The BCP has learnt with shock and dismay at the article in the Echo newspaper of 7th -13th June 2012, titled “No more free ARV’s” In the same article an officer at NACA is reported to have said ”government will continue to meet the full costs of ARVs, but such is not sustainable in the long term. Therefore various cost sharing options may have to be considered in the long run to keep patients on treatment”.
The sentiments of the officer are not dissimilar with the statements that have been uttered by His Excellency, Ian Khama. Shortly after he took on the leadership of the Republic he clearly questioned the sustainability of the ARV programmes. He shared his reservation at the AIDS commemoration in Selebi Pikwe a couple of years ago and also in his state of nation address.
While BCP acknowledges that the management of the HIV programmes is expensive, we do not think that cost sharing should be an option. We are aware that Batswana who have capacity to contribute to their health care are already doing that through the use of private health facilities.
Any attempt to introduce cost sharing will only serve to deepen poverty and further complicate the management of AIDS. As a country, we are already witnessing the emergence of drug resistance for AIDS and also the explosive TB situation which is driven mainly by HIV. The introduction of cost sharing can only worsen the situation and the cost to the nation will be much higher.
The current financial challenges in sustaining HIV programmes are due to lack of foresight and poor management by the BDP Government. The financial challenges associated with HIV and AIDS and other related diseases like tuberculosis are well acknowledged globally. To this end, the global community has established financial support institutions such as the Global Fund for AIDS, TB and Malaria to assist high burden countries to cope with the challenge. A number of African Countries have benefited immensely from these sources of funding and have strategically utilized the funds to strengthen their health systems.
Botswana has not benefitted from this free money due to its lack of foresight. Even Countries much richer than Botswana like South Africa have devised strategies to access millions of dollars from this global initiative. Instead of getting free money, Botswana has compromised the financial situation of the Republic by getting a loan from the World Bank worth millions of US dollars to support the HIV programme. How unpatriotic can the leadership be?
Another sign of poor leadership by the BDP government has been in its choice of medicines. A number of high burden countries have long realized that the use of patent medicines was not sustainable for chronic diseases like AIDS. Instead, they have opted for generic ARVs which are equally efficacious yet much cheaper. Countries with bigger economies and less burden per capita such as Brazil and India have also opted for generics. It is unclear why the BDP government continues to mortgage the country to patent medicines when international health authorities like World Health Organization have clearly pronounced on generic ARV medicines.
The BDP government has also been extremely wasteful leading to an escalating cost of medicines in the country. Each year, millions of pula worth of medicines are destroyed because they have expired at the central medical stores, while clinics and hospitals experience perennial stock outs. This is a clear mismanagement of national resources.
Lastly, the continued verticalization of the AIDS programme in the country is draining the health coffers unnecessarily. While it was understandable from the beginning to create stand alone programmes for HIV and AIDS, it’s no longer necessary to continue in this mode. We now need to fully integrate HIV and AIDS programme in the health services.
We call upon the President to re-prioritize the HIV and AIDS response in the country. We can not afford to lose the gains of the past. More than ever we need to strengthen our response to this national disaster by ensuring that new cases are arrested and those in need of treatment have access. Trivializing a complex phenomenon like HIV explosion as being drive by alcohol abuse does not help.
We need to examine structural factors that create vulnerability to HIV such as poverty, gender imbalance and unsupportive laws. We must respond on the basis of evidence rather than our feelings. There is no turning back. Experiments like cost sharing will surely undermine our gains.
By Dr Hubona
Secretary for Health