Maggie Huff-Rousselle, MA, MBA, PhD, Social Sectors Development Strategies, Inc., 1411 Washington Street, No. 6, Boston, MA 02118, Annette De Mattos, MPH, Social Sectors Development Strategies, 1411 Washington Street, Suite 6, Boston, MA 02118, 617-421-9644, firstname.lastname@example.org, Maureen Daura, MSc, HSSP Project, Abt Associates, 4800 Montgomery Lane, Bethesda, MD 20814, and Nicholas Chikwenya, Donor Coordination Office, Ministry of Health, Lusaka, Zambia.
Pharmaceuticals are rationed in Zambia, although not in an explicitly-defined manner. Given the HIV/AIDS crisis, antiretrovirals (ARV) are not the tail wagging the dog of essential drug policies in Zambia, but there is a significant risk of ARVs reducing financial support for more cost effective treatments that should be in full supply, including those for HIV/AIDS opportunistic infections and for the prevention of transmission, such as the use of Nevirapine in the prevention of mother to child transmission (MTCT). The surge of pharmaceutical funding in Zambia – a 4-fold increase over the past 5 years – is focused on HIV/AIDS, TB and Malaria. Meanwhile traditional essential drugs appear to be loosing their funding base. The Zambian government was to fill the gap left as Japan gradually reduced funding for vaccines, but vaccine stocks declined along with immunization rates. Even among HIV interventions, Nevirapine, which can reduce MTCT for less than a dollar was out of stock, had not yet been re-ordered in late 2005. With the extension of life provided by ARVs, HIV/AIDS prevalence and costs can be expected to rise to alarming levels as chronic care continues – if programs are successful. Policy formulation needs to consider how the planned expansion of free ARVs in Zambia's public sector relates to the Basic Health Care Package, to the essential drugs concept as defined in the National Drug Policy, and how – over the coming years – free ARVs will impact the availability of all “essential drugs” in Zambia's public sector.
Keywords: Developing Countries, Cost-Effectiveness
Presenting author's disclosure statement:
Any relevant financial relationships? No
The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA