Government officials might be presenting to the public a very successful HIV treatment programme, but it is now emerging that they are finding it difficult to cope with the increasing number of people coming onto to the treatment program.
Senior government officials confided that they are unable to offer steady supply of antiretroviral drugs to those who need them as the numbers are overwhelming.
So serious is the situation that the government a couple of weeks ago rushed to the US President Emergency Plan for AIDS Relief (PEPFAR) to bail it out with antiretroviral drugs.
It is understood that the current stocks will last the country up to the end of this month, with Ministry of Health officials crossing their fingers for the PEPFAR deal to workout. This deal is expected to avail drugs enough to last for six months as the Ministry sorts out its procurement problems.
The imminent stock-out is coming at a time when an unprecedented number of people have been enrolled onto the treatment programme. At the moment, the government has a staggering 330,000 people on antiretroviral therapy, with 7,000 coming into the treatment fold every month. This year target is to have 389,000 people on treatment and about 640,000 by 2013.
“It is just too much for us. We might not cope if the government and donors continue to operate with current funding,” said a senior official in the Ministry of Health, who sought anonymity due to the sensitivity of the matter.
The Rapid Results Initiative which the government has used for the past six years to undertake a rapid scale-up of ARV treatment seems to have landed it in the current scenario.
While the number of people on treatment has been increasing using this proactive approach encourage many people to do so, the funding for purchase of drugs has stagnated.
The high numbers of people on treatment have also made it next to impossible for the government to maintain a six months buffer stock to cushion it from any stock-outs.
In many cases, the government has had to transfer drugs from regions with some stock of drugs to areas with high demand or lean on international organizations to bail it out.
This situation might get worse if the government implements the new World Health Organization guidelines which recommends people whose CD4 count-the indicator of immune strength- is below 350, be put on ARVs treatment regardless of their symptoms.
The 2005 government guidelines require a person to start ARV treatment once the CD4 are below 200. What this means is thousands of people whose count is between 200 and 350 are to start taking ARVs. With the current problems, would it be wise to adopt the WHO recommendation?
Government officials are now telling Kenyans to brace themselves for frequent stock-outs if the current funding problem is not sorted out.
When contacted for comment, the Director of NASCOP, Dr Ibrahim Mohamed said: “We are facing challenges but the government and development partners are in control of the situation.”
“The government is addressing the funding issue and everything will be fine,” he added.
While funds for purchase of ARVs have largely been coming from donors, the government is yet to intervene in a bigger way.
In each of the financial years 2008/2009 and 2009/2010, it has allocated Sh 500 million for procurement of antiretroviral drugs, a drop in the ocean compared to the billions of shillings required to provide treatment HIV positive persons.
For the year 2009/2010, about Sh 6 billion is required for financing ARVs, Sh 8 billion in 2010/2011, Sh 10 billion in 2011/2012, and Sh 11 billion in 2012/2013, according to the National Aids and STDs Control Programme (Nascop) report, Scale up of access to ART in Kenya. Any funding gap is met by donors.
The minimal government funding towards HIV/AIDS programmes, HIV experts argue, is unsustainable. NASCOP is now working on a proposal to have government share of financing increased to Sh1 billion each year to meet the rising demand for treatment instead of leaving a huge percentage of funding to the unpredictable donors.
The other problem is PEPFAR, the leading provider of ARV treatment, has put a ceiling to the number of people it is going to support in its phase II programme at 190,000 people for the next five years. At the moment, PEPFAR has around 130,000 people on ARV treatment.
If their target is met by the end of this year, then the next time they might recruit new patients is after 2013 under PEPFAR III.
The ARV procurement case pending in court and the many issues the government has had with the Global Fund for HIV/AIDS, Tuberculosis and Malaria are another nightmare for the government.
In 2003 and 2008, the Fund withheld funding of about Sh 2.8 billion and Sh 22 billion respectively, over corruption concerns resulting in the country’s proposal being rejected. The 2008 funds were to be apportioned as follows: Sh 9.8 billion for HIV programmes, Sh 7.6 billion for malaria and Sh 5.3 billion for tuberculosis.
Again in 2009, the Fund’s Technical Review Panel rejected a proposal for Round nine of about Sh 20.5 billion due to poor coordination between the Ministry of Medical Service and that of Public Health and Sanitation.
Compounding the matter is the poor planning by the agencies required to purchase ARVs. In 2008, a government report on Quantification of ARV drugs for Nascop ART Programme: 2007-2009 warned of serious problems if ARVs procurement is not planned well.
“The Kenyan antiretroviral drug treatment programme is being overwhelmed by the number of new patients coming onto to treatment, putting massive pressure on the existing stocks. And without good planning and efficient procurement procedures, the country was likely to be plunged into problems,” the report warned.
Agreeing with the report contents, HIV experts cautioned then that the scale-up of antiretroviral drugs, which was enrolling 3,500 people every month was not in line with the amount of drugs being procured, causing confusion and problems.
The report recommended the implementation of a new drug ordering system to ensure drugs are always at the permitted stock levels. For many years, the country has been operating a procurement system that gives inaccurate reports, and either under or over procures, resulting in constant stock-outs or wastages, the report said.
“For the short term commodity security, it is critical that all procurement entities work as expediently as possible to ensure that the resources committed translate into actual procurements in the shortest time possible to avoid stock outs,” said the authors of the report.
According to the report, government needs to put in place a commodity security strategy policy which anticipates changes in stock levels especially if donor funding ceases or there are delays in disbursement of funds. Such a move is critical with the current number of people being enrolled on treatment programmes.
In November last year, Dr Mohamed said in a report titled: Scale up of access to ART in Kenya, reduced donor funding, shift of patient to less toxic and second line drugs; weak health system; and a mismatch in testing and treatment sites were some of the issues in the current HIV/AIDS management.
This is the sad scenario in the ARV programme even as the number of people trooping to the over 900 Antiretroviral Therapy sites soars.
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