex, and sometimes they don’t want to have sex but they have to because their husbands don’t allow (them to refuse).”

Many women who have come to the camp have fertility problems. Otim says pelvic pain takes a long time to cure and the women will need about 40 dollars for more follow-up visits at regional health centres, which are usually more than 40 kms away.

“Women cannot claim to have peace if their reproductive health is still an issue they are trying to contend with and struggle with on a daily basis,” Isis-WICCE’s programme manager Helen Kezie-Nwoha tells IPS.

She says because of the sexual violence behind these reproductive health complications, women in northern Uganda need a specialised programme to provide them with the needed health services.

“Reproductive health issues are not easily spoken about, it is not something women will come out in public and speak about,” Kezie-Nwoha says. But “we have built confidence over years of working with these women; that’s why the women can be able to open up and talk about the wartime rapes.”

She says government needs to rethink its approach in post-conflict northern Uganda by putting human security needs first.

The district health officer in Lira, Nelson Opio, tells IPS that most of the reconstruction in the health sector has largely concentrated on building structures, and cannot address the immediate medical needs of a post-conflict community.

“When war ends, there’s a silent war that has to be fought,” he says. “Politicians here think they will just put up structures so they can say ‘This is what I did during my time’ and ignore people’s real needs.”

Most health centres in the district have no medical officers, while the entire district has only two gynaecologists.

Excerpt:

By IPS Correspondents and - -
RIFT VALLEY, Kenya , Aug 10 2011 (IPS)

The Mawingu camp for internally displaced persons affected by Kenya’s 2007- 2008 post-election violence is a desolate place. Located in the Rift Valley, the camp is a collection of tattered, sagging and forlorn tents.

The Mawingu camp for internally displaced persons is a desolate place. Credit: Peter Kahare/IPS

In the middle of the haphazardly erected tents that provide shelter from the vagaries of the weather stands a frayed, faded tent.

Initially there is a deafening silence. But then Truphosa Achudo, the owner of the tent, emerges with her hands on the scarf wrapped around her head.

“I have just taken my drugs, they are strong and I am weak, which is why I am breathing heavily,” says Achudo.

Achudo is HIV-positive and she has a two-week-old baby girl, Philomena Wambui. She does not know her daughter’s HIV status.

But unlike other lactating mothers, Achudo is not eating fruits and vegetables or even drinking milk to aid with her milk supply. She cannot afford these luxuries. Instead her diet consists of only starchy maize and maize flour, which are donated by government every few months.

When the supply runs out, Achudo’s husband, Samwel Njau, has to find casual work in order to buy them food. Njau, whom she tells IPS is suffering from severe flu, left at 7am to look for casual work.

But her family is not the only one having a hard time. The living conditions in the camp are deplorable and are taking a toll on HIV-positive people. Food and financial insecurity is rampant; most here only get one meal a day as they rely on government’s relief supply, which comes once every several months.

There are 2,300 people in this camp, both children and adults. Many of those who live here were informal traders before the 2007-2008 violence and many did not have their own homes. Instead they lived in rented houses and they have not returned because they still fear recurrent violence. Violence erupted in the country after incumbent President Mwai Kibaki was declared the winner of the presidential election.

At the peak of the violence, the United Nations Secretary General’s representative on IDPs estimated that there were between 350,000 and 500,000 internally displaced persons.

While government has managed to relocate many IDPs, it has had a problem finding suitable land on which to resettle this community. Also, many have resisted attempts by government to resettle them on arid and semi-arid land.

Achudo’s predicament encapsulates the desperate situation characterising life in the camp for HIV- positive people. She was diagnosed with the virus in 2007 and immediately started taking anti- retrovirals (ARVs). She is still on ARVs and, like other HIV-positive people in the camp, she gets the treatment for free at the nearby Olkalou District Hospital.

Achudo also has a persistent dry cough. After visiting the Olkalou District Hospital, she was given drugs to treat it. It brings her daily regime of pills to 24 tablets a day.

“The drugs are strong, I should be eating well for them to work in the body, but there is no food,” she says.

She coughs through the night and she can only pray that it is not a relapse of tuberculosis, which she suffered from early this year. It is an opportunistic disease that affects many HIV/AIDS patients in the camp.

She has found some solace in her condition by becoming a member of the camp’s HIV support group Tumaini, which means hope. But general despondency prevails in the camp and among members of the group.

The few toilets in the camp are a health hazard as they are full and overflow with human waste. When it rains at night the tents get soaked, offering little protection to those inside. And hygiene is an issue. The HIV-positive women cannot afford sanitary towels, for instance.

But all is not hopeless. The group is chaired by the strong and outspoken Margaret Gathoni who says “the members have refused to die.”

“We have been denied casual work out there with some employers saying we shall infect their workers and friends. Our colleagues in the camp whisper negatively as we pass by, (the) majority of us are widows and we feel vulnerable,” says Gathoni.

Stigma has been a major concern in Kenya for people living with HIV, but this group has decided to be open about their status.

Out of the 45 people in the group there are only two men. The youngest in the group is a 17-year-old girl, while the oldest is a 60-year-old.

“There are up to 250 HIV-positive people in this camp. (The) women have tried to come out and accept their condition but men have shied away and kept secret their (status), though we know them, we even meet with them at the hospital,” says Gathoni.

But Francis Wanderi is one man who has come out and accepted his condition. He says acceptance is equal to prolonging one’s life.

Until a home can be found for those living in the camp, the HIV-positive group has banded together to support each other through their challenges.

Excerpt:

Only six sub-Saharan African countries have failed to reduce the number of women dying in childbirth over the last two decades. High-spending South Africa is among them, with maternal mortality rates more than quadrupling since 1990. Human Rights Watch researcher Agnes Odhiambo says this is largely due to a lack of accountability.

Maternal mortality rates in sub-Saharan Africa as a whole have been reduced by a quarter compared to 1990 levels. But the continent’s most developed economy is moving in the opposite direction: South Africa’s maternal mortality rate in 1990 was 150 per 100,000 live births; in its 2010 MDG progress report, the country reported this had risen to 625 per 100,000.

“HIV is a big factor in maternal mortality in South Africa,” says Odhiambo, adding that improved reporting means deaths that might have gone unrecorded in the past have also been added to the total.

“But even with all that, the kind of negligence that is happening in our facilities… from what women were saying, substandard care is a big problem and that is an issue that we truly have to think about.”

Health workers failing patients

The survey, ‘Stop Making Excuses: Accountability for Maternal Health Care in South Africa’, reveals a picture of serious neglect, including women in labour being sent home from hospitals without being examined, women ignored or made to wait for hours – even days – by nurses when they asked for help, women being physically and verbally abused by staff, and others forced to change their own sheets or carry their newborns around the hospital while still weak from giving birth. Women with HIV and those from other parts of Africa also reported experiencing discrimination.

“For me, that is failing women,” says Odhiambo. “You fail women when a woman loses her baby and you don’t even bother to explain to her what caused the death of that baby… Or when women are made to clean up their own blood, or when women are forced to sleep (in the same bed) with their baby barely three hours after a c-section, when they’re not yet strong enough.”

The provincial secretary for the National Education, Health and Allied Workers Union (Nehawu) in the Eastern Cape, Xolani Malamlela, acknowledged that health workers’ performance sometimes falls short, but said the union’s assessment is that the problem begins with poor management of health institutions.

Malamlela says that health workers are frequently overworked and are not always paid on time, leading to a demoralisation of staff. He also says procurement policies that have centralised control of stocks of medicine and equipment in the provincial capital have deprived individual hospitals of the capacity to manage vital supplies.

“But we cannot deny that you might here and there find those reckless staff… and we must also play our part in encouraging our members not to deal with patients in a very reckless manner,” he says.

Managers failing patients and health workers

Odhiambo’s report is critical of a failure to act on complaints – not only in sanctioning individual health workers but in recognising system-wide problems that contribute to abuse and neglect. She points out that South Africa’s health authorities are negligent on another level, in failing to collect appropriately detailed information about maternal mortality that would guide policy.

The country has not conducted a Demographic and Health Survey since 2003, for example. Cost is cited as the reason for the delay, but countries with lesser resources have more up-to-date statistics.

“Our health systems are challenged,” says Marion Stevens, a midwife and member of Women in Sexual and Reproductive Rights and Health. She says the main factor in maternal deaths is HIV/AIDS, but argues that the national health department’s focus on the pandemic is poorly executed.

“Accountability is an important issue, because it asks the question why. With all the resources that are being spent on AIDS, why are we not looking also at women’s health, and in particular at maternal mortality as a related issue?”

The focus on AIDS, she says, has come at the cost of considering a continuum of health care. For example, women are told not to go for antenatal care until they are 20 weeks’ pregnant because clinics are overwhelmed by other demands.

“So for women who are ill when they’re pregnant, if they want to get well, or if they are HIV-positive, or if they want to choose to have an abortion, then they essentially come in very very late, and that’s problematic.”

Stevens says the health department has designed a powerful new strategy for sexual and reproductive health rights which provides for greater accountability and integrating issues of HIV and AIDS into a holistic view of women’s health, but since it was completed in May, the document has been sitting on someone’s desk.

Restoring accountability

Odhiambo says that South Africa’s health system lacks adequate monitoring by patients. “A lot of monitoring of what is going on has been done from a provider point of view, but I think there’s a need to bring in patients to say what is not working for them.”

She envisions that this could help to break down the barrier between health workers and users of the system. “Health workers are feeling targeted by this notion of patient complaints, but they’re feeling targeted because the mechanism is not being used in the way it should.

“If patient complaints are implemented properly, then health users and health workers should be friends, because health users are complaining about the problems they’re facing in different facilities, as are health workers and nurses, so the two can really join forces and push the government to make the changes needed so that you’ve got happy users and happy providers.”

By Abdurrahman Warsameh
MOGADISHU, Jul 28 2011 (IPS)

As the first of food aid from the United Nations World Food Programme was airlifted into Mogadishu on Wednesday, it came too late for Qadija Ali’s two- year-old son Farah.

A mother and daughter who survived the dangerous journey from south Somalia to an aid camp in Mogadishu. Credit: Abdurrahman Warsameh/IPS

He died in his mother’s arms as Ali and her eight other children made the 16-day epic journey from their drought-stricken village in Wanlaweyn district, Lower Shabelle, in southern Somalia to Mogadishu.

“I carried him a whole day while he was dead thinking he was alive and just asleep. We did not have anything to give him. No water or food for three days,” an emotional Ali tells IPS at Badbado Camp on the outskirts of the Somali capital.

Ali’s family had 50 head of cattle, 20 goats and five camels before the onset of the current drought in southern Somalia that has raged for two years. Her family was one of the well-off ones in the region, where ownership of numerous livestock, the mainstay of a rural economy, is a sign of wealth.

“It started with (a) shortage of rains for the first three seasons and then no rains followed. Grass dried up, wells and rivers dried up. Our animals began dying one after another as there was no pasture or water for them,” Ali recalls as she carries one of her remaining three young sons who is weak and malnourished.

Camp Badbado, which in Somali means ‘rescue’, is the city’s largest settlement for the drought displaced people from southern Somalia. The U.N. Refugee Agency (UNHCR) says that it is currently home to an estimated 28,000 people, approximately 5,000 families.

Ali’s entire family is not with her, however. Her husband remained behind in their village to look after the family’s remaining belongings. Ali is not aware of her husband’s fate. But she made the arduous journey along with hundreds of other families to escape the severe drought and famine in search of aid.

But aid has come too late for some.

Many children arrive at the camp too weak and malnourished to be saved by doctors. Some children have gone for days without food and water.

Most of the children are too small for their age with a three-year-old having the frame and stature of a one-year-old.

“They come here very weak from hunger and exhaustion. Two or three children and adults die every week in Mogadishu, but we have no exact statistics as camps are located in diverse places in the town,” Muna Igeh, a nurse at Badbado, tells IPS as she weighs one of the dozens of malnourished children at the camp.

Daahir Gabow, a father of seven, had to watch as two of his children succumbed to severe malnourishment just after they arrived in Mogadishu.

He says doctors and nurses at Banadir Hospital, one of Mogadishu’s main health centres, did everything they could to save the life of his second child, a girl, but “fate had its way”.

He says his family had tried to “weather” the drought but could not this time and had to leave their home in search of aid.

“We tried to weather the drought as we did many other times but our livestock could not survive until the rains arrived. Many of our neighbours began leaving after losing all their livestock, so we decided it was time to go,” says Gabow as he prepared for the burial of his daughter who died of malnutrition complications.

“We walked for 21 days. (We) ate (and) drank what we could find and slept where the sun set on us. This is not what I have seen or (what) my father told me happened in his lifetime. (These are) testing times so we have to be patient and strong,” Gabow says.

Elhadji As Sy, the regional director of UNICEF (the U.N. children’s fund) for eastern and southern Africa, called the famine “a child survival crisis”.

Somalia is the country worst affected by a severe drought that has ravaged the Horn of Africa, leaving an estimated 11 million people in dire need of humanitarian assistance. Kenya, Ethiopia and Djibouti are all also facing a crisis that is being called the worst in 60 years. Last week the U.N. declared a famine in parts of southern Somalia.

The agency estimates that in total 2.23 million children in Somalia, Kenya and Ethiopia are acutely malnourished. The U.N. says it has delivered 1,300 metric tonnes of supplies to southern Somalia, including therapeutic supplies to treat over 66,000 malnourished children.

Meanwhile, people are still fleeing their homes in southern Somalia. The U.N. says almost 100,000 displaced people have arrived in Mogadishu, with nearly 40,000 of those in the past month.

“Over the past month, UNHCR figures show that nearly 40,000 Somalis displaced by drought and famine have converged on Mogadishu in search of food, water, shelter and other assistance,” says Vivian Tan, UNHCR spokesperson in a statement on Tuesday.

The U.N. estimates that the number is growing by the day, with daily arrivals averaging 1,000 in July.

Local non-governmental organisations are providing much-needed humanitarian aid but camp residents say the aid is limited and Somali government officials are echoing calls for more assistance.

The U.N. World Food Programme (WFP) on 27 Jul. began its first airlift of food aid to Mogadishu, the first such shipment since the Islamist extremist group, Al Shabaab, banned international aid agencies from operating in regions it controls.

The WFP flew in 14 tonnes of ready-to-use food supplements for malnourished children at the camps in Mogadishu.

Spokesman for the agency, David Orr, told reporters at Mogadishu airport that more aid will be flown in over the coming days.

Excerpt:

By Miriam Gathigah
NAIROBI, Jul 27 2011 (IPS)

On the road between the Kenyan and Somali border lie the dead bodies of children who have succumbed to the famine and the hardships of making the journey from their drought-stricken villages to Kenya.

A child from drought-stricken southern Somalia who survived the long journey to an aid camp in the Somali capital Mogadishu. Credit: Abdurrahman Warsameh/IPS

And it is the story of these children who die between Somali’s southern town of Dobley, which is the last border town before crossing into Kenya, that is yet to be told, aid workers say.

Ahmed Khalif, who works for a local non-governmental organisation in Kenya and regularly crosses the border between the two countries for his work to aid people in Somalia, talks of seeing the bodies of numerous children on the roadside.

“I am a regular on the route between the Kenyan and Somali border, anyone who has used this route will narrate horrific stories of dead bodies, mostly children.

“Their mothers are dying too. It’s not a heartless mother leaving a child behind, just a mother who wants to survive for the sake of living,” attests Khalif.

He says he sees droves of mostly women and children attempting to cross the border to Kenya. But when the children become too weak to walk any longer, they just fall down on the roadside while their mothers and families, half dead with starvation, continue to walk on in an attempt to reach the border and hopefully, aid.

“It is a shocking image to see (children) on the brink of death, their skin sagging from extreme dehydration, their frame too small for their height, their lips dry. They don’t talk, they just lie there.

“(Their) eyes sink into their sockets, but still they stare back at you. It is very disturbing. You think the others are heartless for abandoning them, but they too are in the same physical shape. Only the will to reach Dadaab keeps them going,” Khalif explains.

Those children who die along the way are not buried.

“Who has the extra strength to do so? Those moving on are very weak too, they just keep going…at the camp, that’s where they get buried. When they die there,” Khalif says adding that Dadaab has a makeshift graveyard.

