STATEMENT BY THE MINISTER OF HEALTH HON. BRIG. JIM K. MUHWEZI ON THE OCASSION OF THE LAUNCH OF THE FREE ARV TREATMENT PROGRAM IN UGANDA. MULAGO HOSPITAL, KAMPALA 11TH JUNE 2004. This ceremony marks yet another landmark in the protracted fight by the people of Uganda against the scourge of HIV/AIDS. Today will be remembered as the day when the Movement Government fulfilled the promise to avail universal access to the people of Uganda of free life prolonging Antiretroviral drugs which are targeted particularly at the poor. Uganda’s struggle against HIV/AIDS has bone through three phases. The first phase started with the visionary leadership of H.E. President Yoweri Kaguta Museveni way back in 1986. He saw that this was a deadly disease without a cure and sounded an alarm loud enough to enable the people of Uganda to rise up against this disease. This first phase accordingly consisted largely of public information campaigns which raised awareness levels and resulted in behaviour change and the decline in prevalence of HIV in the population. This was carried out through the Aids Control Program in the Ministry of Health but with the President personally chairing a number of planning meetings. The second phase followed the realization that HIV/AIDS called for multi-sectoral action. It therefore consisted of the building of institutions and centers of excellence for coordinating the national response not just to prevent the spread of new infections, but also to provide care and support to those infected and affected and through research to seek solutions for the future. This was done through legislation that set up the Uganda Aids Commission as a coordinating agency. This has created an enabling national environment for multiple players to participate within clearly defined boundaries. During this phase, centers of excellence such as JCRC, the Blood Transfusion Service, Uganda Virus Research Institute, Mild May, Hospice, etc., Collaborative research with international partners such as Case Western Reserve University, Johns Hopkins, CDC, Medical Research Council of the UK and many others. This has also made it possible for communities to set up thousands of NGOs such as TASO, NACWOLA, ….and many small ones in districts, towns and villages across our land. The whole country was switched on to fight the epidemic and international partners were harnessed in very productive partnerships. Ladies and gentlemen, this third phase starts today and what is special about it is that it adds to prevention, care and support the new element of provision of universal free life prolonging treatment with ARVs. Up till today, a diagnosis of HIV/AIDS has meant a death sentence to ordinary Ugandans who could not afford these drugs. Only the well off have been able to access antiretroviral treatment while the poor have just waited to die. This has been an intolerable injustice in our society. The introduction of antiretroviral drugs will bring with it new challenges because this treatment is different from that for opportunistic infections, palliative care, home based care and cotrimoxasol prophylaxis which we have been providing and will continue to provide. It is different in the sense that these drugs are delicate, have a variety of side effects and have to be taken regularly and correctly for life. However, I am confident that Uganda will succeed to roll out this treatment to our people. My confidence is founded on our track record of success in management and coordination and in our tested principles of partnership with government playing her mandate as steward, coordinator and resource mobiliser while the other partners in civil society and the international community bring in their respective strengths. We all know that the whole country has been waiting for this day with great anticipation. Many have been waiting anxiously whether and when this day will come. Questions have been asked as to how it will all work out. Let me start by giving a brief description of the historical background to antiretroviral treatment in Uganda. We started way back in 1992 with only a handful of people accessing the drugs in JCRC, Mulago and a few private clinics. In 1997 government negotiated with manufacturers and signed Memoranda to avail drugs to Uganda at subsidized prices through the Medical Access program. This made Uganda, at that time, to be one of the four pilot countries in the developing world along with Thailand, Ivory Coast and Brazil to pilot increased access to ARVs. Subsequently, with centers of excellence in this field emerging at JCRC, Mulago Hospital/Makerere University and Mild May. The appearance of generics on the market coupled with government negotiations with manufacturers resulted in a drastic reduction in the prices of the drugs from a staggering $1,500 per month to the present $30 per month. Some studies have also been carried by CDC in Tororo on community based treatment and MSF has an ongoing program in the West Nile region. The reduction in prices of the drugs and the experience that has been accumulated in the country has made it possible for the government and the international community to decide that these life saving drugs should be made available to all the people of Uganda free of charge as part and parcel of the national health services. The resources for the antiretroviral treatment program will come from the following sources: The drugs that we are using for launching the program have come from the Multisectoral AIDS Project of the World Bank at a cost