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HAI Africa Network Update: November-December 2006

Inside this issue:

  • HAI Africa publishes advocacy manual for civil society organizations
  • Kenya HIV treatment literacy working group formed
  • Practical Pharmacy newsletter relaunched
  • Price survey results released for 9 African countries
  • Debate over DDT use in Africa re-ignited
  • New cervical cancer vaccines present major opportunity for developing countries

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November-December update

HAI Africa publishes newadvocacy manual for CSOs

HAI Africa, under its collaboration with the World Health Organization for access to essential medicines, has published an advocacy toolkit, titled "Medicine Prices: A Critical Barrier to Access; How to Advocate for Implementation of Recommendations from Medicine Prices Surveys."

This 52-page toolkit contains practical tips and tools to enable countries and civil society to develop strategies to carry out effective advocacy aimed at improving the affordability and availability of medicines.The toolkit has been developed for use along with the WHO/HAI price survey methodology, "Medicine Prices: A New Approach to Measurement".

It is available for download from the HAI Africa web site on http://www.haiafrica.org.


With medicine prices survey results released in 9 sub-Saharan African countries, it is a good time for civil society to use the data in their advocacy work.

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Kenya HIV treatment literacy coalition formed

HIV and AIDS treatment has rolled out in Kenya. However, treatment literacy continues to be a challenge. The gains made in extending antiretroviral therapy could be threatened unless people receive accurate and useful information about their treatment.

The Treatment Literacy Working Group (TLWG) is a coalition of civil society organizations including Médecins Sans Frontières, Society of Women and AIDS in Kenya, the Kenya Treatment Access Movement, Women Fighting AIDS in Kenya (WOFAK), the Mission for Essential Drugs and Supplies and HAI Africa, all of whom carry out work to promote access to treatment. The nature of the virus that causes AIDS is that treatment has to be administered with great care and accuracy. It is essential that people receiving take their medicines regularly for the rest of their lives. If they do not, they risk death or the development of resistant strains of the virus.

If their treatment fails, they may need more expensive, complicated regimens. People on ART need to understand what is happening to their bodies and how their medicines function. They must be equipped with information concerning nutrition and possible side effects of their medicines.Treatment literacy is one of the most critical aspects of a successful treatment program. It has crucial implications to adherence and to the realization of Universal Access by 2010.

TLWG believes that treatment literacy should be integrated into already existing structures.

The goal of the coalition is to see an effective national treatment literacy campaign in Kenya and for every Kenyan to be treatment literate. It will review international recommendations and guidelines on treatment literacy and adapt them to fit the Kenyan context.The coalition may also aim to document the level of treatment literacy in Kenya through research/rapid assessment (thus to understand the treatment literacy gap from the international recommendations - for the purposes of advocacy)It will carry out advocacy for the promotion and strengthening of treatment literacy in Kenya and to see its integration into the entire health system, and will disseminate treatment literacy tools.

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Practical Pharmacy newsletter relaunched

During the 1990's a group of experts founded a newsletter called Practical Pharmacy. Written in simple language, it was created to help health workers in developing countries to manage medicines supply. Many of these workers found themselves responsible for managing medicines even though they had little training or information in this field.

Between 1996 and 2000, fifteen issues of Practical Pharmacy were produced, and circulation reached over 4000. An evaluation confirmed the need for this type of information but unfortunately it was not possible to continue publishing at that time.

Now, a group of organizations including Ecumenical Pharmaceutical Network (EPN), Mission for Essential Drugs and Supplies (MEDS), Sustainable Healthcare Foundation (SHEF), and HAI Africa, partnered together to revive the quarterly newsletter with the guidance of an expert advisory group.The first editions of Practical Pharmacy laid a solid foundation, beginning from basic essential skills for medicine management in a health centre setting (storing medicines, stock control, etc) and moving on to patient-centred topics (rational prescribing, medicines in pregnancy and the elderly, etc).

The October 2006 issue is taking up from where the last issue stopped: on the topic of malaria. The older issues of the newsletter are currently being updated and will be reissued soon on the web so that the vital information they contain will not be lost.Over the next few months, the new issues of the newsletter will cover the following topics:

  • HIV and AIDS: HIV treatment, adherence to ARVs
  • Tuberculosis: treatment, multi-drug resistant TB
  • Rational use of medicines in the community
  • Infection control.

Since the newsletter was first published, the Information Age has taken off, even in the developing world. For this reason, as well as for reasons of cost, the newsletter will be distributed electronically through individual (no cost) subscriptions, and through the networks of EPN, MEDS, SHEF, HAI Africa, HAI Asia Pacific, HAN Ghana, and CWGH Zimbabwe.To read more, please go to www.haiafrica.org and to receive Practical Pharmacy by mail, please subscribe by sending a request to practicalpharmacy@gmail.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it

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Price survey results released for 9 countries

The World Health Organization (WHO) and HAI Africa have released the findings of medicine price surveys conducted in 9 sub-Saharan African countries.WHO, in collaboration with HAI developed a methodology to systematically measure medicine prices. Because the methodology is standardized, it enables comparisons to be made within countries (across sectors) and between countries.