Those Somali children who have survived and make it to the Dadaab refugee camp in Kenya have done so after enduring unimaginable levels of hardships, walking for at least 10 days in intense heat, through a hyena-infested no-man’s land, to get to the camp.

“The Al Shabaab (extremist group that controls much of southern Somalia) continues to make it difficult for people to access Kenya and Dadaab by making Dobley, the last border town in Somalia, inaccessible to Somalis who come from Al Shabaab-controlled regions,” Khalif says.

This is despite the fact that the town is now controlled by Somali government forces, who seized control from Al Shabaab three months ago.

So instead of walking 15 kilometres from Dobley to Kenya, many have to take a route that bypasses the town and walk an additional four to nine days just to get to the border.

But this longer route is dangerous. Roaming bandits rape women and steal the meagre possessions of those trying to find aid.

But at Dadaab, which has now become the largest refugee camp in the world with over 380,000 people, life is still difficult, especially for children. Four children die daily as almost 1,300 Somalis fleeing the drought continue to arrive everyday. This is according to United Nations (U.N.) agencies, which say over 300 million dollars are needed over six months to help save the children affected by the drought.

“The children are too small, too light for their age. Their condition has exceeded the global acute malnutrition rate. This drought is reversing gains made in reducing child mortality,” says Oliver Yambi, the United Nation’s Children’s Fund’s (UNICEF) representative in Kenya.

Yambi adds that U.N. agencies are now encountering malnutrition levels of up to 35 percent, a severe form of malnutrition characterised by extreme weight loss and children having a very small frame for their age.

The World Health Organisation has set a 15 percent threshold against which the extent of malnutrition is measured. Anything above the 15 percent mark shows an advanced state of acute malnutrition and children in this stage rarely survive. They are 10 times more likely to die before age five.

According to UNICEF, the number of acutely malnourished children under five years in Somalia increased from 476,000 in January to 554,550 in July.

And their mothers are not faring any better.

“Children are not the only ones dying at Dadaab. Maternal mortality is very high. We estimate that for every 100,000 live births, at least 298 women will die. But these figures are moderate. The numbers are rising due to the extreme anaemia as well as the ratio of patients to nurses. On average, there is one health facility for every 1,700 refugees and counting,” explains a source from OXFAM. Eighty percent of the refugees in the region are women.

The U.N. said in a statement on Jul. 27 that the famine can lead to complications during pregnancy and childbirth and increases the risk of maternal deaths and infant illnesses.

“Experts estimate that eliminating malnutrition among mothers can reduce disabilities in their infants by almost one third.

“UNFPA (the United Nations Population Fund) country offices in Somalia, Kenya, Ethiopia and Djibouti are carrying out emergency measures to distribute reproductive health care supplies, medical equipment and dignity kits to affected populations. This will ensure life saving treatment for mothers and their children, while also facilitating safe deliveries of newborns,” the statement said.

Excerpt:

By Mantoe Phakathi
MBABANE, Jul 25 2011 (IPS)

Swaziland’s economic crisis has affected its ability to provide healthcare as the country’s buffer stock of antiretrovirals (ARVs) has fallen below the prescribed three-month supply.

And people living with HIV/AIDS are extremely concerned about what will happen to their treatment if the country cannot afford to purchase ARVs.

Led by the Swaziland National Network of People Living with HIV/AIDS (SWANNEPHA), civil society organisations took to the streets on Jul. 21 to demand that government ensure that there are enough ARVs in the country. “The ministry of health is not (being) clear if people on antiretroviral treatment (ART) are assured the availability of ARVs,” said SWANNEPHA vice-president Vusi Nxumalo as he delivered a petition to the director of National Emergency Response Council on HIV/AIDS (NERCHA).

The Swazi government is faced with an economic crisis after the Southern African Customs Union cut its revenue to Swaziland by 60 percent. The money was used to finance 60 percent of the country’s budget.

Efforts to obtain international loans are proving futile for government, which is said to be losing 11.5 million dollars a month due to corruption. Hopes to get a 176 million dollar loan from the African Development Bank were quashed after government failed to comply with some of the recommendations by the International Monetary Fund.

Government failed to cut public servants’ salaries by 4.5 percent after trade unions opposed this move calling for a change of regime in the Kingdom, which is ruled by King Mswati III and where political parties cannot contest power. Cutting salaries would enable the government to save 35.2 million dollars annually and help reduce the wage bill, which accounts for 18 percent of GDP – one of the highest in the region.

So desperate is the situation that Swaziland has even approached the South African government for a loan but there is strong opposition from the Congress of South African Trade Unions (Cosatu) and the South African Communist Party (SACP), which form a tripartite alliance with ruling African National Congress.

Cosatu and the SAPC are calling for political reforms in King Mswati III’s regime before South Africa could consider any financial assistance. So far, no funds are forthcoming.

As a result, many government services are grinding to a halt because there is no money to keep financing its various programmes, which were mainly available at no cost to the public. There are over 60,000 people living with HIV/AIDS on ART in the country, which has an HIV prevalence rate of 26 percent among 15 to 49-year-olds – the highest in the world.

The panic has been further aggravated by the fact that government is no longer able to send cancer patients to South Africa for chemotherapy and radiation services. These services are not available in Swaziland and local patients have attended South African private clinics for treatment, through the financial assistance of government’s Phalala Fund, which has since been exhausted.

As a result, cancer patients who cannot afford to pay for these services, which cost up to 3,000 dollars a day, are dying. So far eight cancer patients have died.

“If cancer patients are meant to pay for their medication, what will stop government from subjecting people on ART to the same situation?” wondered Nxumalo.

According to Lomcebo Dlamini, the national coordinator of Women and Law in Southern Africa- Swaziland, although the lack of ARVs will affect everyone, women will suffer more because they are taking care of the sick.

“Running out of drugs will be an additional burden to women, particularly those in rural settings,” said Dlamini. “Right now we’re dealing with food insecurity and extreme poverty.”

SWANNEPHA is still reeling from shock after finding out that some of its members eat cow dung mixed with water before taking their ARVs. People living with HIV/AIDS in Lugongolweni, in the drought- stricken Lubombo region, are caught up in the fiscal crisis after government suspended the provision of food rations to poor people. This has forced many poor people to go to bed without food. And those on ARVs say they cannot take the medication on an empty stomach and hence have resorted to eating cow dung before taking the ARVs.

Emmanuel Ndlangamandla, the director of Coordinating Assembly of Non-governmental Organisations, said it is a bad reflection on government that some people have reached a point where they are forced to eat cow dung.

“This crisis means death to ordinary people,” said Ndlangamandla. “It’s a pity that any humanitarian crisis impacts more on the poor.”

Dlamini said the economic crisis couldn’t be viewed in isolation but as part of the issue of poor governance in the country.

Meanwhile, NERCHA director Derrick von Wissel admitted that the buffer stock has gone below the prescribed three months. However, said Von Wissel, government has repeatedly assured the nation that the country will not run out of ARVs.

“There are orders in the pipeline and government has assured us that money to buy more drugs is available,” he said.

But he admitted that NERCHA, a non-profit organisation established by government to coordinate the country’s HIV response, is facing financial difficulties after government failed to give the organisation seven million dollars or 588 000 dollars monthly for administrative costs. Since April, NERCHA has not received a cent from government.

“We’re now using money for prevention to finance administrative costs, like the paying of salaries,” said Von Wissel. NERCHA also failed to secure funds from Round 10 of the Global Fund on HIV/AIDS, TB and Malaria.

NERCHA is not the only organisation facing financial difficulties but many non-governmental organisations (NGOs) are downsizing, while others have closed because they have failed to attract donors to the country.

Ndlangamandla attributed the drying up of donor funds to the fact that Swaziland is classified as a lower-middle income country amidst the worldwide economic meltdown.

“It’s sad to see NGOs closing down because they are helping a lot of people in the country,” said Ndlangamandla. And people living with HIV/AIDS are anxious about the availability of ARVs because with NGOs barely coping, they have no one to turn to for help if government runs out of the life-saving drugs.

Excerpt:

By Miriam Gathigah
NAIROBI, Jul 21 2011 (IPS)

When Lucy Omollo found out that her husband was HIV-positive six years ago, the couple thought the best way to prevent her from becoming infected with the virus was not to have sex.

“For the first three years we never engaged in sex, but I gathered courage and we began using condoms,” Omollo says.

But Omollo is well aware that this is not 100 percent safe. “Every encounter still fills me with fear, the condom could burst and my fate would be sealed,” explains Omollo.

But now she has some hope. Omollo and other Kenyan couples in discordant relationships – where one partner is HIV-positive and the other is HIV-negative – have welcomed findings of a recent study that found taking a daily dose of antiretrovirals (ARVs) reduced ones chances of contracting HIV.

While it is good news, it is uncertain whether the Kenyan government has the resources to provide ARVs for these HIV-negative people as the country is still struggling to provide treatment for large numbers of HIV-positive people.

“I am hopeful that an antiretroviral pill taken daily could reduce my chances of getting infected even if the condom were to burst,” Omollo says.

Peter Mathenge, whose girlfriend is HIV-positive, agrees.

“It is very stressful constantly wondering whether every sexual encounter with your girlfriend has left you infected with HIV. It puts a strain in the relationship, if an ARV pill taken daily can be my additional protection, I think it would change the lives of many of us living with HIV-positive partners,” explains Mathenge, who has been in a relationship with his girlfriend for the last two years.

The findings seem like a slow but sure shift from curative to preventive measures in the fight against HIV.

Africa carries the greatest burden of HIV infections and deaths resulting from AIDS. It is also home to more than 15 million children who have lost one or both parents to HIV/AIDS and whose lives will never be the same again.

But years of fighting the disease have not drastically reduced the number of those infected in many African countries. Neither has society’s improved level of HIV/AIDS awareness made a difference to the high infection rate. This comes as the Kenyan ministry of special programmes says that the number of new infections have risen to a high of 100,000 a year.

“(Despite) the devastating impact that HIV has had on people’s lives and development as a whole, a lack of significant positive behavioural change can be construed to mean that people are still not taking the disease seriously in spite of the fact that we are all either infected or affected,” says Dr. John Ong’ech, a gynecologist and HIV specialist in Nairobi.

The Kenya National Aids Control Council, a corporate body which works towards an HIV-free society, has confirmed that being in a stable sexual relationship, either homosexual or heterosexual, increases ones chances of being infected as unfaithful partners continue to widen the web of infection as they veer off into highly risky sexual behaviour.

“We now know that close to half of all new infections come from people within steady unions and maybe it will be most logical to focus on such groups and come with effective preventive measures in which the non-infected partners are also taken into full consideration,” explains Girmay Haile a Senior Institutional Development Adviser at UNAIDS.

Various studies, the most recent and outstanding having been carried out in both Kenya and Uganda, have been touted as a breakthrough in the fight against HIV/AIDS. Similar studies are being conducted in Tanzania, Malawi and South Africa.

In Kenya, the study dubbed the Partners PrEP trial, was carried out among 4,758 HIV discordant couples at Kenya’s largest referral hospitals, Kenyatta National Hospital and Moi Teaching and Referral Hospital, in conjunction with the Kenya Medical Research Institute and the University of Washington in the United States.

The results of the study released on Jul. 14 proved that taking a combination of antiretrovirals (tenofovir and truvada, or a combination of tenofovir and emtricitabine) already in use in Kenya for treatment of HIV, can reduce the risk of HIV infection by up to 73 percent.

“It is prevention that will win us the war against the epidemic in the absence of a curative treatment… The research to find a curative measure is still underway,” explains Haile.

He adds: “If you look at national responses and the prevention revolution that is required to reduce new infections to manageable proportions, and then to zero infections, within a short period – it is the way to go.”

Dr. Nelly Mugo, a gynecologist in Nairobi and a leading researcher in the PrEP study, is quick to warn that ARVs should be used in combination with other methods, such as male circumcision, which has been proven to reduce HIV infection by at least 60 percent, and condoms.

“The drugs taken daily by the participants is a significant preventive therapy,” she emphasises.

As various stakeholders and medical experts rally behind the PrEP trial, providing ARVs to HIV-negative people in Kenya will greatly strain resources that are yet to cater for those already infected. In Kenya at least 400,000 people of the 1.4 million people infected are on ARV’s.

The Kenyan government also only provides ARVs to those with a CD4 count of at least 200. This is opposed to the World Health Organization guidelines that say people with a CD4 count of at least 350 should be on ARVs.

The strain to cater for the already high number of HIV-positive people in need of ARV’s is a challenge that needs to be acknowledged.

“When we talk of HIV-negative persons accessing and using ARVs, it means (a) much greater burden on available resources to respond to the epidemic. However, this latest finding has created a momentum towards narrowing further and preparing to address the pockets of new infections in a much more focused and effective manner,” Haile says.

Excerpt:

By Joshua Kyalimpa
KAMPALA, Jul 15 2011 (IPS)

In pharmacies in the heart of Kampala men and women line up to buy drugs that you usually need a prescription for, like Coartem, a drug used to treat malaria.

Edna Nakyanzi had malaria symptoms, so she bought the antimalarial drug, Fansidar, without a prescription. According to Dr. Emmanuel Semugabi of Hope Clinic, Fansidar should only be prescribed to patients after the first line treatment of Coartem fails.

But Nakyanzi said that she prefers this drug because she has to take fewer doses of it. “I only take three tablets of Fansidar and go to bed and the next day I am fine. But with Coartem you have to swallow many tablets and I hate that,” said Nakyanzi.

But Nakyanzi’s story is a common one. In Uganda patients can easily buy drugs you normally need a prescription for over the counter as government has been lax in stopping the illegal practice. Under the Pharmacy and Drugs Act of 1970 sale of prescription drugs over the counter is prohibited. Those doing so could loose their pharmacy license and also face a jail term. While National Drug Authority inspectors are mandated to regulate this, they have never been effective.

And increasingly people are resorting to self-medication to treat themselves for malaria and other ailments, either to save the money they will have to spend on costly doctors fees, or because some areas lack health officers.

Thelma, another advocate of self-medication, told IPS she regrets spending the equivalent of 10 dollars in consultation fees when she was ill recently because doctors could not adequately diagnose what was wrong with her.

“They told me that I was suffering from fatigue because of over work and advised me to rest and gave me some painkillers. Imagine, I spent close to two hours there after a day at work,” Thelma said. The Uganda Medical Association warns that this commonplace unregulated self-medication is responsible for growing drug resistance in the country.

“Some drugs, like antibiotics, are (bought over) the counter and abused, which causes serious problems. Really those loopholes should be checked,” said Dr. Margaret Mungherera president of the Uganda Medical Association and a member of the Medical Council.

In many cases patients use strong combinations of drugs for minor illnesses, sometimes drugs are taken in inappropriate doses and sometimes the incorrect drugs are used.

Dr. Peter Langi of the malaria control unit at the Mulago National Referral hospital said self-medication is one of the reasons why the fight against malaria has not succeeded.

“When people self-medicate, they fail to take the adequate doses they need to cure malaria, which causes some to develop resistance against the drugs and hence (results in) their eventual death,” said Langi.

A report by the ministry of health says that in some districts resistance to malaria treatment is more than 60 percent. However, the national average of resistance to malaria treatment stands at 11.7 percent.

Aggrey Mubaale said he often suffers from bouts of malaria but swallows several doses of antimalarial tablets without going to a doctor.

“When I was still studying I would carry some antimalarial tablets just in case and still do, even after I left school. It (taking antimalarial tablets) has become a part of me,” said Mubaale.

Mungherera said her association has now teamed up with the Pharmaceutical Society of Uganda, the National Drug Authority and the Association of Nurses and Midwives to address the growing problem. They intend to inspect pharmacies to find those that are dispensing prescription drugs over the counter. Those found to be doing so will have their licenses withdrawn or could face arrest.

“Most of the people dispensing medicine (in) most pharmacies are not trained and will not insist on getting a prescription. In fact, some cannot even read or understand the documents,” said Mungherera.

But this does not mean that all pharmacies in Uganda sell prescription medication over the counter. John Mukama, a dispenser at a pharmacy in Kampala, insists they do not sell prescription drugs to people without a doctor’s prescription.

