HIV Commodities Stock Outs Affect Treatment Programmes

The treatment programme in Ghana has largely been supported by the Global Fund with the US President's Emergency Plan for AIDS Relief (PEPFAR) and the World Health Organisation (WHO) providing technical assistance in health systems strengthening.

In spite of all these, the frequent shortages of HIV commodities like HIV test kits, reagents and antiretroviral drugs have led to a lot of questions being asked by concerned citizens, development partners and most especially Persons Living with HIV (PLHIV) as to what is happening to HIV commodity security in Ghana?

Unfortunately,anytime there are stock outs, a lot of guesses are thrown about and there is no formal communication as to what the true situation is. As to whether this is a deliberate act or not nobody knows. Lack of information then leads to fuelling of speculations and the news is all over the media and the Internet and suddenly the information goes viral "Ghana has run out of ARVs". Telephone and mobile phones start belling and if you are lucky you get a response which is mostly inadequate (Example of a typical response: there are no shortages per say, our stock levels have gone down and we have a strategy in place to move drugs from low volume areas to high consumption areas and also rationing the drugs to forestall the shortfalls we are experiencing so that everybody will get limited stocks until we restock). In most cases the phones of the key personnel suddenly go off and out of coverage area.

Drug holidays

At this very moment, there are reports that ARVs and HIV test kits have run out of stock and some patients have gone on "drug holidays" while others have been receiving rationing stocks of about a week or two instead of the usual three to six month stocks. We also hear that we have just received triple fixed dosed combinations of ARVs for 56,000 patients which will last for about three to fourth months.

The reality is that stock-out whether perceived or real rebates lots on anxiety and fear among persons living with HIV and on treatment. This is because they have been advised by health counsellors about the risk associated with drug default which includes having resistant viruses which do not respond any longer to therapy and the ultimate is treatment failure and probably death. This is why it strikes fear in the HIV community. It also becomes a good excuse for people not to test because after all the drugs are not even available.

The question is: How does Ghana manage it's HIV commodity security? Do we have Early warning systems? Whose responsibility is it to ensure that there are no stock outs? What governance arrangements exist to ensure that there are no stock-outs? How is information on HIV commodities shared and by whom?

The first ever HIV commodity security plan was developed in 2005 and it expired in 2010. The reality is that the plan appeared not to have been implemented as it lacked the needed financial muscle and for that matter lacked ownership and was not also coordinated. The question again is: How did we manage our stocks from 2005-2010 when the plan wasn't implemented? Could it be that our problems with stock outs could have been traced to our ineffective implementation of the commodity security plan?

Now, the number of people on ART is growing rapidly. How are we going to ensure that health products and pharmaceuticals are available at the right time, in the right quantities, the right doses at the right places of need? With the help of Deliver JSI through PEPFAR, a new security plan has been drafted for 2011-2015. Learning from history, there is the need to give this plan life so that it can achieve its intended purpose.

There is need for leadership from the Minister of Health to ensure that capacity is built in the country for forecasting and quantification of HIV commodities. Furthermore, people need to be held accountable for delays in procurement of health products, realising that stock outs of HIV commodities strike fear of death in those infected and as such it cannot be treated as business as usual. The decisions on procurement of HIV commodities must be transparent, prompt and timely.

System failure

There is the need for the minister to take personal interest in this since the system appears to be failing. This is because any time there are stock outs, it means the system has failed. Ghana cannot achieve universal access to prevention, treatment, care and support services for all HIV persons who need it if our commodity security cannot be assured.

There is the need to revive the HIV commodity security committee which should become the platform for coordinating the new HIV community security plan and most importantly for information sharing and tracking of commodity pipelines and stock-levels. Our over reliance on the Global Fund is a threat to our HIV treatment programme. The Global Fund has helped immensely to strengthen country systems and kept Ghanaians alive. The current global economic crises now means we need to diversify our funding sources and increase government input. The Government has shown commitment to support the National Strategic Plan 2011-2015. We,therefore, need effective, efficient and sustainable approaches to ensure that our HIV treatment programme and the national HIV response as a whole, are optimised and delivering on results.

There is the need to consider placing ARVs on the essential drug list of the National Health Insurance Scheme. This discussion is long over due and this is the time to show political commitment to getting this done once and for all. We need to strengthen local production of ARVs to become a cheap source of ARVs for the NHIS.

Local production of ARVs

Ghana stands to benefit if the Government provides the needed tax incentives for the importation of raw materials as well as building technical and financial capacities of the private sector through trainings and loans to make local production a reality in line with the Pharmaceutical Manufacturing Plan for Africa coincidentally adopted by the African Union in 2007 in Accra.

These are tough decisions which require strong political leadership from the Office of the President and by extension the Minister of Health and the Director General of the Ghana AIDS Commission. Let's get this done to ensure that persons living with HIV will have some respite from the fact that commodity security has been covered by the Government in a sustainable fashion and all they need to do is to adhere to their drugs and be healthy and contribute to the development of Ghana.

Article: Dr Richard Amenyah

The writer is Director of Technical Services, Ghana AIDS Commission