This paper produced by the Access to Essential Medicines Campaign uses the example of a poor township 30 kilometres outside Cape Town to find out if antiretroviral therapy is possible in severely resource-constrained environments and to discover the best ways to deliver these drugs. AZT first became available in Khayelitsha township's two maternity wards in early 1999, and the programme has subsequently become one of the continent's biggest. Treatment was initially limited to opportunistic infections, but in May 2001, this was broadened to include antiretroviral therapy (ART), making the project the first to use antiretrovirals in government health facilities outside the context of clinical trials.
Resource allocation and health financing
DEMYSTIFYING ANTIRETROVIRAL THERAPY IN RESOURCE- POOR SETTINGS
THE COSTS OF ANTI-RETROVIRAL TREATMENT IN ZAMBIA
This report from Partners for Health Reformplus analyses the costs and resource requirements associated with the provision of antiretroviral (ARV) therapy in the public health sector in Zambia. It provides per-patient cost estimates for highly active anti-retroviral therapy (HAART), voluntary counselling and testing, several opportunistic infections, and prevention of mother-to-child transmission services. These per-patient cost estimates are used to project total program costs, which are then compared to currently budgeted resources with an emphasis on financial sustainability.
Zimbabwe's Challenge: Equity in Health Sector Responses to HIV and AIDS in Zimbabwe
HIV has severely affected the overall health of people in the southern Africa region by impacting directly on individuals and their families, and by placing additional burdens on economies, social structures and health services. Poorer people are disproportionately affected because they have fewer resources to deal with the impact of HIV on their daily lives. Now that international advocacy has led to reductions in process of antiretroviral drugs (ARVs), there is concern that poorer people will not have access to these drugs. To examine these issues, a study was commissioned by the Regional Network for Equity in Health in Southern Africa (EQUINET) and Oxfam GB to highlight equity issues in HIV and AIDS, health sector responses and treatment access in four countries in southern Africa.
Further details: /newsletter/id/30097
ACCELERATING ACTION AGAINST AIDS IN AFRICA
Total funding for the response to AIDS in the world's low- and middle-income countries is only half of what will be required in 2005 to effectively confront the epidemic, according to a Joint United Nations Programme on HIV/ AIDS. This report, presented at ICASA 2003 in Nairobi, assesses current global commitments to addressing HIV/AIDS. It states that, despite the fact that the pandemic has recently reached the top of the African and international agenda, resources are still nowhere near sufficient.
Aid, public expenditure and the MILLENNIUM Development Goals: is collaboration possible?
Is public expenditure in developing countries inefficient and biased against the poor? How could better aid delivery enhance the likelihood of achieving Millenium Development Goals (MDGs)? What changes are required in current patterns of public expenditure and monitoring and in donor-recipient relations?
Fairly fair? Approaches to health equity in Namibia
Many health inequalities are due to unequal access to society's resources. In theory, they are avoidable - but how? The international community tends to define health equity as 'equality of health status'. But is this the most useful approach in developing countries? Researchers working with Namibia's Ministry of Health and Social Services (MHSS) think not.
The researchers suggest that developing countries should focus on improving fairness in the allocation of healthcare resources.
Demystifying ARV therapy in resource-poor settings
Few areas of public health have generated as much debate, controversy and protest in recent years as the drive to expand access to antiretroviral therapy – the drugs that have transformed AIDS from a death sentence to a chronic condition – in developing countries. Several years ago, it was a futile discussion: with a yearly cost of US$10,000 per patient, there was little possibility of widespread access in developing countries. But, largely as a result of a potent combination of generic competition and activism, prices have plummeted, with triple therapy now being available for as little as US$209 a year, causing a huge shift in the debate about availability. Today, the debate centres on if antiretroviral therapy is possible in severely resource-constrained environments, and, increasingly, on the best ways to deliver these drugs.
POVERTY REDUCTION OUTCOMES IN EDUCATION AND HEALTH: PUBLIC EXPENDITURE AND AID
Overseas Development Institute (ODI) (2003)
This paper looks at the role of public expenditure programmes in the health and education sectors and their impact on poverty. It argues for a closer donor involvement at the sector level. The evidence reviewed shows that progress towards the Millennium Development Goals has slowed in some low income countries, notably in Sub-Saharan Africa. Public expenditure has a much less powerful impact on outcomes than demand-side factors. Policies and practices for making public programmes more effective that have been recognised for some time remain unimplemented.
Africa has a right to support from international community in its fight against HIV/AIDS, malaria, and tuberculosis
Africa has a right to demand support from the international community in its fight against AIDS, tuberculosis, malaria and other diseases, Professor Jeffrey Sachs, executive director of the Earth Institute at Columbia University, told a meeting of African heads of state in Maputo, Mozambique in July. Professor Sachs said that only a very small fraction of the more than $10bn (£6.2bn; €8.8bn) needed each year to effectively combat these illnesses had yet been allocated to African countries.
Economists tell scientists AIDS drug projects can be scaled up
Economists said at the international AIDS conference on HIV pathogenesis and treatment in Paris on July 14 that nations with a high HIV/AIDS burden should spend more of their resources on antiretrovirals, a move which directly contradicts current medical opinion. The medical community has said that handing out antiretrovirals would be a waste of resources; could worsen drug resistance; and instead it urged preventative measures. Three pilot studies presented at the meeting from the Ivory Coast, Senegal, and Uganda--funded by UNAIDS--found that with a little help to set up medical infrastructure, drugs can be delivered, even to remote areas, without increasing drug resistance. (Access requires registration.)