Excerpt:

By Wambi Michael
BUDUDUA, Uganda, Jul 13 2011 (IPS)

Even though government health services are free, Grace Nafungo Kutosi doesn’t mind paying the two thousand shillings (about one dollar) when she visits the non-governmental Beatrice Tierney Clinic in Bumwalukani village. In fact, paying the fee at the clinic, which is a 20-minute walk from her home, is cheaper than her having to travel to the nearest government clinic almost seven kilometres away.

Dr. Lisa Umphrey is the resident doctor at the Beatrice Tierney Clinic. Credit: Wambi Michael

Government health care in Uganda has been free since 2001, but patients in the rural village of Bumwalukani, in Bududua district some 200 kilometres from Kampala, would rather pay a small user fee to their local independently-run clinic because they know they will get the services they need.

“You can come here when you are sick and you are sure of medication unlike the government hospital,” said Kutosi as she waited amidst mothers, children and men.

The Beatrice Tierney Clinic was founded by the Foundation for International Medical Relief for Children as a sick bay for pupils at Arlington Academy of Hope. It not only provides health care to students of the school but to the surrounding community.

The villagers have taken advantage of its existence to access treatment for their families and don’t mind paying the user fee of two thousand shillings per visit per adult. Children are treated for free.

“That is not a lot of money. Because you can use more than that if you were to visit Bududa hospital,” Kutosi said.

Residents of Bumwalukani are also fortunate because the clinic has a volunteer medical doctor working alongside the nurses. A government clinic is usually run by an enrolled nurse who works with a midwife, two nursing assistants and a health assistant.

Wilson Mangoye, a health outreach coordinator in Bumwalukani, and a regular user of the clinic, says the presence of qualified doctor has attracted patients from neighbouring districts who are in desperate search of better medical care.

“Sometimes we get patients from the regional referral hospital coming here for treatment because they are assured of the medicine,” he said.

Sam Bulukwa, 43, traveled about 10 kilometres from Bubiita sub-county for treatment.

Bulukwa said he did so because the services at local government hospitals were deplorable, especially for the poor who cannot bribe health workers. Services in government facilities are supposed to be free, but in many cases health workers extort money from patients desperate for services.

“The workers in government hospitals have no passion to serve; you cannot be respected as patients. Even cleaners can shout at you but you cannot say anything because you never know they could (put you in touch with) someone who can treat you,” said Bulukwa.

But despite charging a small user fee, the clinic is still under-resourced.

Dr. Lisa Umphrey, the resident doctor sits in a small blockhouse attending to her patients. She is a specialist in child-related disease like malaria, respiratory diseases like pneumonia, and malnutrition among others.

Umphrey said it is challenging to provide needed services for patients in an under-resourced clinic.

“Even with support from donations, there are too many patients that need our care. So we are forced to find creative ways to reach many patients, care for many diseases. We try to educate and reach communities to prevent the illnesses before they reach the clinic,” explained Umphrey.

The clinic, according Umphrey, attends to between 100 to150 patients per day. She says the inclusion of outreach programmes to the community has had some benefit because people now have some understanding of diseases and how to prevent them.

In the past government had attempted to start similar outreach programmes but they were not successful because of a lack of funds.

Health care provision and infrastructure in Uganda are chronically under-funded and highly variable in quality.

A system of ‘cost sharing’, whereby hospitals used to charge user fees was abolished by government because of intense pressure from activist groups and politicians who thought it was very costly to the majority of Ugandans who live on less than a dollar per day.

Asked whether the clinic was not contradicting government’s policy by reintroducing user fees Umphrey explained that it had been done in conjuction with the community.

“We used our outreach services to educate the entire community about the idea before we started. They embraced it because of the services and felt that they could contribute to it as well,” she said. However, there is a need for transparency on how the money is utilised.

“At the end of every month we have an open day where we inform the community what we did with their money,” she said. Money is used to purchase medicine and to pay for the transportation of patients to other health centres.

Excerpt:

By Isaiah Esipisu
NAIROBI, Jul 11 2011 (IPS)

In Kenya buying medicine from any unregistered pharmacy outlet means that you are running a higher risk of buying either substandard or counterfeit drugs that form 30 percent of all drugs sold in the country.

It is not easy to identify counterfeit drugs from the genuine. Credit: Isaiah Esipisu/IPS

“The biggest challenge is that it is very difficult to identify counterfeit medicine by just looking at either the medicine or the packaging. In many cases, we have seen counterfeit medicines that have been packaged better than the original ones,” said Dr. Jayesh Pandit, the head of Pharmacovigilance at the Pharmacy and Poisons Board in Kenya.

The board is urging Kenyans, through media campaigns, to consider buying both lifestyle and life- saving drugs from only registered pharmacies and pharmacists in order to reduce the risk of buying substances that would be detrimental to their health.

“I am not saying that we should trust certified pharmacists 100 percent. But buying drugs from such outlets can reduce the risk of buying substandard or counterfeit medicine by more than 50 percent. This is because these pharmacies are routinely inspected by the Pharmacy and Poisons Board without notice,” said Pandit.

The only way to identify such pharmacies and pharmacists is by looking at the certificate, which is supposed to be hung openly. Pharmacists are also issued with green badges, which are supposed to be worn at all times, while pharmaceutical technologists are issued with blue badges.

“However, the other challenge is that unscrupulous traders are already making fake badges to deceive the public. But we have a special inspection team out there on the lookout. And so far, some culprits have already been arrested and charged in court,” said Pandit.

In one of the most memorable frauds in Kenya, a full container of counterfeit Panadol Extra tablets worth over 62,000 dollars was impounded three years ago. (Panadol Extra is a painkiller manufactured by GlaxoSmithKline pharmaceuticals). When the tablets were examined by the Kenya Medical Research Institute, they were found to contain chalk with no active ingredients whatsoever.

Some counterfeit products are found to have too many active ingredients – subjecting the end user to an overdose. While others have little or no active ingredient – subjecting the patient to under-dose. Others are found to contain potentially lethal substances including pesticides, heavy metals, chalk, leaded highway paint, printer ink and arsenic.

According to Steve Allen of Pfizer – the world’s largest pharmaceutical company – a huge number of counterfeit medicines are still in the market. Some of these counterfeit medicines are in the genuine supply chain, in many cases without the knowledge of the suppliers and retailers. “Fake medicine can, and does cause serious harm to patients, which can sometimes lead to death,” said Allen, the company’s Senior Director for Global Security for Europe, Middle East and Africa.

Between 2004 and 2010, authorities all over the world seized 65 million doses of counterfeit Pfizer medicines. However, Pfizer estimates this is just one third of what is already on the market.

“This is just a tip of the iceberg. We need concerted effort to stem out the vice which is not only affecting Africa, but also the developed world,” added Allen. In order to do this, Kenya’s legal framework needs to be addressed.

“The laws that we have at the moment are either outdated, or are not being implemented,” said Pandit.

He points to Kenya’s current law, which provides guidelines to govern the Pharmacy and Poisons Board in the country.

“This legislation was put in place in 1957. And since then, many things have changed, hence, it must be redressed in order to make sense in the present world,” he said.

“The only way to fight against the vise at the moment is through collaboration with all the players starting from end users of the drugs, to all manufacturers, distributors, regulatory authorities, customs, and police among others,” Pandit said.

The Kenyan Pharmacy and Poisons Board wants people to report counterfeit or substandard medicine.

“We have developed a ‘simple to understand’ form in simple English to be used for reporting substandard and poor quality medicine. It is available in PDF form on our website for anybody to print, and at all public health facilities for people to pick and fill, and present to nearby provincial pharmacists, or e-mailed directly to the board,” said Pandit.

The form requires the complainant to report any anomalies identified with the drug. It could be the colour, ineffectiveness or suspicious packaging, among others.

Over the last two years the board has received 190 reports from the public, through which counterfeit and substandard medicines have been impounded and culprits arrested. At the same time, a number of drugs have been recalled from the market for being substandard or because they failed quality tests.

Though it is not easy to trace the origin of counterfeit medicine due to a lack of records, Pfizer officials believe that most are manufactured in China, India, Egypt and Columbia.

Excerpt:

By Ranjit Devraj
NEW DELHI, Jul 10 2011 (IPS)

While ‘data exclusivity’ clauses will not feature in the India-European Union free trade agreement (FTA), the threat posed by the impending deal to the world’s supply of cheap generic drugs is far from over.

India’s commerce and industry minister Anand Sharma assured Michel Sidibe, chief of the United Nations joint programme on HIV and AIDS (UNAIDS) at a meeting this week that India would reject attempts by pharmaceutical giants to include data exclusivity clauses in the FTA.

“The government of India reaffirms its full commitment to ensure that quality generic medicines, including antiretroviral (ARV) drugs, are seamlessly available, and to make them available to all countries,” Sharma said.

Sidibe was told that India will resort to flexibilities allowed under World Trade Organisation (WTO)’s Trade Related Aspect of Intellectual Property (TRIPS) agreement to ensure that people living with HIV have access to life-saving medicines.

Data exclusivity clauses are designed to stop clinical test or trial data submitted to regulatory authorities to prove the safety and efficacy of a drug from being used by the manufacturers of “copy cat” generic drugs.

“No data exclusivity and no TRIPs Plus are the stated positions that India takes on all such occasions,” Sachin Chaturvedi, senior fellow at the Research and Information System (RIS) for the Developing Countries, a New Delhi-based autonomous, state-funded, think-tank set up to promote South-South cooperation, told IPS.

After his meeting with Sharma, Sidibe said in a statement that the BRICS countries – Brazil, Russia, India, China and South Africa – could “forge an alliance with other high-income countries to ensure that no single person in the world dies for inability to afford life-saving medicines or healthcare.”

Brazil, which has a growing generic drugs industry, has also not accepted data exclusivity in bilateral deals.

Chaturvedi said that in the present climate of FTAs it makes sense for the BRICS countries to collaborate and produce affordable drugs, especially against infectious diseases in the developing world.

India’s generics industry is a world leader producing more than 85 percent of the first-line antiretroviral (ARV) drugs used to treat people living with HIV, pushing down the cost of the least expensive first- generation treatment regimen to less than 86 dollars per patient per year.

“Millions of people will die if India cannot produce generic ARV drugs, and Africa will be the most affected,” the UNAIDS chief said.

“Data exclusivity would have blocked the production and sale of affordable generic medicines by giving big pharma a backdoor means to get a monopoly on drugs ineligible for a patent under Indian law,” Leena Menghaney, a lawyer with the non- government organisation Médecins Sans Frontieres (Doctors Without Borders) told IPS.

“We understand that the EU will no longer push for data exclusivity,” Menghaney said. “Over the last few months there has been an amazing global mobilisation against the harmful policies in the proposed EU-India trade deal,” she added.

The World Health Organisation, UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria have also lent weight to those concerns.

However, Menghaney said, the EU continues to push several other policies in the Indo-EU FTA trade deal that will make it harder for affordable generic medicines to be produced and exported.

She pointed to “IP enforcement” provisions that would allow the seizure of legitimate generic drugs and incriminate those handling such medicines, including MSF.

Worries include “investment” provisions that would allow EU companies operating in India to sue the government if their profitability is threatened by legislation.

For example, enforcement of bigger pictorial warning on cigarette packets or banning a carcinogenic chemical could attract compensation claims worth millions of dollars.

“This could happen under investor-state arbitration proceedings on the grounds that such measures damage investments and profits,” Menghaney explained.

Menghaney said the MSF, together with the other groups that are fighting EU’s policies, will continue to oppose efforts to stop the flow of affordable generic medicines that MSF relies on to treat patients in more than 60 countries.

Menghaney believes that the best way forward is for the BRICS countries to pool their strengths and markets to beat the challenges thrown up by the Western intellectual property systems, which work by blocking access to medicines and research data.

Increasing numbers of people are taking to more efficacious and tolerable first-line treatment. Also, as patients develop drug resistance and require costly, patent-protected second and third-line ARVs, costs are bound to escalate several fold.

An estimated 15 million people are eligible for ARV treatment in low and middle-income countries, and about 6.6 million people have access to HIV treatment. India alone provides free ARV treatment to more than 420,000 people living with HIV.

Pharmaceutical companies argue that generation of test data is costly and that it is unfair to allow the manufacturers of generics to ride on data submitted for registration purposes.

On the other hand, it has been pointed out that that repeating scientific tests on human beings, purely for commercial reasons, violates ethical norms.

In 1970, India eliminated patents on drug products and used its large domestic market to develop a powerful generic drug industry that gave it the reputation of being a “pharmacy to the world”.

“But, in 2005, India implemented changes required by the WTO’s TRIPS agreement and it is only after that India began providing patent protection,” Chaturvedi said. “What is needed now is a firm developing countries position on drug access.”

Excerpt:

By IPS Correspondents
NAIROBI, Jul 4 2011 (IPS)

One person dies weekly in Kenya due to a shortage of anaesthetics and the situation is worse in slums and rural areas across the country.

Medical officers place a patient under anaesthesia. Credit: Protus Onyango/IPS

Kamau says anaesthetics are only found in Nairobi and provincial hospitals. “In our visits across Kenya, we have witnessed cases where many health facilities operate on people without using anaesthetics. Surely, we shouldn’t be letting (people), and particularly our children, undergo surgery without the use of anaesthetics?” he asks.

Dr. Frasia Karua of Gertrude Children’s Hospital agrees. She says she has carried out clinical research around the country and found out that the shortage of anaesthetics is real and rampant in rural areas. Dr. Japheth Akwabi, the vice chairman of the Clinical Association of Kenya, who works at the Western General Provincial hospital, adds “many patients are operated on without these essential drugs.”

Both experts and civil society say that an insufficient health budget, corruption and bureaucracy are to blame for this.

Dr. Willis Akhwale, the head of disease control at the public health ministry, is calling on African-based pharmaceutical manufacturers to play a greater role in the global drug market.

“Having drugs manufactured locally will not only reduce costs, but also ease the time used to procure such drugs to treat all ailments,” he says.

Akhwale says Kenya has many instances of drug shortages, apparently due to the tedious procurement process. “It is a shame that many citizens die due to lack of basic drugs like anaesthetics, which are used during surgical procedures,” he says.

The Kenya Medical Supplies Agency (KEMSA), a government parastatal, is charged with planning, procuring and distributing drugs to all public health facilities in Kenya. But it says it does not have enough money to procure all drugs needed in the country.

“Though the government gave the ministry of health a total 870 million dollars in this year’s budget, anaesthetics was lumped together with other drugs while about 12 million dollars was earmarked for purchase of ARVs, two million dollars for the purchase of modern equipment for screening cervical and breast cancer and 79 million dollars for immunisation,” says Dr. John Munyu, acting KEMSA chief executive.

But he adds KEMSA has bought a planning system worth 1.5 million dollars to improve procurement of essential medicines and medical commodities. It will also aid in tracking the storage and distribution of all pharmaceuticals and non-pharmaceuticals commodities to over 4,000 facilities in the country. But this will only be implemented in September.

Professor Anyang Nyongo, the medical services minister says government is aware of the situation and is looking for money from donors to buy enough drugs, including anaesthetics.

But meanwhile, patients are undergoing excruciating pain.

When Clare Anyango from Western Kenya broke her hand she was taken to a local nursing home for surgery and was operated on without anaesthetics.

“It was like hell. I was enduring the pain and thought the doctor would ease it. But when he started the operation, the pain doubled and I had to endure it for almost an hour. I wouldn’t undergo a similar exercise again,” says Anyango.

Dr. Gilchrist Lokoer, who is in charge of Turkana District Hospital, says the situation is worst in Turkana.

“Many patients come to us for surgery but in most cases, we lack the anaesthetic machines, gas and sprays to numb their senses.

“For simple processes sutures, removing lumps or circumcision, we do them when patients are fully awake. For more serious cases, we refer them to mission or general provincial hospitals with good facilities and drugs,” says Lokoer.

Dr. Loise Mutai, a paediatric cardiologist and lecturer at the University of Nairobi operated on a child in Kericho, 300 kilometres west of Nairobi, without the use of anaesthesia in March.

“I had gone to Kericho district hospital to diagnose children’s heart problems using my echo machine. I detected an abnormality in a child’s heart, which could not last a day.

“I was shocked to find there were no drugs and equipment for anaesthesia. Using my echo machine, I expertly operated on the child without using anaesthesia. The child survived but I empathised with the patient because I know the pain she was going through. We should equip our hospitals to avoid similar situations,” she says. Anna Wangeci, who lives in Mathare slum in Nairobi, says she experienced a rupture while delivering her baby and needed stitches.

