E-drug: UN session tackling African pandemic (cont'd)
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Dear All,
I feel I have to correct some of the misleading comments from
previous messages on PMTCT in Zimbabwe. First the facts:
Zimbabwe is one of the 44 developing countries (as of July 2003)
receiving Nevirapine donations for the last two years from Boehringer
Ingelheim (BI). PMTCT centres have been rapidly developed in this
short time with a total number of 159 PMTCT sites functioning as of
July 2003, and more sites getting trained as I write this. 75% of these
PMTCT sites (119 sites) are set up in rural health centres while the
remaining 40 sites are located in urban centres. A total of 137 sites
use Nevirapine from the donation by BI (personal communication
from National AIDS and TB Unit of Ministry of Health and Child
Welfare of Zimbabwe).
The following is just to illustrate what this so called "very simple
intervention" brings with it:
A national strategy and implementation plan was systematically
developed in Zimbabwe to make PMTCT part of routine prenatal
care. A national Expansions Program was set up including
development of national guidelines, communication strategy, training
manuals and regular training programmes, distribution system, etc.
PMTCT Intervention protocols were developed for
1. Antenatal clinic level care: provision of HIV info to groups ie. group
counselling, individual VCT, ANC management of HIV positive
(medical, psychosocial) and negative women; discussion of infant
feeding
2. Delivery room level care: labour and delivery management (safe
obstetric practice + NVP administration and postpartum care of HIV+
women and postpartum care of HIV exposed baby, discharge plan
(infant feeding plan, prophylactic cotrimoxazole, etc.)
3. Outpatient Department level care: Long term care of HIV exposed
children, long term care of HIV+ women
The Ministry of Health & Child Welfare received significant support
form UNICEF, WHO, Kapnek Charitable Trust The Elizabeth Glaser
Pediatric AIDS Foundation and USAID (and possibly others) for
planning and implementation. It didn't just happen because nevirapine
is there for free and it is not as simple as pushing a tablet to the
mother and the syrup to the baby. It couldn't happen overnight
because if you think of providing training to all the thousands of
involved midwives, nurses, doctors, VCT counsellors, lay counsellors,
nurse aides and health educators about the different components at
different stages you can imagine the enormous task of training,
production of training education material(packages, posters, videos).
I think Zimbabwe in spite of the present incredible strains on its health
system was able to roll out this PMTCT program nationally in a
relatively short time because of the existing primary health care
centred structure of the public health sector. I think it would be
mistake to put Zimbabwe into the same basket with South Africa
where the legacies of apartheid still constitute major barriers to
provision of basic health care for all.
I think in many other countries in Africa where they do not have the
favourable health system structures/ processes like in Zimbabwe, it
can take easily longer to implement a "simple intervention" like this
even if nevirapine is there free.
I just can't resist to end it here with a comment, that this could be a
warning sign for the introduction of HAART where so much emphasis
is placed on lobbying for cheaper drugs yet very, very significant
financial/technical support will be needed for actual delivery of care in
almost all African countries, in my opinion. Even if all antiretrovirals
would be free next week, without such support treatment will not
happen quickly enough to save those in need.
Klara Tisocki
(ex-Zimbabwe clinical pharmacologist)
Dr Klara Tisocki
B. Pharm., M.Sc., Ph.D.
Phone: + 965 7975493
Fax: +1 775 4169388
Kuwait City
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