of $1,3 million. A further $1.7 million from the same project will follow. THE Global Fund to fight Aids, TB and Malaria will provide $7.6 million in the nest one year and a further $70.4 million over years. Uganda is also a beneficiary of President G W Bush HIV/AIDS Support Initiative (PEPFAR) under which an estimated 60,000 people in Uganda are to access ARVs over the next five years. We are going to receive support for this program for drugs and capacity building from other partners such as the Academic Alliance for Treatment of HIV in Africa, the Clinton Foundation and others. I am therefore able to state with confidence that in the next five years resources for the program have been identified. It is also our sincere hope that during that time, the prices of these drugs will drop even further making the case for sustainability even more promising. How will this program work? Three years ago, the Director General of Health Services appointed a Task Force chaired by Dr. Peter Mugenyi to draw up a national policy and guidelines for rolling out the ARV program in the country. This Task Force has done their work very well. We have in the country a clear frame work for implementing ART services. Treatment guidelines, training standards and accreditation criteria for treatment sites have all been developed and disseminated. This Task Force has now been established as a Committee to coordinate and guide the National ARV program. The program will be integrated into the existing health system so that it benefits from the strengths of the system and at the same time it will also contribute to the strengthening of the health system. Therefore, patients and their families will access the ARVs using the normal health services. This will help to reduce stigma and at the same time it is cost effective. For the avoidance of doubt, let me remind the country how the Ugandan Health system works. We have several levels of care staring at Community level or Health Centre 1. At the level, Community Based Health Workers and NGOs will be able to identify patients and refer them to health facilities nearest to their homes. When patients are put on treatment, community volunteers will provide support to the patients in order to ensure that they adhere to the treatment program in the same way as is done for Tuberculosis. At the Health facilities situated at Parish Level, Sub County Level, County Level and at District Level, trained health workers together with NGOs and civil society will be able to provide Voluntary Counselling and Testing services and ARVs to those who will qualify using the guidelines that I have already referred to. As you all know, in Uganda, government health services are very well integrated and coordinated with NGO health services and the same will apply to this program as well. As we launch the program today, 26 accredited health facilities will receive these drugs. The list of these is available. More health facilities will be receiving ARVs as they get prepared and meet the accreditation criteria within the coming months. The key guiding principles therefore are the following: There will be one coordinating and monitoring mechanism led by the Ministry of Health. There will be clearly defined roles for all players in order to avoid duplication and unproductive competition. All corners of the country must be covered by the program. In view of the different sources of financing, there will be consultation so that procured drugs will as much as is possible, be standardized. In this connection, I am happy to report that during the World Health Assembly a few weeks ago, the Secretary for Health and Human Services of the USA, Tommy Thompson, met with Health Ministers from countries benefiting from PEPFAR and informed us that the USA government will license generics and that American companies have come together to produce combination tablets. Such a move is very welcome as it will reduce confusion among the population if the tablets that they take, even from diverse sources, are not too different from each other. We will also have some special programs for some sections of the Public Service such as the UPDF, The Police, The Prisons, Health Workers, Teachers and the rest of the Public Service. Let me also clarify at this stage that Grade A clinics in government hospitals will be used by those who are eligible to use them. However, while they will not pay for the drugs, they will have to pay for consultation fees. As I conclude, I would like to appeal to all the people of Uganda to ensure that this program succeeds. We are very fortunate that we have friends who have been good enough to make these expensive drugs available to us. The best way to thank them is to show them that we have used the treatment properly and that the quality of life of those infected and affected has improved and has been prolonged. I also want to thank our partners who have made this possible and to assure them that in Uganda they have a very serous and committed partner with a credible track record. Let me also thank all those who have worked so hard to bring this program to this stage. I know that it has not been easy. These include the Staff of the Uganda Aids Commission, the National Medical Stores, the National Drug Authority, Dr. Mugenyi and his Committee and last but not least, the Ministry of Health and their colleagues in the NGO health services. It therefore with great pleasure that I now launch the Program for Universal Access to Free Antiretroviral Treatment in Uganda.