“It was at night and the doctor stitched me while I was awake. The pain was unbearable given that it was just a few minutes after I had delivered,” she recalls.

Dr. Wilberforce Wanyanga from the United Nations Industrial Development Organisation is calling on African governments to offer incentives for local pharmaceuticals like allowing them to import goods without paying value added tax.

“Kenya is a regional pharmaceutical hub and it is ironical that it continues to import basic drugs for anaesthesia. It should promote local manufacturing of such drugs,” he says.

Excerpt:

By Servaas van den Bosch
WINDHOEK, Jun 29 2011 (IPS)

In one of the most sparsely populated countries on the planet, people travel up to 200 kilometres in the simmering heat to see a nurse or get basic medication.

Registered nurse George du Plessis takes a patient's blood pressure in the mobile clinic. Credit: Servaas van den Bosch/IPS

Most people who fall ill on a Namibian farm wait out their illness. They rather risk developing a chronic condition than making the arduous trip to a far away clinic in the forty degree Celsius heat. And even if they go, they most likely will have to wait for a long time before a medical officer sees them. In addition, the chances of them being sent home with an over-the-counter painkiller is high.

To fill this gap in primary healthcare provision Dutch non-governmental organisation PharmAccess, together with the health ministry and the private sector have started a mobile clinic in one of the most remote regions of Namibia, in rural Otjozondjupa.

The project called Mister Sister has converted trucks into mobile clinics, receives medicine, vaccines and consumables from the health ministry, and funding from a growing complement of corporate sponsors.

“Mister Sister addresses an extremely important and often not recognised problem,” remarked professor Rich Feeley from Boston University and advisor to the project at the project’s launch in mid-June. “Even when the costs are free, getting to the healthcare facilities is a problem.”

In June the first Mister Sister mobile clinic commenced its month-long route along farms in the rural Otjozondjupa Region some 100 kilometres (km) from the capital Windhoek. Ultimately the service will operate three mobile clinics with a budget of 230,000 dollars each per year.

The average distance to a clinic in Namibia is 69km, to a doctor 99km, hospitals are approximately 107km away and for a dentist one travels 170km. But these are averages. In a country roughly the size of Pakistan, but with only two million inhabitants, having to travel 200km to access healthcare is no exception.

Though classified as an upper middle-income country by the World Bank, Namibia has the world’s highest income inequality on record and only 15 percent of its people have medical health insurance.

“Private insurers will only service the insured. We wanted to put in place a system that delivered unified care. Farm workers and their dependants have free access to our healthcare, while for teachers or police officers at roadblocks we can claim the treatment from their insurance companies,” said Ingrid de Beer, Namibian general manager of PharmAccess in Namibia.

She adds that the system is unique in the way it brings public and private players together. De Beer: “It doesn’t make sense to have a private and a public system servicing the same population. Instead PharmAccess runs the service, with contributions in kind from the government and monetary input from the employers.”

“We in the private sector have a habit of criticising a (health) system that doesn’t work,” commented Derek Wright, president of the Agricultural Employers Union, which promotes the initiative among its members. “But in the agricultural sector we have learnt that it is better to find a solution. It’s important to invest in the health of our employees and their dependants.”

While the clinics are free for workers, farmers along the route have to pay a 700-dollar annual participation fee, regardless of the size of the staff complement or its dependents. So far 27 commercial farmers have signed up.

Sakkie Coetzee, chief executive officer of the Namibia Agricultural Union thinks it is a good deal for the farmers.

“There are a lot of advantages. The clinics save the farmer time and will undoubtedly increase productivity on the farms. It makes sense for farmers to pay the contribution. By taking healthcare provision in their own hands they will save money in the end.”

Another benefit of the public-private partnership is that red tape is reduced to a minimum, said Feeley.

“In this setup its easier to replace a starter motor, without first having to obtain three quotes. Or when the blood pressure pump breaks, the supply lines are probably infinitely shorter.”

“It is also an unique opportunity to put in place evidence-based management, learning from the project as we go along and implementing these lessons here and elsewhere,” he added.

“It’s a very good initiative because access to healthcare in these areas is a big, big challenge for the rural population, especially farm workers. We give them good treatment, the best actually,” George du Plessis, who heads the mobile clinic’s team, told IPS.

The teams consist of a registered nurse, an enrolled nurse and a driver. Du Plessis and his colleague see about thirty patients every day.

“Many patients suffer from neglected chronic conditions such as diabetes and high blood pressure,” he explained. “With an elevated blood pressure it is easy to get a stroke, yet the condition can be treated easily and on our next visit we simply bring three months worth of drugs so that the patient doesn’t have to go to hospital to renew the prescription.”

De Beer estimates that such ‘medical backlogs’ constitute a part of the clinic’s early work. But by enrolling these patients on an automated system, listing their conditions and starting treatment later cost to the healthcare system and the agricultural sector can be avoided.

“Other conditions that we encounter are back pains and headaches from working in the fields all day long in the burning sun and respiratory problems in kids, such as coughing and sneezing,” continued Du Plessis, whose lapel insignia identifies him as an experienced nurse, qualified in delivering babies, treating psychiatric patients and offering community health care.

“Many children also are behind with their immunisations, which is a big problem. The initial vaccinations at birth in the hospital are not followed up because of the long distances.”

Du Plessis says the clinic also plays an important role in voluntary HIV/AIDS counselling, as well as family planning. “Sometimes a single mother has six kids and can hardly cope. Employers, therefore, encourage women workers to make use of family planning to prevent unwanted pregnancies.”

It’s a far cry from the days when government officials handed out condoms and Panadol on their visits to rural areas.

“We sit down with the patients and take as much as thirty minutes to talk about their problems. The farm workers respect you for that. They really appreciate the service,” Du Plessis said.

Excerpt:

By Wambi Michael
MBARARA, Uganda, Jun 28 2011 (IPS)

When the monthly contraceptive injection that Bernadette Asiimwe, a mother of four, got from government health centres in western Uganda was out of stock for weeks, she fell pregnant with her fifth child.

A nurse shows one of the mostly commonly used contraceptives. Credit: Wambi Michael/IPS

Asiimwe is not alone, many mothers like her in western Uganda have had unintended pregnancies due to shortages of commonly used contraceptives at government health facilities. Depo-Provera Contraceptive Injection is one of the most commonly used.

Donata Muhereza, a counselor at Reproductive Health Uganda in Mbarara, told IPS that the one-month contraceptive injection that Assiimwe used is popular because rural women find it easier to use compared to pills. Women also preferred it, Muhereza said, because they could take the contraceptive without the knowledge of their husbands. But the injection is rarely available at government health facilities.

“Mothers come here late after failing to find their injections at government hospitals. When we test them we find that they are pregnant. We cannot put them on any contraceptive. So we counsel them and let them go home.”

She said it was a common problem that usually occurred when government clinics ran out of the two most-used contraceptive injections. Muhereza added that women were subjected to violence by their husbands when they unintentionally fell pregnant.

“It happens that the husband was aware that his wife was on a contraceptive, but you find that the husbands become hostile (when they find out that their wives have fallen pregnant). Sometimes they abuse their wives. In the long run when a mother is not counseled well, then they resort to backyard abortions,” said Muhereza.

She said unintended pregnancies and abortions in Mbrarara are common and that non-professionals perform most abortions. An estimated 297,000 abortions are performed in Uganda because most of the pregnancies are unintended according to a study conducted in 2005 by the Guttmaacher Institute between 2003 and 2005.

A health worker at Kakooba Health Centre, who declined to be named, told IPS that the centre has not had three types of the commonly used contraceptives for about two months.

“We are equally in a dilemma. We want to help the women because we know the dangers of not taking the pills as required,” she said.

“We instead give them condoms advising them to convince their husbands to use protection until we have restocked. But some women are not be able to convince their husbands (to use condoms) so they fall pregnant,” she added.

Kaguna Amoti, district health officer at Mbarara District Administration said the shortages were not widespread in the district. “We are aware of the problem but it is not affecting all contraceptives. Our counselors are suggesting other types of contraceptives until when we have stocked again,” said Kaguna.

However, family planners have explained that not all forms of contraceptives are suitable for everyone. For example, pills are not suitable for rural women because they are required to be taken daily. Most rural women prefer to take a monthly contraceptive injection.

Wagama Theresa, a senior nursing officer in the neighbouring Bushenyi district told IPS that the situation there was no different from Mbarara. “We are lucky that some health centres have the injectables in stock but some don’t have so mothers are advised to try the next health centres where the contraceptive is in stock.”

She explained that persistent contraceptive shortages were frustrating for the husbands who supported their wives with family planning.

“Some men have begun supporting their wives in family planning. But when they come and don’t find their selected contraceptive (available), they get frustrated and you will never see the husbands back here,” said Wagama.

Eliab Tayebwa, the head of Reproductive Health and HIV/AIDS in Bushenyi district explained that the district experienced contraceptives shortages when there was a delay in delivery from National Medical stores.

“Contraceptives come in medicine kits like other drugs. So when the kits have not been delivered then you will not have contraceptives and other medicines,” he said.

Access to and use of family planning in Uganda has been identified as one of the factors in achieving 2015 United Nations Millennium Development Goals (MDGs), but progress in both these areas has been slow.

The 2006 Uganda Demographic Health Survey showed that 41 percent of women in Uganda needed contraception, but could not get it.

Dr. Moses Muwonge, a reproductive health expert, said government was not committed to family planning initiatives, which has led to the contraceptive shortages. Muwonge said that only 600,000 dollars was allocated to contraceptives in the financial year 2010/2011.

But Dr. Kenya Mugisha, the Acting Director General at the ministry of health services blamed some districts for causing contraceptive shortages. “Money is sent to districts with tentative budgets, but the districts re-prioritise and contraceptives may not get the vote they deserve,” he said.

Mugisha explained that his ministry has devised a new strategy to deliver family planning services to rural populations, given that 51 percent of Uganda’s population lives more than five kilometres from the nearest health facility.

The community-based access to injectable contraceptives, according to Mugisha, is expected to reduce unmet demand for family planning.

Mugisha added the strategy would only work once more money was made available to extend services and purchase the needed contraceptives. “We need more than double what we are offering today. And that is the big challenge we are facing, not just with contraceptives but in the general health sector,” he said.

Excerpt:

By Isaiah Esipisu
NAIROBI, Jun 22 2011 (IPS)

People in Western Kenya are now able to buy effective anti-malarial drugs at low prices thanks to the success of the Global Fund’s subsidy programme, and thanks to honest pharmacists who are reselling the drugs at the recommended low prices.

The drugs subsidised through the Affordable Medicines Facility - malaria. Credit: Isaiah Esipisu/IPS

Early findings from a survey conducted by the Kenyan government show that 80 percent of pharmacies in Nyanza Province in Western Kenya have stocked the subsidised drugs. The study is yet to be released but it also found that most locals have taken advantage of the subsidy to access the highly effective medicine. Unsubsidised, the drugs cost about seven dollars.

“We recorded anomalies in prices, where some pharmacists were selling the subsidised drugs slightly higher than the recommended price of 40 Kenyan Shillings (Ksh) (50 cents), but most of the prices were within affordable limits,” says Dr Elizabeth Juma, the managing director for the Division of Malaria Control in Kenya.

Artemisinin Combination Therapy (ACT) is subsidised through the Affordable Medicine Facility – malaria (AMFm) programme, which is hosted and managed by the Global Fund. The Fund is an international financing institution that invests in the fight against HIV/Aids, tuberculosis and malaria.

Since the launch of the subsidised anti-malarial drug distribution in August 2010, the private sector has ordered 13 million doses. According to Juma, eight million doses were delivered by May. They Kenyan government has placed orders for 12.2 million doses for the subsidised ACTs.

According to Juma, the Division of Malaria Control partnered with the Pharmacy and Poisons Board to conduct a survey covering 270 private pharmacies in all districts within Nyanza Province (a malaria endemic zone) during March.

“We found out that all the surveyed pharmacies had stocked the recommended ACT drugs for malaria, while 80 percent (216) had the subsidised ACTs,” says Juma. “The mode and median price was Ksh 40 (50 cents) while the average price was Ksh 49 (above 50 cents). In only one pharmacy did we find the subsidised drugs being sold at more than Ksh 100 (2.50 dollars),” adds Juma.

It is a significant success in a country where 25 million of the 34 million Kenyans are at risk of contracting malaria.

And the slight overpricing of the ACTs did not seem to have a huge impact on those in need of the drugs. “The average of Ksh 49 was found to be far better than Ksh 600 (7.50 dollars) people were paying for the same (unsubsidised) dose,” she says.

Dr Olusoji Adeyi, the director of AMFm in Geneva, echoes her sentiments. Adeyi was optimistic that prices of the subsidised drugs will eventually drop with time.

“When the AMFm started, the government of Kenya set a recommended retail price of Ksh 40 (about 50 cents) for AMFm co-paid ACTs. In our understanding, this was set as a desirable target, not a decree, because the AMFm in the private sector works through markets. Yet with the ongoing public information campaigns to make both buyers and sellers aware of these recommended prices, the cost of ACT will soon go down,” Adeyi tells IPS.

There is no legislation of price control in Kenya, hence shopkeepers, including pharmacists, usually decide on what price to mark the subsidised ACTs, despite government’s price recommendation.

However, Josephine Akinyi, a resident of Kisumu city in Nyanza Province appreciates the fact that the subsidised drugs are available despite anomalies in the prices. “Though I am aware of the recommended price of these drugs, I find it far easier to part with double the recommended price for a dose, which is several times cheaper than what we used to pay for the same dose of (unsubsidised) medicine,” says the mother of six.

Adeyi says that the project’s success means people will no longer be forced to buy cheaper anti- malarial drugs that are not effective.

“Nyanza province has already achieved its strategic objective of reducing the retail price of ACTs to about the same range as those of SP (Sulfadoxine-pyrimethamine–based) and amodiaquine (anti- malarial drugs that are no longer effective in treating the disease). This means that high prices will no longer force people to buy ineffective medicines. Instead they can easily buy quality-assured ACTs for about the same price or even cheaper,” he says.

Though the SP drugs, which include Fansidar and Metakelfin, are banned in treating malaria because of their ineffectiveness, many people in Kenya still buy them because they cannot afford alternative effective drugs. The banned drugs retail at about Ksh 100 (2.50 dollars).

“I receive customers on a daily basis who seek to buy Fansidar because they know it is cheaper than the (unsubsidised) ACTs. But upon realisation of the availability of the subsidised ACTs, they usually change their options and go for the highly effective alternative,” says Willis Otieno, a pharmacist in Kisumu city.

In Kenya, the AMFm program has reduced the retail price of ACTs by up to 92 percent. According to the program’s plan, the private sector is entirely responsible for all costs of distribution, storage, staff salaries and overheads. It is a strategy, Adeyi says, that has never been attempted in global health financing for malaria treatment.

He says there was a need to increase the availability of ACTs and to reduce variations in their retail prices. Adeyi says this will happen when the supply of ACTs is large enough to meet the demand everywhere.

Excerpt:

By Joshua Kyalimpa
KAMPALA
, Jun 21 2011 (IPS)

The nurse at Najembe Health Centre in Buikwe district says the centre’s supply of malaria drugs will be finished in two days. A malaria epidemic has hit the area and the demand for the drugs is high. But the centre, which serves the entire sub-county, will have to wait up to six weeks before their supply will be replenished.

The health centre gets supplies from the Kawolo district referral hospital every two months and last received supplies at the end of May. The next supply will only be delivered at the end of July. Meanwhile, staff from the centre cannot make a special request to either the district hospital or the National Medical Stores for drugs that are in short supply. So those patients in need of anti-malarial drugs will have to go without or will have to privately purchase the drugs.

“They give us the same quantities of drugs irrespective of the needs and this means we are always running out of some drugs, while other drugs expire because nobody is using them,” says the nurse who prefers not to be named.

The Ugandan government changed the policy of distributing drugs to parish and sub-county health centres in 2009 by implementing a policy where the National Medical Stores decides what drugs to supply and in what quantities. (A parish health centre is a clinic that provides medical treatment for up to 12 villages.) Previously heads of these health centres requisitioned the drugs, depending on their needs. The National Medical Stores supply 70 percent of the drugs in public health centres and district health officials locally procure the remaining 30 percent.

