[procaare] Economics Derail AIDS Service Delivery in Zimbabwe

["ProCAARE" <procaare@healthnet.org>]

Economics Derail AIDS Service Delivery in Zimbabwe
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Cross-posted from AF-AIDS 


Spotlight Economics Derail AIDS Service Delivery in Zimbabwe,        Godsway Shumba  
           
     
An article from the HDN Key Correspondent Team  
17 June 2008  
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Media reports claiming that Zimbabwe's leading medical aid service provider, Cimas, has suspended work at its antiretroviral drug facility have been found to be false.

But the economic situation in the country has had a serious impact on efforts to scale-up access to antiretroviral therapy (ART) and members of civil society groups who recently participated in a Partners Zimbabwe online discussion said that Cimas faces economic uncertainty.

If the economic situation in Zimbabwe persists, the government will not be able to achieve Universal Access targets on HIV and AIDS prevention, treatment and care by 2010. The latest figures from the Ministry of Health and Child Welfare show that just over 100,000 of the 300,000 people in need of ART have received it.

The current socio-economic situation in Zimbabwe, which is characterized by hyperinflation and foreign currency shortages, a lack of human resources, corruption and logistical problems, is compromising the delivery of antiretroviral drugs.

Rampant inflation rates of over 1million percent have caused increases in the cost of basic commodities and medical aid service providers such as Cimas have not been left unnaffected.

In 2007, the Zimbabwean government launched the National Incomes and Prices Commission (NIC) to authorize all price increases in an attempt to control soaring inflation rates and protect consumers. The price controls have been largely unsuccessful and many businesses are now operating at a loss.

Cimas member said, 'like all other businesses in Zimbabwe, Cimas is required to negotiate contribution increases with the Commission, before it can increase its rates. Price increases to health service providers occur separately and are granted by the NIC independently. Due to the hyperinflationary environment, the result is that Cimas' medical aid cover has become almost valueless."

"You are often told that only two of the three drugs are available on the Cimas program and the third drug can be purchased in the pharmacy and a claim submitted to Cimbas for reimbursement," an anonymous contributor said during the Partners Zimbabwe discussion.

Martha Thalanah, a beneficiary of the Cimas medical facility, said she once missed a dose because the drugs she needed were not available in city pharmacies.

Even Cimas clients given the option to pay for the drugs and seek reimbursement from the group are facing difficulties due to the crippling of Zimbabwe's banking sector and difficulties in accessing cash.

A month's supply of Lamivudine reportedly cost nearly nine billion Zimbabwean dollars at the end of last month. It is almost impossible to withdraw this much money from a bank in the country.

Participants in the online discussion also said that some pharmacy staff were selling drugs such as Lamivudine on the black market at a slightly reduced rate of five billion Zimbabwean dollars but that they were not giving clients the reciept they needed for reimbursement by Cimas.

While these issues are not new, they are compromising services at the Cimas ART facility. The emigration of qualified medical personnel to other countries is also affecting the quality of services offered by the group.

As one contributor to the online discussion said, "resources are available but are no use since they do not have pharmacists and logisticians who understand the Zimbabwean system of inventory management."

One of the main goals of the Zimbabwe National HIV and AIDS Strategic Plan 2006-2010 is to reach access and utilization of treatment and care services goals of 75% by 2010. Unfortunately, this looks like a pipe dream.

Despite efforts towards the achievement of Universal Access goals in Zimbabwe, the current economic situation is likely to reverse any gains made. Reports of severe drug shortages in pharmacies dispensing Cimas products and referral hospitals are disturbing as shortages could encourage drug resistance.

The Standard newspaper recently reported that people accessing public ART roll-out programs were being asked to buy a number of unavailable drug combinations from private pharmacies. In a country where 85% of the population is unemployed, most people are likely to miss doses because they cannot afford to pay for the drugs.

Efforts by the government and international donors are not far reaching enough to tackle this crisis. As noted by one participant in the online discussion, "most of all, please, let's have the drugs available at all costs. This is paramount, walk the talk as per your assurance to deliver."
                   
                 
           
     
The KC Team is coordinated by Health & Development Networks (HDN).  
Website: www.healthdev.net/kcteam   Email: kcc@hdnet.org  
     



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