In addition to prices, the methodology allows for the measurement of affordability, by relating the cost of medicines to the salary of the country's lowest paid government worker. It can, therefore, be seen how many days' work it would take someone at such an income level to buy the treatment they need.The surveys have been done in over 30 countries across the world, including 13 in Africa.

These include: Cameroon, Chad, Ethiopia, Ghana, Kenya, Mali, Nigeria, Senegal, South Africa, Tanzania, Uganda and Zimbabwe. Recommendations that came out of these surveys are now being implemented, and it is hoped that this process will be an integral part of the ongoing work of governments and their partners to increase access to essential medicines for all people, especially for the most poor and vulnerable. Information for the 9 countries is available on the HAI Africa web site.

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Debate over DDT use in Africa reignited

A heated debate was sparked off following a recent announcement by the World Health Organization (WHO) in support of the use of DDT in indoor spraying and in malaria endemic areas. This change in policy has strong backing from USAID and some US government officials.

The debate revives a longstanding controversy over the use of DDT which has been highly restricted since the 1960's, largely due to Rachel Carson's Silent Spring, which connected DDT to cancer of the liver in humans and damage to bird reproduction.

Although DDT is generally not toxic to human beings and was banned mainly for ecological reasons, subsequent research has shown that exposure to DDT at amounts that would be needed in malaria control might cause pre-term birth and early weaning, abrogating the benefit of reducing infant mortality from malaria.More than a million people in Africa die each year from malaria, most are children under the age of 5.

In light of this public health catastrophe observers over the years have argued that the benefits of using of DDT in small quantities for indoor spraying of walls and ceilings far outweigh the risksIronically, developed nations which successfully eliminated malaria by using DDT in the 1940's and 1950's, now support a restriction on the use of DDT in poorer countries where malaria is endemic.While many (also in developing countries) have warmly welcomed the new policy, others remain flatly unconvinced.

At the recent Intergovernmental Forum on Chemical Safety conference in Budapest, some delegates staged a protest over the new DDT policy, citing concerns about the potential effects of indoor spraying on reproductive health, neurological effects, effect on breast milk and increased risk of breast cancer, not to mention the possibility of resistance of mosquitoes to DDT. Inevitably, some raised the suspicion that dropping restrictions on DDT was ultimately driven by the financial interests of chemical industries in the US, rather than a concern for public health in Africa.

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New cervical cancer vaccines present major opportunity for developing countries

The introduction of new vaccines against Human Papillomavirus (HPV), the virus that causes cervical cancer, could have a major impact on the health of women in the developing world. In 2005 more than 250 000 women died from cervical cancer, the vast majority in developing countries.Cervical cancer is the second most common type of cancer among women, with deaths projected to rise by almost 25 per cent over the next 10 years, according to the World Health Organization (WHO).

In 2005 there were more than 500 000 new cases of cervical cancer. Left untreated, invasive cervical cancer is almost always fatal.

Well-organized screening and early treatment programmes have been very effective in preventing the most common kind of cervical cancer but they are costly and difficult to implement in low-resource settings. A vaccine that protects against infection and disease associated with the HPV was licensed earlier in 2006, and another vaccine may be licensed soon.

The licensed vaccine is effective in preventing infections with the HPV types (16 and 18) that cause approximately 70 percent of all cervical cancers, as well as in preventing infections with those types (6 and 11) that cause approximately 90 percent of genital warts. This and another HPV vaccine are under regulatory review in countries around the world and may offer a new opportunity to eliminate cervical cancer.

"New vaccines against HPV in the developing world could save hundreds of thousands of lives if delivered effectively," said Dr Howard Zucker, WHO New cervical cancer vaccines present major opportunity for developing countriesAssistant Director-General for Health Technology and Pharmaceuticals. "The roll-out of effective HPV vaccines is important for several reasons: They help in combating a deadly cancer and are a potent technology to add to existing cancer control programmes based on prevention, screening and treatment."

Initially targeted at girls - and may be expanded to boys in the future - before or around the time of first sexual activity, the vaccines offer the unique opportunity to address segment of the populations that are traditionally difficult to reach: young adolescents. Thus, a multifaceted strategy should exploit the opportunity to promote sexual and reproductive health by strengthening health programmes for adolescents.

"We don't know the final cost of the vaccine in developing countries," said Arletty Pinel, Chief, Reproductive Health Branch of UNFPA. "But, we can be certain it is going to be a major challenge to introduce quickly where it is needed most - in the poorest countries. Eighty per cent of women who die of cervical cancer are generally poor and live in underserved areas. They will be the ones to benefit most from affordable prices and access to this vaccine."

Mobilizing resources for strengthening health systems and purchasing HPV vaccines, both nationally and internationally, must be a priority and there must be innovative ways to finance HPV introduction. At an international level, partnerships will be needed to try to reduce the usual time-lag between formal registration and availability in developed countries, and establishing a negotiated price and adequate production capacity to supply developing countries.

In addition to being a new tool for the prevention of a very common form of cancer, the introduction of effective HPV vaccines has other potential benefits for health systems in general. The roll out of such vaccines could help build synergies among immunization, cancer control and sexual and reproductive health. It also has the potential to provide valuable experience for the introduction of any future vaccine against HIV.

For more technical information on the two HPV vaccines, visit the following website: www.who.int/vaccine_research/documents/816%20%20HPV%20meeting.pdf

 

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