Hamis Kaheru, spokesperson of the National Medical Stores, says the policy change was necessary because there was a lack of competent personnel at lower levels to handle the old system.

“Personnel at the health centres (at parish and sub-county level) had no capacity to ascertain their needs and were not sending their requests on time. In the end the National Medical Stores was not sending drugs on time and some items would be missing because they were omitted from the list,” Kaheru says. He adds that they have been reviewing the policy every six months and is convinced it is working.

But the system is not working according to Denis Kibira medicines advisor at the Coalition for Health Promotion and Social Development (HEPS) a civil society organisation campaigning to stop the shortage of drugs. Kibira says the policy is wrong and should be reviewed.

“Drugs are out of stock most of the time and the moment people learn that some have been brought at their health centre they rush to get as much as possible to keep some for use during a shortage. This means the drugs will be always out of stock,” Kibira says. He says this is possible because most nurses at the parish and sub-county health centres do not test patients to identify their illnesses but instead treat them based on symptoms. He says most people fake symptoms to get the drugs that are in short supply.

Kibira says the HEPS have conducted research in at least 20 districts since government first revised the drug distribution system and found the system is not working, despite government’s assurances. At one health centre in Kayunga district villagers told IPS they did not have medicine for over two months and there was no nurse on duty.

Government implemented the current system in an attempt to reduce chronic shortages of essential medicines that were experienced by the parish and sub-country health centres from 2008 to 2009. Kibira, however, says those shortages were largely due to mismanagement of supplies, deficiencies in the procurement process and inadequate funding.

“We were under the impression that the original shortages were because of no money. Our expectation was that when the budget allocation to the National Medical Stores went up, the services would (improve). But what we are seeing is the reoccurrence of the disease we hoped to heal,” says Kibira.

In the 2009/2010 national budget the National Medical Stores received an allocation of almost 90 million dollars compared to a previous allocation of only 20 million dollars.

Kibira says with this kind of money the National Medical Stores should be in a position to supply vital drugs to health centres across the country without resorting to a policy change. Previously the National Medical Stores was not allocated funding through the national budget and would supply drugs on credit and then invoice the ministry of health and other health facilities for payment. This caused terrible delays.

But Kaheru says the policy has already been reviewed twice after consultations with the district medical officers, who should know the needs of their areas of jurisdiction.

“This policy solves more problems than it creates, the reason why drugs run out is because health officials at the lower levels are just giving people drugs under the clinical treatment based on symptoms and without testing. This (leads) to shortages and not because the policy is bad,” says Kaheru.

But HEPS have asked government to review the policy and increase funding. Currently government supplies about 400 dollars worth of drugs to each parish health centre monthly. Sub-county health centres receive about 800 dollars worth of drugs each.

Kibira says HEPS have met with ministry of health officials who have assured them that they will revert to the old system. The National Medical Stores, however, denies this will happen.

Meanwhile, the nurse at Najembe Health Centre has no option when the drugs run out. She will have to give her patients prescriptions for the anti-malarial drugs and hope that they will have the money to buy them.

Excerpt:

By IPS Correspondents
WASHINGTON, Jun 17 2011 (IPS)

By 2015, women demanding family planning products and services in the developing world will likely reach 933 million, a terrific increase from the current 818 million women demanding access to these basic reproductive commodities.

In addition, according to the Reproductive Health Supplies Coalition (RHSC), the number of family planning users will soar from 603 million to 709 million – an increase of 64 million users across 66 developing countries, and 42 million spanning 89 middle-income countries – by the middle of the decade.

The increased cost associated with this skyrocketing demand is an estimated 5.7 billion dollars per annum for both low- and middle-income countries – including the expenses of procuring more contraceptive commodities, securing transportation for the products, expanding communication capabilities to educate the public, and stepping up training for health providers to distribute reproductive products and services.

“Today, there are over 200 million women in the developing world who want to prevent or delay pregnancy, but are not using any means of modern contraception,” John Skibiak, director of the RHSC, wrote earlier this month. “This is, without a doubt, a horrifying figure. But the greatest tragedy for us – those of us who have dedicated our professional lives to ensuring global access to family planning – is that this figure has not budged in nearly two decades… Each step forward is more than matched by comparable increases in demand in new users, [so] despite our best efforts, we are caught in a deadlock.”

According to Skibiak, 424 million dollars worth of commodities will be needed to satisfy demand for contraceptives by the year 2020, in donor-dependent countries alone.

If donor funding continues at its current rate, the world can expect a shortfall of nearly 200 million dollars annually, or a total deficit of 1.4 billion dollars between 2008 and 2020.

“What we need now is a reinvigorated effort to ensure [reproductive health and commodity security],” Skibiak said. “True contraceptive security exists when every person is able to choose, obtain and use quality contraceptives and condoms for family planning and for the prevention of HIV and AIDS and other sexually transmitted infections.”

Simple Technologies, Huge Results

Coming on the heels of the successful Global Alliance for Vaccines and Immunisation (GAVI) pledging conference earlier this week, which raised over 4 billion dollars to push the global health agenda forward, a congressional hearing on public-private partnerships in Washington D.C. Thursday raised the bar a little higher.

The Program for Appropriate Technology in Health (PATH), Research!America, the Global Health Technologies Coalition, and Bioventures for Global Health, in collaboration with Congressmen Albio Sires and Mario Diaz-Balart, presented ‘Partnerships for innovation: Simple solutions that save lives’, which outlined the use of fast solutions to immense global issues.

“The briefing on the Hill is meant to highlight the benefits of investment by the United States government and the U.S. Agency for International Development (USAID) in innovation, and to spotlight how we’ve been able to use this funding to produce technology that is greatly improving people’s lives,” Christopher Elias, president and CEO of PATH, told IPS.

With 32 field offices spanning 23 countries worldwide, PATH employs a user-driven design process, whereby its innovation efforts are fed directly from the grassroots.

PATH believes that it is only by monitoring and understanding local and community needs that the characteristics of a particular solution can be properly identified.

“One of the problems our field staff encountered was that the basic contraceptive diaphragm was not available in developing countries because it required gynaecology exams to determine which size should be used on the woman,” Elias told IPS. “As a result, scores of women in low-income countries were missing out on a simple method of birth control because of the absence of the necessary intermediary.”

So PATH worked to design a new silicone “one-size fits most” contraceptive diaphragm that eliminates the need for gynaecologists and that has been welcomed by women from Africa to Latin America and South Asia.

“We worked on this for ten years and went through over 20 different designs in a totally interactive design process, so that the end product was something the women would definitely use,” Elias told IPS. “One thing we were not expecting was that colour mattered a lot to the women – and in fact the final product is a very soft shade of purple, almost lilac, something that was universally popular. This is something we could not have anticipated without worldwide feedback!” he added.

In addition to creating new products, PATH believes that public-private partnerships are essential for deploying already-existing technologies to the women most in need.

Last year, the United Kingdom-based HIV/AIDS charity, AVERT, reported that in 2009, over 400,000 children under the age of 15 became infected with HIV – the large majority of them through mother-to- child transmission (MTCT).

In fact, the absence of proper treatment means that HIV-positive pregnant mothers face a one in four chance of passing the infection to their newborns. Given the current statistic of 18 million HIV-positive women in the world today, these numbers portend an almost-certain tragedy.

Nevirapine, an antiretroviral that has been made available free of charge by the German manufacturer Boehringer Ingelheim, reduces the risk of MTCT by 50 percent; however most women – especially those in remote rural areas – have been unable to access the required dose, delivered in syrup form, since their last visits to health workers often take place several weeks before birth.

“So PATH worked with USAID funding and Kenyan health workers to create the nevirapine pouch,” Elias told IPS.

“We developed a very simple system where nurses in antenatal clinics could fill a syringe with the right dose, cap it and seal it in a foil pouch with very simple, low-literacy instructions on it so that a mother could safely and easily give her baby the six drops of medicine to prevent MTCT, in her own home, minutes after delivery.”

“All it took was a simple packaging solution to enable millions of mothers to prevent unnecessary transmission to their children,” he added. “This is just one more example of the immense possibility of partnerships in reaching the most vulnerable populations.”

Luckily, PATH is not alone in its efforts. Next week, various members of the reproductive health community will converge in Addis Ababa, Ethiopia, to observe the tenth anniversary of the 2001 Istanbul conference ‘Meeting the Challenge’, which pioneered the global reproductive health supplies movement.

The RHSC’s two-day-long ‘Access for All: Supplying a new decade for reproductive health’ workshop series will form the nucleus of the conference, harnessing voices and strategies from the health community to meet the challenges of the coming decade.

Excerpt:

By Kristin Palitza
CAPE TOWN , Jun 17 2011 (IPS)

Access to treatment for drug-resistant tuberculosis (DR-TB) remains compromised, especially in developing countries, because too few pharmaceutical companies manufacture quality-assured drugs. Lack of competition has led to skyrocketing prices and this means that public health budgets are quickly spent.

Prices for DR-TB drugs remain too high worldwide. Credit: Kristin Palitza/IPS

The situation is particularly severe in countries with high numbers of HIV infections, especially where access to antiretroviral treatment is patchy and HIV-TB co-infections are common. South Africa is one of them.

One of the key access barriers to treatment is the limited availability and high cost of quality-assured medicines to treat DR-TB. For some medicines, there is only one quality-assured manufacturer or a single source of the active pharmaceutical ingredient required to produce the drug.

“There has been little investment in research and development of TB drugs, because TB is seen as a disease of the poor and therefore not a lucrative market for the pharmaceutical industry,” explains MSF South Africa medical coordinator Dr. Eric Goemaere.

This has led to extremely high prices for most DR-TB medications. One patient’s treatment can thus cost up to 9,000 dollars, says MSF – nearly 475 times more than the 19-dollar treatment course for drug-sensitive TB.

Alarmingly, prices have increased even further in recent years. “While drug prices usually go down with increased demand, prices for DR-TB drugs have gone up, some by 600 to 900 percent. That’s simply wrong,” says Goemaere, who heads a HIV and TB treatment project in South Africa’s third-biggest township Khayelitsha.

The exorbitant pricing is less an issue of patents, he explains, but rather caused by the lack of a working mechanism to control prices as well as the termination of subsidies that kept prices lower. High prices are also reflection of insufficient market competition. Only six products (for five different DR-TB drugs) have been prequalified by WHO, and only four sources (for two different medicines) are recommended for purchase in 2011.

The World Health Organisation (WHO) responded to the growing need for affordable DR-TB drugs in 2000 by creating the Green Light Committee (GLC), which reviews governmental and non-governmental treatment projects and ‘green-lights’ them for access quality-assured drugs at reduced prices.

Although the GLC is theoretically a helpful initiative, its highly bureaucratic application process has prevented many treatment programmes around the world to become part of it. In 2010, only 12,000 patients were enrolled in GLC-approved treatment programmes, compared to 440,000 new cases and 150,000 deaths, according to MSF. Only 13 percent of the estimated DR-TB drug market is currently channelled through the WHO Global Drug Facility.

“The WHO has a responsibility in this disaster,” believes Goemaere. He says it took years of pressure from NGOs like MSF until the WHO agreed to establish the GLC. But the commission’s strict conditions and long-winded administration processes prevent many health care providers from benefiting from it.

“The GLC offers little incentive because its quality approval process is far too bureaucratic and centralised. The rules are self-limiting, making the WHO a gatekeeper instead of offering support,” says Goemaere.

WHO medical officer for TB in South Africa, Dr. Kalpesh Rahevar, acknowledges the GLC’s administrative barriers, but points out that the WHO has started a process to reform the GLC in early 2010. One of the planned modifications is to make participation in the GLC easier, he promises.

“We are looking at simplifying the GLC application process”, says Rahevar. “The WHO is also planning to broaden its mandate to monitor TB programmes worldwide, not only those participating in the GLC.” But until then, hundreds of NGOs and health departments have to continue purchasing DR-TB drugs from pharmaceutical companies that may offer uncertain quality and substantially higher prices. The South African Department of Health (DoH) belongs to this group. Instead of applying for GLC membership, the DoH purchases drugs at fixed prices directly from South African subsidiaries of American drug manufacturers Sanofi Aventis and Sandoz.

According to DoH acting director for TB advocacy, communications and social mobilisation, Garvon Molefe, the health department decided to purchase drugs exclusively locally, even if at a higher price, to benefit the country’s economy.

“The reason why the DoH is not following the GLC initiative is because, as South Africa is already facing alarming rates of unemployment, the DoH doesn’t want to disadvantage pharmaceutical companies (that employ South Africans) by procuring TB treatment from other countries,” he told IPS.

The DoH currently pays 4,400 dollars for the DR-TB treatment of one patient. Goemaere says, MSF, through the GLC, pays about 30 percent less for those drugs. That means that the humanitarian organisation can treat many more patients for the same amount of money.

Political will – or lack thereof – seems to be another deciding factors for the success of the GLC. “Applying to the GLC is the political decision of each government,” says Rahevar. “As WHO advisor to the South African government, I can only advise and encourage, not impose.” He is hoping the GLC reform measures, which he says will be announced within the next couple of months, will change the South African government’s mind.

Excerpt:

By Poindexter Sama and Jessica McDiarmid
FREETOWN, Jun 16 2011 (IPS)

Bubble-wrapped pills are scattered across the crude table in a busy market beside crumpled boxes of lubricant, paracetamol and anti-fungal powder.

Regulators say many of the drugs sold on the informal markets in Sierra Leone are fake or substandard, posing a huge risk to the public. Credit: Poindexter Sama/IPS

A young man approaches and mutters a few words. The proprietor shuffles through the piles of sexual aids that cover the table – generic viagra, ‘man-woman’ cream (lubricant), dubious-looking condoms – before cutting a section containing two antibiotic capsules off a sheath. He hands them over, collecting in return 600 Leones, the equivalent of about 15 cents.

So-called “drug peddlers” ply the streets of cities and villages across Sierra Leone and much of West Africa, selling pharmaceuticals, often counterfeit or substandard, at reduced rates.

Strides have been made over the past few years to ensure drugs are safe and effective, but medical practitioners still cite these drugs as one of the largest obstacles in their fight to save lives. In Sierra Leone, still struggling to overcome the devastation of an 11-year war that left the nation in ruins, efforts remain beset by hurdles such as weak infrastructure, a lack of regulatory regimes in neighbouring countries, and few resources stretched in many directions.

Pharmacies in Sierra Leone are regulated under its Pharmacy and Drugs Act. Enforcement has been stepped up substantially in recent years, but what to do about those peddling on the streets remains elusive.

Drug peddler Abubakarr Keai says the majority of his supply comes from Guinea, where drugs are sold at cheaper prices and easily smuggled in over West Africa’s infamously porous borders. Other times, he buys them from local pharmacies.

He’s been selling since the war – when the formal healthcare system disintegrated and peddlers were the only option – and says he’s never had a complaint about his products. He recommends drugs and describes how to take them, though he can’t read most of what’s written on the packaging.

Keai says police frequently harass drug peddlers. Occasionally, authorities seize his drugs and arrest him. Sometimes he even goes to jail for a while.

“But there are no job opportunities, so even if we are arrested, we’ll start selling the drugs again when we are released,” says Keai. “We are doing this to survive.”

The registrar of the Pharmacy Board of Sierra Leone, Wiltshire Johnson, tasked with regulating drugs in the country, says about half the drugs sold in Sierra Leonean pharmacies three years ago were fake or substandard. Now, Johnson estimates more than 95 percent of products from pharmacies tested by the board are real.

Johnson says Sierra Leone is left vulnerable, however, because while it has beefed up its monitoring and enforcement of the formal sector, the country imports all its pharmaceuticals – some 30 to 40 million dollars worth a year. A crackdown on formal imports has been largely successful.

“The people involved in the formal sector realise you can no longer bring bad drugs to Sierra Leone,” says Johnson. “Our big challenge is the informal sector, the illegal sector, the drug peddlers.”

Liberia and Guinea, which neighbour Sierra Leone, have virtually non-existent drug regulations. The borders between countries are porous, allowing traffickers to move supplies in with relative ease, and customs and border officials are poorly paid. It doesn’t take a large percentage of profits from a lucrative drug trade to convince someone to overlook a few cartons of packages of – supposedly – penicillin.

