Free State ARV fiasco
A “damning” government report leaked to the Mail & Guardian reveals that the Health Department cannot say with any certainty how many HIV-infected patients in the Free State are receiving antiretroviral (ARV) therapy. This is because of inefficient computer software that has regularly broken down since 2001.
The document, written in April this year, also says that “reports are centralised so that individual ARV treatment sites have no indication of what is going on in the management of their programme”.
The chaos in the Free State Meditech software monitoring system has serious implications for the province’s already crisis-ridden response to HIV.
According to the Treatment Action Campaign (TAC), the Free State is again running out of ARVs, as it did earlier this year. Interruption of treatment leads to drug resistance.
The M&G has established that the problem is much wider than a single province. The Budget and Expenditure Monitoring Forum (BEMF), which monitors the provision of public sector ARVs, said this week that only the Western Cape, Northern Cape and North West were sure of avoiding treatment interruptions because of budget constraints and mismanagement in the near future.
Nationally, there is a R1-billion funding shortfall for ARVs.
Health Minister Aaron Motsoaledi recently announced that the government could not meet its target of providing life-prolonging antiretroviral treatment to 80% of HIV-infected people suffering from advanced infections by 2011.
The Free State document was written by the Integrated Support Task Team, which was formed by the government to investigate ARV shortages in the province.
According to the BEMF’s Mark Heywood, the “damning report” is being withheld, and “there is no evidence yet that it is being acted on”.
Heywood said Free State Health Minister Sisi Mabe recently said on national radio that there was “no shortage” of medicine, but TAC representative Sello Mokolepi visited several clinics this week and found them without drugs.
“At the Welkom Clinic I found ARV patients lining up for three days, only to be told that the drugs never arrived,” he said. “The government also distributes waiting list numbers that are significantly lower than the real need.”
Health Department spokesperson Fidel Hadebe said this week that 850 000 people are on ARVs in the public sector. But activists and health experts say government figures are unreliable, as there is little consistency in the methods used to collect them. If the health department does not know how many people are on ARVs and how many need it, they said, addressing the problem becomes increasingly complex.
Hadebe said “differences in treatment figures have to do with some ARV patients having died since they started treatment”.
He said the government has applied for additional funding from treasury and international donors, and has received “very positive feedback”.
Hadebe conceded, however, that treasury funding on average “takes at least two months to arrive in our bank account due to all the processes that have to be followed”. This could lead to several provinces not receiving interventions in time. One international donor has given strong indications that it will procure ARVs on behalf of the government as a matter of urgency, but Hadebe was unwilling to reveal its identity.
The two largest foreign donors are the United States government’s President’s Emergency Fund for Aids Relief (Pepfar) and the Global Fund to Fight Aids, TB and Malaria. Pepfar’s policy is to procure drugs on behalf of governments, rather than fund them directly.
South African HIV Clinicians Society president Francois Venter said Motsoaledi would have to do “considerably more” than apply for more funding if he wanted to prevent “thousands of unnecessary deaths”.
Venter said the drug supply was a “hangover from the [former health minister] Manto Tshabalala-Msimang’s era”, and that Motsoaledi will have to “get rid of far more people in the Health Department than director general Thami Mseleku, whom he has courageously dismissed. There’s a lot of dead wood.”
In a recent article, Heywood said the funding shortfall was “only half the story — As the national treasury is well aware, what money is available is misused — Corruption is rife.” The M&G has seen a letter from pharmacists at Shongwe Hospital, near Komatipoort in Mpumalanga, to the provincial department complaining that they have been repeatedly told there is “short stock”, active ingredients have been stolen or the government has not paid its bills.
The hospital has been out of stock of HIV-related drugs such as antibiotics for eight months, whereas sources said the number of patients needing ARVs had increased, with more than 1 000 turning up at the hospital since the beginning of the year.