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Target-setting may undermine HIV/AIDS treatment

By Thompson Ayodele

The Punch, Wednesday, 1 Dec 2010

TODAY, the world marks the annual World AIDS Day with the theme: Universal Access and Human Rights. Africa, the disease’s epicentre, is home to sixty-seven per cent of people living with HIV/AIDS. HIV/AIDS is not only a human tragedy robbing people of their lives and children of their parents, it is also an economic tragedy.

Given the damage already done to African economies by decades of misguided policies, it is important to provide treatment to victims and prevent the spread of the disease. Globally, about 33 million people are living with HIV. Last year, there were 2.6 million new HIV infections. According to the UN’s programme on HIV/AIDS, only five million people had access to anti-retroviral drugs between 2004 and 2009. Despite the huge financial and global commitment, deaths from HIV/AIDS-related illnesses under the same period merely reduced from 2.1 million to 1.8 million.

Unmet goals and missed targets have characterised HIV/AIDS treatment programmes. In 2003, the World Health Organisation set a goal of treating five million people by 2005. Despite the media fanfare that characterized it, less than one million were treated. In 2006, the UN member states agreed to achieve universal access to HIV prevention, treatment, care and support by 2010. Many countries also set individual target dates.

A few days to the end of 2010, this goal and target appear unrealistic. According to a 2010 WHO report, only 37 per cent of those in need of treatment in Africa have access to the appropriate medicines to fight the disease.

Target-setting can be a good way of keeping health ministries focused. But lack of access to life-saving medicines suggests treating and delivering appropriate medicines to millions of victims and it requires more than setting targets. Of the number of who need treatment in Nigeria, only 31 per cent of them are getting it. In West and Central Africa, large amounts of money are spent on purchasing antiretroviral (ARV) drugs but poor distribution networks deter HIV patients from getting them.

In setting their universal targets, WHO and UNAIDS apparently ignored the many different challenges confronting health sectors in diverse countries.

Setting a noble goal has triggered unintended consequences. The HIV and Aids industry has grown in size and budget. For instance, the Global Fund To Fight Aids, Tuberculosis and Malaria budgetted $11.7 billion for the next three years. This represents an increase of $2 billion over the previous budget. Yet, dramatic increases in funding require increases in transparency and accountability, something that has been lacking.

The 2006 Global Corruption Report produced by Transparency International reported that about $48 million donation meant for HIV/AIDS treatment could not be accounted for by the officials of Kenya’s National AIDS Control Council. In June this year, Global Fund suspended health funding worth over $300 million to Zambia over alleged corruption. Funding to Uganda was also suspended five years ago over mismanagement. There were reports last year of alleged misappropriation of about $2 billion HIV/AIDS funds in Nigeria.

Government’s policies in Africa have thwarted the set goals and targets. Aside from huge tariffs imposed on imported drugs in some African countries, sometimes, a change in customs officers brings about a new interpretation of the tariff regime. Moreover, it takes about two years to register new anti-retroviral drugs for instance in South Africa. This creates supply gaps exploited by counterfeiters. Recently, the Medicines Control Authority of Zimbabwe issued a warning that drug dealers were importing and selling counterfeit Anti-Retroviral.

As each country tries to meet set targets, it puts unnecessary pressure on them to source drugs from doubtful sources. In March last year, the Dutch authorities intercepted a shipment of abacavir sulfate tablets, a second-line ARV medicine meant for patients in Nigeria. The Dutch government claimed the drugs were counterfeit while the Nigerian government insisted they were legitimate ARVs for patients who had developed resistance to first-line medicines.

Patients in Africa have every right to safe and effective medicines, just as patients in the West do. With the prospect of drug resistance a constant threat, treatments for Nigerians and all Africans should meet the quality that would be administered in the developed world.

Over and above concerns about drug quality are the massive structural problems militating against effective healthcare delivery that are often not addressed. The basic infrastructure to deliver medicines is lacking.

Power supply to refrigerate drugs is erratic, coupled with poor transport system. The morale among healthcare professionals is low. The ratio of doctors to patients falls short of World Health Organisation recommended ratio of one doctor to 1000 people.

A severe shortage of doctors in South Africa has resulted in a doctor patient ratio of 1-4,000, leading to overwork. In Nigeria, many states have fewer than around 100 trained doctors for a population of more than 1.5 million. Addressing these local challenges remains one of the ways in which treatment of HIV/AIDS and indeed other pressing health problems could be enhanced.

It is pointless setting more targets without addressing the key issues that prevent appropriate medicines from reaching those who actually need them. It is up to African governments to solve the obstacles to access to medicines rather than attempting to comply with meaningless targets. Only then will the goals of attaining universal access be met.

Ayodele, the executive director of the Initiative for Public Policy Analysis, writes from Lagos, Nigeria. Link: http://www.punchontheweb.com/Articl.aspx?theartic=Art201012010301679