Johnson says the pharmacy board works with police and the judiciary to enforce the pharmacy act, but argues that tougher punitive measures are needed to deal with drug peddlers.

The current law tops the time in prison at two years and the fine at five million Leones, about 1,200 dollars.

But the actual punishments meted out are usually far lower – between 100,000 and 300,000 Leones, or 20 to 60 dollars – doing little to discourage the practice, says Johnson.

“It’s a mafia, they just pay the monies and go back to the street and sell,” he says. “Tougher penalties are the only way we can really change.”

The regulatory laws on pharmaceuticals are currently under review.

Umaru Kamara, a pharmacy technician at Connaught Hospital in Freetown, says many, if not most, of the drugs for sale on the streets are substandard or fake.

It’s a regular occurrence in the hospital for staff to notice that medication – which patients will buy outside for cheap prices instead of at the hospital pharmacy where drugs are sold on a cost-recovery basis – isn’t working. Investigations reveal that the drugs the patients bought aren’t what they should be.

The dangers of substandard and counterfeit drugs are many, says Kamara. For example, fake antibiotics lead to worsening infections and complications, while substandard antibiotics cause drug resistance.

“(Drug peddlers) either give the wrong dose, give the insufficient dose so it will have no effect, or give an overdose,” says Kamara. “They can kill thousands of people.”

While education campaigns seek to inform the public of the risks of fake or substandard drugs, poverty gets in the way. Drug peddlers often offer lower prices and will sell a single dose, rather than having to buy a course of treatment all at once.

“Drug peddling is directly poverty related,” says Johnson. “It’s a social issue of survival.”

From the peddlers on the street to the patients buying their products to the people smuggling cartons of weak amoxicillin through the jungle, crippling poverty – some 70 percent of Sierra Leoneans live on less than one dollar a day – means there are few other options.

In April of last year, Sierra Leone introduced free health care for pregnant and nursing women, and children under five, including free medicines, in a bid to improve one of the world’s highest rates of maternal mortality and infant death. The ambitious program has seen a huge rise in the number of women and children accessing treatment, but drug supply remains a challenge, driving many to the streets to find medicines even when they’re covered by the program.

“You can have all the doctors, all the free health care, but if you don’t have the medicines, people are still going to die,” says Johnson.

Excerpt:

By IPS Correspondents
WASHINGTON, Jun 15 2011 (IPS)

When the devastating ‘Boxing Day’ tsunami hit Sri Lanka in December 2004, claiming over 35,000 lives and rendering 1.5 million people homeless, the World Health Organization (WHO) was confronted by a second disaster soon after it arrived to begin relief efforts in early January.

For a population of nearly 20 million people, Sri Lanka was home to just 19 specialised psychiatrists – every single one of them concentrated in the capital city of Colombo.

Faced with thousands of decimated families, scores of orphans, countless refugees and other severely traumatised people, the WHO had to work quickly to prevent another crisis – one of lingering health problems caused by prolonged mental distress – from unfolding in the tsunami-wrecked island.

“We grabbed the opportunity and asked ourselves what we could do with local workers,” Shekhar Saxena, program manager of the department of mental health and substance abuse at the WHO told a gathering of health professionals at the Global Health Council Conference that opened in Washington D.C. Monday.

“We knew that community healthcare and social workers were just as well-placed – if not more so – to meet the needs of traumatised people during moments of crisis, so we seized the moment to start building local capacity,” he said.

While tackling the mental health issue in post-tsunami Sri Lanka, the WHO asked the question that not many humanitarian agencies stop to ask in the immediate aftermath of a disaster: ‘What do we want to see ten years from now?’

“Now, in 2011, Sri Lanka has mental health facilities in 20 of its 25 districts,” Saxena said at a panel aimed at addressing mental health needs in humanitarian settings Tuesday. “This, in a place where there is a lot of stigma and a lot of resistance, is no small achievement,” he said.

Saxena added that myths surrounding the provision of mental healthcare in humanitarian post-disaster or conflict settings – including the mistaken belief that community health workers and local general practitioners cannot be mobilised and trained to do the work of highly-qualified specialists – often prevents interventions that could avert protracted mental health-related problems.

“Members of the local community can be trained in very short time periods to provide curative and preventative treatments for everything from bi-polar disorder to schizophrenia while in the field,” Saxena argued.

Dispatches from the Field

The Global Health Council’s week-long conference, ‘Securing a Healthier Future in a Changing World’, was convened to address the challenges of rapidly changing global demographics, and pose the question: ‘What will the population look like in twenty years?’

Plaguing nearly 450 million people worldwide, mental illnesses account for 14 percent of the global disease burden, and well over 30 percent of all non-communicable diseases (NCDs), according to the WHO.

Yet, the John Hopkins Bloomberg School of Public Health reported in 2009 that the overwhelming majority of mental health patients – as many as 75 percent in developing countries – receive little to no treatment.

This figure climbs even higher in conflict or disaster zones, where the rush of search-and-rescue missions or emergency interventions often dwarfs the invisible plague of mental illness.

“We believe that governments and aid workers need to fully integrate the WHO Inter Agency Standing Committee (IASC)’s guidelines on mental health and psychosocial support in emergency settings into all aspects of humanitarian missions – including in the provision of sanitation, shelter and nutrition,” Inka Weissbecker, the global mental health and psychosocial advisor of the International Medical Corps (IMC), said at the panel on Tuesday.

“There is so much that can be achieved through effective psychological first aid,” she said, adding that effective interventions in medical health must flow vertically from the bottom up, with local, grassroots practices and practitioners informing the actions of aid workers and, ultimately, the decisions of policy- makers.

“While the work done in the moment is absolutely crucial, what is equally important is what comes after that,” Weissbecker warned, noting the tendency for mental health crises to be buried under the rubble of homes and corpses – generally resurfacing only after aid-workers have petered out and the resource pool is shallow.

“After the tsunami in Japan, one of the worst things for people was the lack of quiet houses in which to mourn the dead,” Weissbecker said. “IMC helped people to create these spaces.”

Experts believe that hearing community voices is of the utmost importance during times of emergency.

“We need to build evidence-based research and systems based on what works for whom,” said Judith Bass, assistant professor at the John Hopkins Bloomberg School of Public Health.

“Rather than randomised control trials, we need strong systems in place that can monitor the needs of the population, and involve them in their own recovery,” Bass said, adding that existing practices, data and populations must also be employed in addressing mental health in times of crisis.

Describing a joint project between IMC and the Japan-based non-profit Peace Boat, Weissbecker noted that community members in the Miyagi prefecture were mobilised after the quake to clear rubble and remove sludge. This partnership with locals had the double benefit of avoiding the cost of migrant workers from Tokyo, while simultaneously fostering a sense of solidarity in the community.

“In moments like this it is really important for people to feel a solid sense of purpose,” Weissbecker concluded.

Excerpt:

Three-year-old David bolts up from his feverish stooper as a needle pricks his thumb, producing a tiny bead of blood. He looks down horrified but is too exhausted to cry and falls back into his mother’s lap as the blood is wiped away

Juane K. Nabieu, a community health officer in the district's main Peripheral Health Unit. Credit: Meena Bhandari/IPS

Juane K. Nabieu, a community health officer in the district’s main Peripheral Health Unit (PHU) drops the specimen of blood onto a strip. Within seconds two fine lines appear and David’s mother Naomi Sam is told that her son has malaria.

Malaria is endemic in the country – it is one of the biggest killers of children. David is lucky. He is treated with the last batch of Artemisinin-based Combination Therapies (ACT) that Nabieu has just collected from the neighbouring district government drug storeroom.

But poor record keeping, wastage and theft may be responsible for the loss of a quarter of vital aid drugs that have gone missing, denying other children like three-year-old David the chance of survival.

The regular UNICEF stocktake found a preliminary figure of 25 percent of the aid was unaccounted for, UNICEF said in a statement on Jun. 14. The drugs are thought to include vital life-saving drugs like ACT.

A UNICEF representative said that the internal stock take began at the end of 2010, and has just been completed. It reviewed stocks from the rural health posts across the country in a bottom-up check of drugs.

It also follows reports from district hospitals across the country and PHUs about an ongoing shortage of ACT, vital in the treatment of malaria. At the Khailahun PHU there are only two more packets of ACT left – serving 156 PHUs. When the remaining doses run out, Nabieu, will refer his patients to the government district hospital.

“Most of the people who come here will not be able to afford the ACT sold privately – they rely on the free drugs,” he says sitting behind a desk with an array of medicine bottles all lined up in front of him. “You can see we have many drugs, but the supply of fast moving essential ones like ACT always arrives in spurts – every month there is a shortage, and every month there will be people who suffer because of it.”

Sierra Leone’s government took a massive step when it announced last April that health care for children under five and pregnant women would be free. The Free Health Care Initiative is 90 percent funded by international donors like the UK’s Department for International Trade and Development, the African Development Bank, UNFPA and 10 percent is funded by the government of Sierra Leone.

In Khailahun district, drugs that were given as aid by the Global Fund and UNICEF are reported to be found in private drugs shops and sold by street market traders.

“We have patients who come from neighbouring Liberia, which puts a strain on our resources, but the drugs in the local market may also be drugs that have come from Liberia or Guinea – the aid that comes into West Africa is generic and that makes it easy to sell anywhere,” Nabieu explains.

On the other side of Khailahun town, at the district hospital, things are no better. In the paediatric ward, tightly packed with mothers and babies all eerily quiet, nurse Alice Mansaray has a stack of paperwork and a new baby with complications from malaria to admit.

“Most children come to us with severe anaemia or convulsions – sometimes their mothers suppress their child’s fever with paracetamol, when there are no free stocks of ACT in their PHUs, and they can’t afford the private drugs.

“When I run out of ACTs I send them to a private drug store. They have to go because they can’t see their children die. We have seen more cases of malaria and more children with complications,” she says as she holds up a strip of ACT.

Though the government’s hospital monitors say malaria cases have decreased compared to last year in Khailahun, there is no record kept of how many patients come back with complications. There is also no record of those who were entitled to free drugs, or who had to purchase them from the private sector because of the shortage of aid.

The civil society organisation, Health for All Coalition (HFAC), implemented a monitoring system, parallel to the government’s. Alhassan Kamara at HFAC estimates that 45 to 50 percent of the aid that comes in disappears finding its way to the market – though no survey has been conducted to substantiate this.

“Our monitors travel in drug delivery trucks. We insist community and district hospital representatives receive the consignment.” This has reduced the “leakages” Kamara calls the thefts. “Transportation from district to the PHU needs to be strengthened. There is less transparency, and scope to sell on route.”

This is not the first time such irregularities have been discovered in Sierra Leone. In 2008 a BBC report discovered UNICEF’s malaria drugs in Kono (Eastern Province) were being re-sold in private pharmacies.

“If there was such mass pilfering, the system would collapse,” says Dr Amara Jambai, director of Disease Prevention and Control at the ministry of health and sanitation. “The community are very active and watch supplies very closely.”

Jambai admits that the capacity of the government is too weak to deliver the drugs to each PHU. “The cause of the shortage is not because there are thefts, but because demand is great, and the system is new.”

The district hospitals in Khailahun, Pujehan in the South, and Bo in Central Sierra Leone, say that when they have approached Freetown for ACT, they still have supply issues. Pujehan hospital said they had not received a delivery since February – though they had a small supply remaining of ACT, other essentials like antibiotics and paracetamol had long been unavailable.

Mahimbo Mdoe, UNICEF country representative says that UNICEF is due to take over the operation to run the logistics of the distribution of Free Health care drugs and supplies themselves. “We are in the process of hiring transport companies who will be responsible for the distribution of drugs and supplies from the District Medical Stores to the peripheral health units.”

“A year ago 80 percent of people didn’t go to the doctors because of the cost. Sierra Leone is a fragile state. The numbers of people accessing the aid for the first time is an important step forward,” Mdoe said.

Meanwhile, Naomi Sam says that she could not have gone to the private drug store to buy the ACT that has just saved David’s life if it were unavailable, because “I have no money,” she says simply. She knows that coming to the PHU means that David will get free treatment. But, the 20 or so women with sick babies waiting outside may not be so lucky today.

(*The story contained a number of errors. The original story stated that vital aid drugs have gone missing from the central government warehouse, they had in fact gone missing between districts and PHUs. Also, the Free Health Care Initiative is not funded by UNICEF but by international donors which operate through UNICEF and other United Nations agencies. UNICEF will be taking over the operation to run the logistics of the distribution of Free Health care drugs and supplies themselves and will not manage the central warehouse.)

By IPS Correspondents
JOHANNESBURG, Jun 15 2011 (IPS)

A reduction in red tape and an improvement in political conditions means that sub-Saharan Africa is becoming a more attractive destination for foreign direct investment, especially from India.

Stephen Gelb of the University of Johannesburg says there is more to trade than dollars and cents. Credit: Tinus de Jager/IPS

Oti Ikomi, group head of corporate banking products at the Ecobank Group, argues that the decrease in political risk and incidents of conflict in sub-Saharan Africa is creating opportunities. Ecobank is a regional banking institution with branches in west, central and east and southern African countries.

“Added to that, GDP (gross domestic product) on the continent is up 70 percent to 1.76 percent of the global total. While this is still very small, it is a substantial increase. Average inflation is dropping from 13.6 percent in 2008 to eight percent in 2010.

“Africa is the third fastest-growing region in the world, after the Middle East and Asia. But foreign direct investment is currently relatively flat compared to numbers from 2008.”

Ikomi says in addition to the favourable political conditions, red tape is also disrupting business less in Africa. In general, economic conditions are becoming more favourable: “It now takes two days, and three steps, to set up a company in Rwanda.

“Government debt is still comparatively low in comparison to the first world and access to this capital should be used to uplift communities in Africa. The fact is the African middle classes are growing rapidly. This means there is more money to spend on goods, creating more opportunities for investors,” Ikomi enthuses.

However, there still remains some caution about the overall conditions for foreign direct investment in Africa. Problems include the substantial lack of human resources and economic skills on the continent. Closer cooperation between African states and India and China could “do much to better the situation”, believes Ikomi. But the interaction must create a win-win situation for all parties.

Stephen Gelb of the University of Johannesburg says statistics show that trade between India, China and South Africa are steadily increasing. Figures from the South African Reserve Bank show that trade totalled 18 million dollars between South Africa and India in 2002. By 2009, these numbers had shot up to 342 million dollars.

Gelb says these numbers may be “a serious underestimation” of the actual trade that happens between India and South Africa. “The investment from Tata Holdings, alone, could be as much as 1.6 billion dollars.

“A large share of Indian investments moves via Mauritius, which then does not reflect on the score sheet. This is done for tax reasons.

“Another factor may be that the official data is simply wrong, as can be seen in the discrepancy between the South African and Indian trade statistics.” This makes a guess on the true value of the trade relationship between South Africa and India very difficult.

Gelb’s research shows that, in 2010, there were 93 Indian companies operating in South Africa, compared to 47 Chinese companies. Some 45 South African companies were operating in India and 32 in China.

Statistics show that four dollars out of every 10 dollars spent on investing in South Africa goes towards the manufacturing industry, despite local countries taking their money out of manufacturing, Gelb argues. “Another interesting trend is that these companies are looking to sell in the local and regional markets and are not looking to export the products back home.”

The Indian pharmaceutical company, Ranbaxy Laboratories, is also putting up the first new medicine production plant in South Africa in 20 years.

Gelb says statistics go far in alleviating fears that Africa is being unfairly treated in South-South trade. “A big fear is that both Indian and Chinese investment comes with imported labour. However, statistics show that this is simply not true. Both countries operate with more than 90 percent of their labour recruited in South Africa.”

Anthony Rayment, CEO of South African Coalmine Holdings, which belongs to a large steel manufacturer in India, agrees. “Perceptions are often not the reality, and that is certainly true of investment in Africa. Many companies are actively persuing direct investment on the continent.

“What helps Indian companies to invest is that the operating environment in Africa is similar to what they are used to. It is an emerging market; there is a lot of value that can be exchanged between the continent and India. The markets are well regulated. Entrepreneurs exist in both spheres. All of these factors lead to a similar feeling for investing.”

Africa receives some 12 percent of India’s outward investment, which is about 10 times higher than the global average. And this creates competition with western investment, which also benefits the continent in the long run.

Excerpt:

By Ranjit Devraj
NEW DELHI, Jun 15 2011 (IPS)

Cooperation between India and Brazil in pharmaceuticals and medical biotechnology has begun to falter, because Indian authorities would rather collaborate with western counterparts than those in developing countries, new research shows.

As a result, cooperation between the two countries, once touted as capable of solving public health problems in the developing world, has failed to come up with marketable products.

The study by the Research and Information System for Developing Countries (RIS), a publicly funded think tank based in New Delhi, cited as a reason for product failure the lingering perception in concerned Indian ministries and departments that “collaboration with the North (referring to developed countries) is much more valuable than South-South collaboration.”

India lags far behind Brazil and China in the number of papers co-authored with scientists from developing countries, in spite of frequently heard Indian rhetoric over the importance of South-South collaboration.

“India has to put its money where its mouth is in order for collaborations to succeed,” said Sachin Chaturvedi, a senior fellow at RIS who led the study. “This means that key ministries and agencies, especially the Department of Biotechnology, must genuinely ‘de-West’ themselves and start seeing the real potential of South-South collaborations.”

Leena Menghaney, a lawyer working with the Campaign for Access to Essential Medicines of the non- government organisation Médecins Sans Frontieres (Doctors Without Borders) told IPS concerned ministries in both India and Brazil need to build innovative mechanisms to facilitate access and sharing of products and technologies with developing countries.

“Particularly, these two emerging countries must steer away from the disadvantages of the northern intellectual property (IP) system which has traditionally been associated with blocking access not only to medicines and diagnostics but research tools as well,” she said.

The study, which is due for release this week, said India-Brazil collaborations have given Indian pharmaceutical firms increased market access in Brazil, as well as in other Latin American countries. The Brazilian market alone is expected to reach a value of 18.3 billion dollars by 2012.

A significant impact of the India-Brazil health biotech collaboration has been increased availability of cost-effective health products. Indian biotech firms have proven their abilities in process innovation, lowering the prices of such products as the vaccine against Hepatitis B.

Brazilian firms could also contribute cost-effective health products to the Indian market, given proper official support. In Brazil, for example, diagnostic kits for AIDS and leishmaniasis (a disease caused by a parasite spread by sand flies) are available at prices 30 to 40 percent lower than in India.

“Research collaboration has the potential to make these technologies available to the public in a way that would increase accessibility through affordability,” said Chaturvedi, adding however that poor product development was denying the public such benefits.

For instance, a leishmaniasis kit, ready in 2003 with the technology transferred to the Brazilian Centro de Produção e Pesquisa de Imunobiológicos (CPPI or Centre for Research in Immunological Products) in Parana State, is only now being adapted in India. A tuberculosis diagnostic kit developed in Brazil has also met a similar fate.

A joint team from the CPPI and the Jamnalal Bajaj Tropical Disease Research Centre (JBTDRC) at the Mahatma Gandhi Institute of Medical Sciences at Sevagram in India is now working to produce TB and leishmaniasis kits suited for India.

The RIS study said the driving force behind successful joint venture deals between Indian and Brazilian pharmaceutical firms has been a desire to tap the large Latin American markets.

“India’s success has depended on an ability to provide high quality drugs and intermediates at cost- effective prices,” Chaturvedi said. “The focus for now is on importation and marketing in Brazil, although research and development are on the cards for the future.”

Indian participation in Brazil began in 1997 when then Brazilian health minister Jose Serra invited Indian companies to invest in his country and use it as a production hub for pharmaceuticals rather than as a mere export destination.

Ten years later, however, Brazil increased import duties on pharmaceutical products, making it difficult for Indian firms to rely solely on exporting their products to Brazil, pushing them to set up local operations or go into collaborations.

Yet, Indian pharmaceuticals in Brazil have expanded over the last decade. In 1999, India’s pharmaceutical exports to Brazil were worth seven million dollars, but by the end of the decade, the figure had grown to 115 million dollars.

Items exported by India to Brazil include antibiotics, vitamins, corticosteroids, vaccines, reagents and surgical instruments.

Brazil accounts for roughly three percent of India’s total pharmaceutical exports, which in 2010 stood at nine billion dollars. India is the world’s fourth largest exporter in terms of volume.

The RIS study quoted an Indian entrepreneur saying that collaborations with Brazil were catalysed by the promulgation of Brazilian rules promoting the manufacture of generics.

Indian entrepreneurs employed a variety of strategies to penetrate the Brazilian market, ranging from setting up manufacturing plants to forging joint venture alliances, and pursuing acquisitions and mergers.

For example, the Indian company Glenmark acquired the Brazilian firm Laboratories Klinger in 2004, and set up a subsidiary in Brazil. Indian companies with subsidiaries in Brazil include Cellopharm, one of the fastest growing firms in the generics field with business valued at 98 million dollars.

India-Brazil entrepreneurial linkages cover various high-tech areas. Brazil, for example, has emerged as a major centre for organ transplants requiring immunosuppressant drugs which Indian companies like Biocon have readily supplied.

India and Brazil became natural partners in the healthcare and pharmaceutical sector, especially when multinational companies all but abandoned research for newer drugs for TB and malaria pandemics.

To be truly meaningful, Menghaney said, collaboration between India and Brazil must, in addition to generics, take on the production of drugs against infectious diseases urgently needed in developing countries.

Excerpt:

By Joshua Kyalimpa and Terna Gyuse
KAMPALA, Jun 14 2011 (IPS)

GAVI, the Global Alliance for Vaccinations and Immunisation, secured pledges of 4.3 billion dollars from donors in London on Jun. 13 with the aim of securing funding to ensure life-saving vaccinations for every child on the planet.

As many as two million children – overwhelmingly in low-income countries – die each year from diseases which could be prevented by vaccinations such as pneumonia and diarrhoea. GAVI’s programmes have already immunised well over a quarter million children in the past 10 years, and if the pledges from the London conference are honoured, the money will allow the alliance to reach a further 243 million by 2015.

Entering an age of immunisation

Thanks in large part to GAVI, the past decade has seen renewed attention to developing vaccines against diseases affecting the world’s poorest, including meningitis, pneumococcal disease and malaria.

Among the organisations whose investments have supported a breakthrough in prevention of one of the world’s most dangerous diseases is the Malaria Vaccine Initiative (MVI), a global programme of the independent non-governmental organisation PATH.

Malaria vaccines are a long-overdue means to prevent infection and work towards eradication of the disease. The eradication of malaria in the developed world has been cited as one reason developing a vaccine previously received little attention from pharmaceutical companies or government research facilities.

The debut of a first vaccine against malaria, for example, could now be less than five years away – final testing is under way in seven countries.

Yet developing an effective vaccine is only part of the challenge – effectively integrating it into public health will require careful planning and execution.

The recent history of Africa’s immunisation programmes – from the re-emergence of polio in West and Central Africa, to the persistence of meningitis and infant pneumonia – is littered with promising solutions that have failed to have the expected impact. Against a background of poverty and conflict, vaccination campaigns have been hampered by weak infrastructure, insufficient staff or funding, and even popular resistance to vaccinations.

Across the continent, there is new attention to the practical requirements of effective immunisation campaigns. Dr Seraphine Adibaku, head of Uganda’s malaria control programme, says his country has already started raising popular awareness of the coming availability of a malaria vaccine, with the most recent meeting of officials from the ministry of health and developers of the vaccine and other stake holders held in May.

“We are conscious not to cause excitement because it can lead to undesirable consequences but we have to tell the people that a vaccine could be here sooner than later,” says Adibaku.

Uganda is banking on using infrastructure like ware houses and refrigerators from the Uganda National Expanded Program on Immunisation, which is already in place and has been used on previous immunisation programmes, to roll out the malaria vaccine. Adibaku says training will be given to vaccinators on handling the new vaccine with funding from GAVI, all of which shall be in line with the national vaccination policy.

Adibaku has questions about the vaccine: “We do not know yet for how long the vaccine will offer protection. Do you get protection for six months, one year, or for the rest of your life? These are some on the questions not answered yet.”

He says for a vaccine to be effective, it should offer a high level of protection – between 80 and 90 percent – provide long-lasting resistance, and be affordable.

New resolve to get it right

The London conference on funding for vaccines is an important signal that the value of immunisation programmes is understood by both donors and governments seeking assistance.

“When GAVI got started, it was something that had never been tried before,” says Dr Helen Saxenian, from the Results for Development Institute.

“The idea was that prices would fall (once large-scale demand for vaccines was created) and so some countries would be able to afford them without assistance. GAVI quickly realised prices were not – and are not – falling fast enough, and realised the alliance would need to be involved with subsidising vaccines for a longer period of time.”

The reasons vaccine prices have not fallen include the cost and complexity of producing newer vaccines, as well as limited competition between a very small number of producers; but Saxenian points out that there have been some successes, notably for the rotavirus and pentavalent vaccines.

In 2008, GAVI introduced a requirement for recipients of assistance to co-finance the procurement of vaccines. The Results for Development Institute recently evaluated GAVI’s policy on co-payment, to assess the ability of countries receiving assistance to cover their share of the costs.

“The finding,” says Saxenian, “is that low-income countries will not be able to pay the full cost of vaccines any time soon. However co-payments (from national budgets) at 20 cents per dose would be affordable for almost all countries.”

Shared responsibility maximising impact

She argues that the co-financing requirement has been a valuable learning process for all involved. It has strengthened forward planning by national health ministries, communication between health ministries and finance ministers who must make appropriate and timely allocations from national budgets, and between various countries and the UNICEF Supply Division, through which all of Africa’s GAVI aid recipients purchase vaccines to meet their obligations.

Aid recipients have said that they prefer to contribute part of the cost of paying for vaccines, says Saxenian. “Immunisation managers would like to see national budgets for vaccinations grow. It’s a key priority for healthcare, and since one can’t assume that donor assistance will last forever, they would like to see national budgets for it grow,” she told IPS over the phone from the United States.

“A basic way of thinking about this is that if something is completely free, there’s not as much of a sense of ownership as when you’re paying for even part of it. When it’s free, then countries may think, I’ll take it, whether they’re ready or not to adopt it.”

Adibaku says that when one considers the cost of Malaria to the national economy, Uganda should be able to contribute to the vaccination programme but if it is within the range of what they have been spending on the disease

Alongside the pledges from public and private donors to support immunisation, developing countries also renewed their commitments to co-financing in London, with GAVI estimating their contribution will reach 100 million dollars a year by 2015.

Developing countries could be required to make substantial contributions towards a malaria vaccine but this could be a worthwhile investment considering the amount of money the economy looses because of their illness.

Excerpt:

By Charles Mpaka
BLANTYRE, Jun 9 2011 (IPS)

As government prepares to roll out the expensive new antiretroviral treatment regime recommended by the World Health Organisation (WHO) this month, there are fears about the programme’s sustainability after two recent proposals for funding were rejected by the Global Fund.

The antiretrovirals government seeks to change. Credit: Charles Mpaka

But the new regime costs almost five times as much as the current one. Principal Secretary for HIV/AIDS and Nutrition in the office of president and cabinet, Mary Shawa, says government currently spends about 34 million dollars annually on ARVs. The new regime will cost up to 105 million dollars a year.

But she insists that despite the fact that the Global Fund has rejected two proposals from Malawi worth a total of 564 million dollars, government will go ahead using its own resources to meet the cost of the new treatment regime. “The president has directed that we migrate to the new regime,” she says.

But the Global Fund, United Nations and Department for International Development (Dfid) support 80 percent of Malawi’s health budget.

Reasons for the rejection have varied. Some say it was due to government’s failure to include in its proposal minority groups, such as same sex relationships, which are illegal in Malawi. Shawa says, however, that government included gays and lesbians in its proposal.

She described the rejection as normal and said government would find a way of ensuring that patients access the new treatment this year.

But the shortage of aid is not just from the Global Fund. The British government announced in May it is suspending all new aid to Malawi following the expulsion of the British envoy for accusing President Bingu wa Mutharika for being autocratic. Germany is also withholding part of its aid for alleged human rights violations by government. This has led to fears that Malawi will not manage the new regime.

But government has announced it is migrating to the new regime regardless and will be able to fund the programme for the next four and half years using its own resources. According to a study commissioned by government on how to implement the new ART guidelines, government will now have to provide treatment to more people. The study found that adopting the new procedures would entail that people living with HIV/AIDS would have to start taking drugs at a higher CD4 count of 350. This would raise the total number of patients on ART by 50 percent. Currently, there are 250,000 people receiving free treatment in public hospitals in Malawi, government records say.

Asked where exactly government would get the money from other than the Global Fund, Shawa said the money will come from other sources including domestic ones. But an inside official at the National Aids Commission says government is preparing another proposal to the Global Fund for the next round.

“I wouldn’t lie that government can manage it all alone for too long. For now though, the two rejections (by the Global Fund) helped government to look elsewhere for money, hence the current position that we can still support the programme for some time. If anything, absence of donor money means resources would have to be taken from other sectors. But we are confident we won’t go in that direction,” said the source.

Health activists are unsure whether government can sustain the new programme without Global Fund support but they applauded government for migrating to the new regime.

Martha Kwataine, the executive director for Malawi Health Equity Network (MHEN), a grouping of non- governmental organisations in health, says it is the constitutional mandate of government to provide quality health care services to its citizens regardless of how much it costs.

“The cost (of running the new regime) is very high but quality has a price. The lower the price, the lower the quality, and consequently the negative side effects of the drugs. The cost is worth it because there is no price tag for life. Considering the negative side effects that people living with HIV have had, especially women, it is time for Malawi to change to the new regime,” she said.

And there are some who cannot wait for the new regime. While waiting in a queue to get her antiretrovirals at Chiradzulu District Hospital just outside Blantyre, a female patient showed IPS her legs claiming they were disfigured because of her ART.

“Honestly, the only good thing with these drugs is that I am still alive. But the side effects make me very uncomfortable. My legs were not like this. When I started taking the drugs in 2008, I felt pain in the legs for about four weeks. Doctors just said it was the side effects of the treatment,” she said, opting for anonymity.

Two other women on the queue complained about experiencing nausea and stomach protrusion.

The last time Malawi reviewed its AIDS treatment protocol was in 2008 when it adopted the current first-line combination of stavudine, lamivudine and nevirapine.

Excerpt:

By Isaiah Esipisu
NAIROBI, Jun 8 2011 (IPS)

Soon chatting to ones friends or family over a mobile phone could mean that an HIV positive person will receive sustainable antiretroviral treatment (ART) that could prolong their life. That is if civil society in Kenya has its way.

A medical expert at the Kakamega General Hospital opens a cabinet with antiretrovirals. Credit: Isaiah Esipisu/IPS

Some of the proposals that civil society has presented to parliament for cabinet deliberation include; imposing a ‘negligible’ levy on every call made using a mobile phone, introducing a similar levy on individuals living in the diaspora, and removing all Kenyans with insurance cover from free medication schemes because their insurance can easily pay their medical bills.

“If the proposal finds favour among the law makers, then the funds raised from such levies will go a long way to scale up the number of Kenyans living with HIV/AIDS who need to be enrolled on antiretroviral therapy, and sustain treatment in case the donors pull out or reduce the funding,” said James Kamau from the non-governmental organisation, Kenya Treatment Access Movement. The organisation advocates for universal access to treatment, care and support for all people living with HIV in Kenya.

Kamau, who is HIV positive, knows how important it is to ensure that ART is sustainable. “I discovered that I was HIV positive 24 years ago. And since I was lucky to access the antiretroviral therapy in good time, I am still alive and working like any other Kenyan. Yet, my life can only be sustained further if I continue taking the drugs,” he said.

Two years ago, the Obama administration considered flat-lining its funding to the President’s Emergency Plan for Aids Relief (PEPFAR). PEPFAR, which is the largest component of the U.S. President’s Global Health Initiative programme, solely funds all paediatric HIV management and Prevention of Mother to Child Transmission programmes in Kenya. It led civil society to investigate alternative ways to fund the programmes.

In Kenya, it is estimated that 1.4 million people are living with HIV, among them, 760,000 have full- blown AIDS. But only 343,000 Kenyans have access to the life-saving drugs.

