The Mozambican Health Ministry fought a battle with the US government over the use of funding to combat the AIDS epidemic - and won.
The story was told by Health Ministry officials, not to the Mozambican media, but to the "New York Times", which ran a long article on the subject last week.
The writer of the article, Deborah Sontag, noted that the US administration did not even consult Mozambique before announcing that it would be one of the 15 countries to benefit from George Bush's emergency AIDS plan.
The money was, of course, welcome, despite the imperial approach of the Bush administration.
But problems soon emerged, when it seemed that the Americans wished to take control of the Mozambican AIDS programme. Health Minister Francisco Songane, reported Sontag, recalled American officials saying "We want to move quickly, and we know that your government doesn't have the capacity." Other donors had accepted that the Mozambican Ministry was serious about the fight against AIDS, and were happy to pool resources, and let the Mozambicans run the programme.
Not so the Americans. In particular, the US wanted to change radically the approach to anti-retroviral therapy. Right from the start, the Mozambican government has insisted on using generic anti-retroviral drugs, much cheaper than the branded drugs pushed by the multi-national pharmaceutical companies.
But here was the US government wanting to spend the money it offered on purchasing the branded drugs, and delivered, not via the national health service, but via NGOs. The Health Ministry decided it would not be bullied. As Sontag puts it, "Mozambique did not want an American programme, dependent on costly foreign consultants, organizations and the largess of foreign political leaders, that would run parallel to its own". After what Sontag describes as "confrontational meetings" in Washington and Maputo, it was, not the Health Ministry, but the Bush administration that gave way.
It agreed that funds could be used for what the Mozambican specialists wanted - such as boosting the health laboratories and blood transfusion centres, and strengthening the capacity of the Ministry itself.
"What I witnessed in Mozambique was a disaster averted," Stephen Gloyd, an international health specialist at the University of Washington who works with Mozambique, told the "New York Times".
Mozambique stood its ground, argued its case, and won.
Others have not been so fortunate. Sontag cites Zambia, where she says local officials have been kept in the dark about the use of the US funds. The Zambian health minister, Brian Chituwo, said his government did not have a formal meeting on the program with the US embassy until this May - 15 months after the US announced that Zambia was among the beneficiaries. Chituwo told the paper that on everything but blood-transfusion services, which were negotiated, the US plans for Zambia have "all come from Washington." Sontag notes that the Bush administration's refusal thus far to use its money to buy generic anti-retrovirals "is complicating the rollout of its own emergency plan. Like the Mozambicans, other African officials have resisted the distribution of brand-name drugs as first-line therapy. As a result, in a half a dozen or more of the focus countries, the governments themselves or other donors are picking up most of the cost of lifesaving drugs".
Songane strongly defended Mozambique's decision to opt for generic drugs. "We are using generics here because they are cheaper," he told Sontag. "And apart from being cheaper, they are prepared in a manner which is simple for our patients, and even simpler for our staff." The generic drugs now come in "fixed dose combinations" - that is they combine three drugs in one tablet, thus making it much easier for patients to take them at fixed times. Opting for branded drugs would mean taking a variety of different pills - cynics might say this is a deliberate ploy by drug companies to increase their profits at the expense of desperately ill people. These three-in-one tablets have been given approval by the World Health Organization. Research published in the prestigious British journal "The Lancet", showed that Indian generic drugs work just as well as the brand-name varieties.
The stand taken by Mozambique and several other African countries may force the Bush administration to change its attitude towards the generic anti-retrovirals. Songane also disagreed with the American stress on numbers.
"To see an increase in numbers of people on anti-retrovirals, that was their only concern," he told the paper. "But this is a complex disease. We cannot judge the success of our fight just by the numbers of people on treatment." Nor did Mozambique want to rely on NGOs - the Americans would pay NGO wages, provide them with vehicles and drugs, but for how long ? Songane thought no programme that relied heavily on NGOs could be sustainable in the long term.
"In one year, two years' time, who is going to follow those people?" he asked. "When the NGO is gone, who is going to take over?"
Fonte: AIM