According to Dr. Nicholus Muraguri, the head of the National AIDS & STI Control Programme (NASCOP), 90 percent of HIV/AIDS programmes in Kenya are donor funded.

“It is a pity that we entirely depend on the donor community to fund such important programs,” said Muraguri.

However, Muraguri noted that in some cases, the donor community is politically driven, meaning that there is a possibility of it being frozen without warning. “Other than this, rich countries will always prioritise their local challenges before they consider supporting donor agencies,” he said.

Two months ago the Japanese government, a major supporter of the Global Fund, announced that it intends to reduce its contribution to the Global Fund for HIV/AIDS, malaria and tuberculosis(TB), in order to spend the resources on reconstructing the country in the wake of the recent tsunami and earthquake.

“We are totally supporting civil society in agitating for domestic funding of HIV/AIDS treatment through additional taxes because the government has not been able to support the (HIV/AIDS programmes) through the national budget,” said Muraguri.

According to Kamau, civil society is targeting mobile phone users because nearly all other sectors have already been overtaxed. “What we are asking for is a 10 Kenyan cent levy for every phone call made from the country. And if managed well, several lives will be saved,” he said.

Zimbabwe was one of the first countries in Africa to develop a comprehensive national AIDS policy by introducing an AIDS levy through an act of parliament. Through the scheme, all taxable monthly incomes are taxed, and the fund goes directly to help people living with HIV to access treatment.

In a similar program, UNITAID – an international facility for the purchase of drugs against HIV/AIDS, malaria and TB in developing countries – has managed to raise about two billion dollars since 2006 through taxes on airline tickets in 15 countries, according to a statement by the organisation.

However, more needs to be done in order to ensure that whatever money raised will be well spent. Kenya is among 10 other countries being investigated over the improper use of money meant for fighting HIV, malaria and TB donated by the Global Fund.

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By Julio Godoy
PARIS, May 30 2011 (IPS)

Pharmaceutical industries in emerging markets are shifting their focus away from poor to developed countries, which will affect access to cheap generic medicines. Poor states should tackle this development by capitalising on the international trade exemptions they still enjoy regarding medicines as “intellectual property”.

These comments come from a new report by the United Nations Conference on Trade and Development (UNCTAD), titled “Investment in Pharmaceutical Production in the Least Developed Countries”, or LDCs.

Michelle Childs, director of policy and advocacy for Médecins sans Frontièrs, agrees with UNCTAD’s call to extend LDCs’ exemption from intellectual property requirements (such as patents) beyond 2016. “LDCs should already be advocating to extend the exemption,” Childs told IPS.

But UNCTAD also notes that, while governments should encourage the creation of local generic pharmaceutical industries in poor countries to guarantee access to basic medicines, meeting all the conditions that could enable foreign investment could be so onerous as to render such a proposal practically unfeasible.

An LDC is a country that has a gross national income per capita of less than 905 dollars, lacking in basic economic capabilities and with very low indicators in human development factors such as nutrition, health and education and adult literacy.

Presently, 48 countries are considered as LDCs, of which most are in sub-Saharan Africa.

Despite the enormous increase and diversification of global pharmaceutical production during the past 20 years, most of the populations of LDCs “still lack access to much needed medicines”, according to the report’s lead author Kiyoshi Adachi, chief of UNCTAD’s intellectual property unit in the division on investment and enterprise.

Adachi recalls that some emerging developing countries, such as Brazil, India and China, have been able to develop a large generic medicines industry based on “their ability to reverse-engineer medicaments patented elsewhere”, thus becoming “important players in providing other developing countries with generic medicines”.

However, Adachi notes, these large generic pharmaceutical industries are now “becoming increasingly interested in selling their medicaments to developed country markets, and are beginning to partner with research and development-based transnational corporations in the sector”.

This shift may lead to a decrease in generic medicines on offer to LDCs.

LDCs can tackle these recent developments by capitalising on the exemptions they still enjoy of not having to offer intellectual property protection to pharmaceutical products patented in industrialised countries. These trends that could be alleviated by larger generic pharmaceutical manufacturers’ increased engagement in foreign direct investment in LDCs to produce medicines.

Their governments and international investment promotion agencies should “encourage investment in (local pharmaceutical production) in a manner that meets important public health objectives in a financially sustainable fashion”, Adachi suggests.

In terms of World Trade Organisation (WTO) treaties and the agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPs), LDCs enjoy exemptions until Jan. 2016.

The exemptions may be prolonged beyond this date, if the WTO agrees on a further extension of the waiver granted to the LDCs.

However, the study also warns that LDCs lack many of the important prerequisites indispensable to attract foreign direct investment in the pharmaceutical sector. UNCTAD lists the industrial and health policy conditions LDCs would have to satisfy to launch feasible local pharmaceutical industries.

These prerequisites vary from human resources to basic infrastructure such as reliable power and clean water and efficient institutions such as a functioning national drug regulatory authority. It includes timely and cost-effective access to key inputs, especially active pharmaceutical ingredients.

The encouragement of foreign investment should go beyond mere industrial policy measures. Governments of LDCs would have to ensure “that the push to support the local production of pharmaceuticals through foreign direct investment and related technology transfer addresses real (local) public health needs”.

UNCTAD also promotes the idea that LDCs would have to guarantee the rule of law and that foreign investors should have the right to repatriate profits – despite the fact that such conditions translate into reduced controls on capital transfers and taxes, with resultant revenue losses.

The long list of difficult conditions that LDCs would have to fulfil, added to the comparative advantages other countries already enjoy, makes it appear as through the UNCTAD proposal is more of a warning than a support for such endeavours. It also says, “it may not make sense for all LDCs to aspire to scaling up their local production of medicines”. Childs from Médecins Sans Frontières (MSF) agrees that not all LDCs will be able to launch feasible pharmaceutical industrial production. “But key countries, such as Uganda, can do it and already benefit from economies of scale by engaging in large-scale production of antiretroviral medicines.

“It is a joint venture between Uganda and India, with considerable technology transfer, and is operating successfully.” MSF is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, healthcare exclusion and natural or human-made disasters.

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By Charles Mpaka
BLANTYRE, May 25 2011 (IPS)

In the shade of a leafy mango tree at the rural Chipho Health Centre in Thyolo, southern Malawi, Melifa Faison sits looking frequently down the road hoping to see an ambulance. Lying beside her is her 6-year-old daughter, weak with malaria.

The medical assistant has referred the child to a larger health centre 22 kilometres (km) away for proper treatment.

“He (the medical assistant) says she will need to be put on a drip and they don’t have the supplies,” says Faison.

The centre does not have the first line drugs for malaria, the top killer of children in Malawi. This is Faison’s second visit in 10 days. On the first visit her daughter was given painkillers.

“I was informed there was no medicine (for malaria) then,” she says.

Located in the border with Mozambique, Chipho Health Centre is the only one in the catchment area of 16,500 people, according to staff at the centre. It is 65km away from the district hospital along a rocky and rugged road that passes through several hills.

McOwen Chagwa is the medical assistant here. He relies on a radio communication system for emergency calls for an ambulance and supplies. There are no private pharmacies in the area.

“It’s difficult working here. What makes life tougher is I can’t assist people properly because of the shortage of medicines and equipment,” says Chagwa.

Chagwa explains that the health centre regularly sends the list of drugs and equipment it requires to the district health office. But the medicines hardly come on time.

“That becomes a problem especially for children who form the largest number of our clients here,” he says.

He is the only qualified medical worker at the centre. The nurse left two weeks ago because she had found another job in the city.

Health experts say inadequate number of nurses and pharmacists is among the leading factors denying people access to medicines in Malawi.

Studies by Malawi Health Equity Network (MHEN), a group of civil society organisations in the health sector, show that while the Central Medical Stores, government’s drug procurement agency, may stock up to 85 percent of the essential drugs, district hospitals do not have most medicines because of shortage of staff to process the ordering. This affects availability of the medicines in outlying posts.

Official figures at the department of health show that by December 2009, there were only two fully qualified pharmacists in Malawi. There were also two pharmacy technicians in each of the 28 districts in Malawi.

In 2010 20 new pharmacists graduated from the University of Malawi’s College of Medicine. This was the first crop of students in Malawi to train as pharmacists following a government programme to address staff shortage.

But the number is still too inadequate to meet the demand for staff for drug procurement for hospitals, says MHEN’s executive director Martha Kwataine.

“Pharmacists are the ones supposed to process drug requisitions from Central Medical Stores through district hospitals. But we know Central Medical Stores always complains that orders come in late. It’s because hospitals don’t have the right staff to do the ordering,” says Kwataine.

Unavailability of essential drugs has been another outstanding problem. Hardest hit are areas like Chipho because they are difficult to reach and are shunned by medical personnel due to lack of infrastructure such as electricity and good housing.

In 2000, government launched the essential health package (EHP) aimed at improving access to health services in public hospitals. The plan included training medical staff and increasing availability of medicines.

Health rights activists say the programme has helped to improve access to medicines and health services through incentives for retention and recruitment of staff. But the situation is still as bad, they say.

The EHP contained 150 types of essential medicines to treat over 11 health conditions. A 2008 MHEN study found that it was still difficult for most rural communities to access free medicines from public clinics. Only 20 percent of those medicines were available in most rural hospitals. In response, civil society organisations launched a campaign against drug stock outs in 2009. Three years on, MHEN says the campaign has helped to make government aware of its obligation and moved it to act accordingly in some cases. But the battle is far from being won. Still critically understaffed and lacking in essential infrastructure such as roads and vehicles to transport medicines, most rural locations are still poorly serviced, it says.

In Thyolo the international Medecines Sans Frontieres (MSF) runs an HIV/AIDS programme. But it also assists government in delivering patients between health centres.,However, MSF winds up its programme in 2013 and people are worried.

“Once MSF leaves, the crisis will deepen. Already, it’s common to see women delivering in tea bushes while on their way to hospital. For us, the choice is between a badly serviced health centre and a traditional healer,” said villager Felix Yaruwera.

During the rainy season, the road to Chipho is impassable. The alternative route is 200km long. “That leaves us out at a critical time. Malaria is rampant in rainy season. So, I would say many children do die,” says Chagwa.

Spokesperson for department of health Henry Chimbali admits that most rural areas in Malawi are yet to see “significant improvement” in delivery of health services.

He says government has since drawn up a plan to make use of health surveillance assistants already available in the communities to attend to most basic health concerns such as fevers, headaches and diarrhoea and accelerate efforts on preventive measures.

Chimbali says the assistants will not be turned into clinicians. But rather, if they get more involved, they will bridge the human resource gap, therefore allowing medical staff time to also attend to drug orders and distribution.

He also suggests that bringing hospitals closer to people will increase access to medicines.

“Ideally, the plan is to have a health facility within a radius of 8km. That’s still a long way off. So, we are introducing mobile and village clinics to service the underserved areas,” he says.

Meanwhile, Faison has been waiting for two hours. The longer the ambulance takes to arrive, the more anxious she gets at the possibility that it might not come. “Sometimes, it doesn’t come until the following day. I pray that shouldn’t be the case today. My daughter is not well at all,” she says.

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By Louise Redvers
JOHANNESBURG, May 23 2011 (IPS)

Fixed targets for universal access to AIDS treatment and funding to make it achievable are what HIV and AIDS organisations want from the upcoming United Nations General Assembly Special Session due to be held in New York next month.

Due to be held in early June and attended by international policy makers and heads of state, this meeting will shape the direction of the global response to HIV and AIDS for the next decade and beyond.

The 2006 Special Session of the General Assembly (UNGASS) and subsequent creation of the Global Fund grant distribution body were instrumental in mobilising funding for the expansion of antiretroviral treatment (ART) programmes, which now reach roughly five million people.

But campaigners stress that this momentum must be maintained to avoid undermining progress made so far in the fight against the disease and funding shortfalls need to be addressed.

Anton Kerr, head of policy at International HIV/AIDS Alliance, said: “We are at a pivotal moment in terms of deciding what the commitment will be going forward.

“HIV has been slipping off the political agenda and you’ve also had the financial crisis, so its crucial that UNGASS secures that high level political will that will unlock money and commitment in the years to come.

“Without political commitment, there is no obligation for governments and donors to act and there will be serious long-term impacts from these decisions.”

In a bid to secure funding and political commitment, groups like International HIV/AIDS Alliance want to underline the benefits of ART as not just a treatment method but also as a tool to reduce transmission.

An United States National Institutes of Health reports revealed in May that if an HIV-positive person adheres to an effective antiretroviral therapy regimen, the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96 percent.

This backs up a similar study published in the United Kingdom’s health journal The Lancet in late 2010 and UNAIDS has suggested that scaling up joint treatment and prevention strategies could cut new infections by half.

“Increased access to ART has not only saved millions of lives, it has also cut the transmission rate,” explained Mara Kardas-Nelson, an access and innovation officer with Médecins Sans Frontières (MSF).

She added: “If people get onto ART early it has a community-wide impact, it’s not just an individual gain.

“People on ART are also living healthier lifestyles so the associated healthcare costs are reduced in terms of hospital time and other medicines, and they are living longer and are able to be more economically active.”

Kardas-Nelson said it was understandable that there had been a drop in support for international causes following the global financial crisis and increased domestic spending pressures.

But she urged donors to look at ART funding as an investment that would pay off in the longer term.

“ART is proven to reduce new infections so this will reduce treatment needs in the long term,” she said. “Money that is invested now will save money in the longer term.”

Finding that money though may not be so easy. Following unfilled pledges from its donors the Global Fund suspended grant allocations during 2011 and applicants who were refused money in 2010 could have to wait until 2013 to receive any cash.

The impact of a lack funding for ART programmes was one topic discussed in the MSF report “Getting Ahead of the Wave” published in May.

Looking at 16 countries in Africa, Asia and Latin America that account for 52 percent of the global AIDS burden, MSF evaluated the impact ART had in those countries and other developments in HIV and AIDS responses.

It found that greater access to ART had reduced HIV-related deaths, lowered infection and deaths of tuberculosis and greatly lowered healthcare costs as people were spending less time in hospital and needed fewer supplementary medicines.

In the Cape Town township of Khayelitsha, where an estimated 16 percent of the adult population of 500,000 is HIV-positive, ART was first provided in 2001 and the study notes that as ART provision increased, so new infections fell.

The study warned, however, that while 12 of the 16 countries evaluated had changed treatment protocols to get people onto ART earlier and 14 had adopted better-tolerated medicines, several, including Malawi and Zimbabwe were struggling under financial constraints.

It also noted that in most of the countries it studied still only around half of people in need of ART drugs were getting them.

MSF concluded that progress in the fight against HIV/ AIDS while positive in many aspects still remained “volatile” if ART strategies could not be sustained in the long term.

U.N. Secretary-General Ban Ki-Moon has called for a target of at least 13 million people to be receiving treatment by 2015, others, including the International HIV/AIDS Alliance, want 15 million, which they say will still offer 80 percent coverage.

Kerr stressed that all targets must also be accompanied by clear measurement indicators to allow detailed tracking and progress analysis.

He added that more effort was needed to create more innovative financing models, and build on existing schemes such as patent pools, which were working to reduce the cost of medicines.

The MSF study did note that there had been great strides in the past decade in terms of reducing drug bills and widening access.

It reports that competition from generic manufacturers has driven the price of the most-commonly- used antiretroviral combination down from more than 10,000 dollars per patient per year to 67 dollars today – a decrease of 99 percent.

Another important step forward has been the introduction of simpler diagnostic tests which can be used in remote areas without electricity and by minimally-trained health workers.

MSF’s Kardas-Nelson said medical innovation was crucial to continuing to reduce costs and increasing accessibility.

“We need innovative diagnostic tools, innovative ways to getting treatment to people and innovative new medicines,” she explained.

“Innovation goes hand-in-hand with increasing access to treatment,” she added.

Despite the advances noted by the MSF report over the last decade, some 10 million people still need ART treatment.

Tido von Schoen-Angerer, executive director of MSF’s Access Campaign, said it was crucial that June’s UNGASS delivered.

He said: “With the right policies in place, we could triple the number of people on treatment without tripling the costs.

“But if key donor governments don’t support a treatment target, they are sending a clear message that they do not intend to ever come to grips with this pandemic.”

The U.N. General Assembly Special Session, which some believe may be the last of its kind to be held, takes place in New York June 8 – 10.

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